Improved perinatal and very low birth weight infant outcomes following neonatal and perinatal regionalization in a rural setting

Abstract

Objective: To evaluate the changes in outcome that occurred during implementation of a comprehensive outreach program to five level I newborn care facilities, by one level III neonatal intensive care unit in rural WA State. Study design: Standardized outreach educational programs were provided. Outcome measures were assessed by collecting monthly perinatal and postnatal data on 61,551 births. Three six-year periods were defined. Period I (1988-1994) was compared with period II (1994-2000) and period III (2000-2006). Results: Comparing the averages for the three periods, there was a statistically significant increase in maternal transports from level I hospitals, and significant decreases in early-onset sepsis, meconium aspiration syndrome, low Apgar scores, major congenital malformations, neonatal and perinatal mortality rates, very low birth weight (VLBW) infant mortality, chronic lung disease and duration of hospital stay (all p< 0.001). Conclusion: A successful regionalization of perinatal service in rural areas can be accomplished by establishing extensive outreach programs. This model can be utilized to improve perinatal, neonatal and VLBW infant outcomes.