International Perspectives

Abstract

Regionalized level III perinatal care was implemented in Poland in 1998, but no comparative analyses of neonatal mortality and morbidity between other European regions and Poland are yet available. Given the large differences in policy and organization of health care between European countries, studying clinical outcomes within this context provides an opportunity to explore the effectiveness of regionalized care. The aim of this analysis was to compare the specific position of neonatal care in Poland with that of other European regions participating in the Models of OrganiSing Access to Intensive Care for very preterm babies (MOSAIC) project. In 1988, there were 18,798 live births in the 11 neonatal units in the Wielkopolska region; in 2003, there were 42,619 live births in the MOSAIC program from 53 neonatal units in the Wielkopolska and Lubuskie regions. There was no change in the rate of very preterm live births between 1988 and 2003, but the mortality rate among infants between 27 and 31 weeks of gestation differed significantly. The in-hospital mortality rate in the two Polish regions was higher in 2003 compared with other MOSAIC participants (35.3%and 17.3%, respectively). There was also a higher rate of congenital malformations, intraventricular hemorrhage, and periventricular leukomalacia. There were also clear differences in organization of perinatal care, with fewer level III centers per 10,000 deliveries in Polish regions compared with other European regions (0.25 and 1.33, respectively) and longer distances of neonatal transport (97 km and 29 km, respectively).