Hospital Level of Care and Neonatal Mortality in Low- and High-Risk Deliveries

Abstract

Increased regionalization and concentration of neonatal resources for low-risk births is justified from a strictly medical point of view. From a public health perspective, closing small obstetrics units may prevent an appreciable number of deaths, but it would have only a very small impact on the risk of mortality from the individual's point of view. The cost-effectiveness of such a step remains to be analyzed from a health economics perspective.

Effect of hospital size and on-call arrangements on intrapartum and early neonatal mortality among low-risk newborns in Finland

“…In contrast to preterm newborns, conclusions in studies on low-risk deliveries are incoherent [5]. Some studies have shown better outcomes for deliveries in tertiary hospitals [6,7] whereas others have not [8,9]. Also, current clinical practice varies among countries, thus making comparisons difficult.…”

Perinatal Regionalization for Very Low-Birth-Weight and Very Preterm Infants

“…29 There is also a risk of bias due to selective transfer of infants with the highest chance of survival 60 and possible increased baseline risk in level III hospital populations due to prenatal referral for known complications. 70 Identifying uniform standards by which to evaluate control of confounding across studies is difficult. Sources of confounding can vary by population or be difficult to measure, such as parental wishes for aggressive resuscitation.…”

Variation in plasma calcium analysis in primary care in Sweden - a multilevel analysis

“…We also selected ICD-10 coded diagnoses and symptoms associated with pHPT [10] . A risk score for a P-Ca analysis was created with stepwise logistic regression [11] based on age, concomitant diagnosis and drug treatment, in order to control for confounding factors. The risk score was divided in quintiles, patients with the lowest risk of P-Ca analyses (group 1) were used as reference.…”