967 EFFECT OF A STATEWIDE REGIONAL PERINATAL PROGRAM ON NEONATAL MORTALITY

Abstract

The Wisconsin Regional Perinatal Care system was one of the early developments in the now national movement towards regionalized perinatal care. There are still only isolated or fragmentary data on the true impact of regionalized perinatal care on perinatal outcome. A program involving regional center development, regional consultation and education and regional transport systems was developed in Wisconsin beginning in 1967. The impact of this program on mortality by weight group, age at time of death and place of death was reviewed for the years 1965 through 1974. Neonatal transfers to center hospitals increased from <0.1% of births in 1966 to 2.2% in 1974. Neonatal deaths occurring in the center hospitals increased from <10% of total for the state in 1966 to 57% in 1974. The greatest reductions in mortality rates occurred for LBW infants and during the first 24 hours of life. Small hospitals related to a regional center had consistently lower neonatal mortality rates in all weight groups than large hospitals not associated with a center. The highest mortality rates in all weight groups occurred in the small hospitals not associated with a regional center. The impact of general educational programs, regional newborn center development and regional high-risk obstetric center development (perinatal) were individually examined in the assessment of the data. The relationship between these changes in care and mortality rates will be presented.