Expansion of community-based perinatal care in California

Objective: In California, hospitals with Community Neonatal Intensive Care Units (NICUS) increased from 17 in 1990 to 52 in 1997. The purpose of this study was to investigate the effects of their growth on level-specific distribution of biths, acuity, and neonatal mortality. Study Design: A total of 4,563,900 infants from 1990 to 1997 were analyzed by levels of care. We examined shifts in birth location and acuity. Neonatal mortality fo singleton very-low-birth-weight (VLBW) infants without congenital abnormalities was used to assess differences in level-specific survival. Results: Live births at hospitals with Community NICUs increased from 8.6% to 28.6%, and VLBW births increased from 11.7% to 37.4%. Births and VLBW births at Regional NICUs decreased, whereas acuity was unchanged. There were no differences in neonatal mortality of VLBW infants born at Community or Regional NICU hospitals. Mortality for VLBW births at other levels of care was significantly higher. Conclusion: The rapid growth of monitored Community NICUs supported by a regionalized system of neonatal transport represents an evolving face of regionalization. Survival of VLBW births was similar at Community and Regional hospitals and higher than in other birth settings. Reducing VLBW births at Primary Care and Intermediate NICU hospitals continues to be an important goal of regionalization.