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Delivering Neonates at High Risk in the Right Place

Delivering Neonates at High Risk in the Right Place Opinion EDITORIAL Back to the Future Again Megan Whitham, MD; Donald J. Dudley, MD Regionalization of perinatal care has long been known to im- capabilities had higher neonatal mortality rates when adjust- prove neonatal outcomes. The March of Dimes, in their origi- ing for multiple potential confounders, including gestational age, infant sex, congenital anomalies, plurality, receipt of antenatal nal iteration of Toward Improving the Outcome of Pregnancy in 1976, strongly advocated for regionalized perinatal care steroids, mode of delivery, maternal race, and the presence of and development of levels of maternal comorbidities of preeclampsia and diabetes. neonatal care. In response, Other notable findings highlighted by Shah et al were that Related article page 358 health care systems created women delivered in hospitals without level III NICU access were regional perinatal networks to facilitate antenatal transfer of more likely to be non-Hispanic black or Hispanic, more likely women at risk for preterm birth in the hopes of improving neo- to receive Medicaid, and less likely to have college degrees than natal outcome and maternal care. In the 1990s, with the ad- those women who presented and delivered at level III hospi- vent of managed care and expansion of Medicaid reimburse- http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Pediatrics American Medical Association

Delivering Neonates at High Risk in the Right Place

JAMA Pediatrics , Volume 174 (4) – Apr 17, 2020

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Publisher
American Medical Association
Copyright
Copyright 2020 American Medical Association. All Rights Reserved.
ISSN
2168-6203
eISSN
2168-6211
DOI
10.1001/jamapediatrics.2019.6059
Publisher site
See Article on Publisher Site

Abstract

Opinion EDITORIAL Back to the Future Again Megan Whitham, MD; Donald J. Dudley, MD Regionalization of perinatal care has long been known to im- capabilities had higher neonatal mortality rates when adjust- prove neonatal outcomes. The March of Dimes, in their origi- ing for multiple potential confounders, including gestational age, infant sex, congenital anomalies, plurality, receipt of antenatal nal iteration of Toward Improving the Outcome of Pregnancy in 1976, strongly advocated for regionalized perinatal care steroids, mode of delivery, maternal race, and the presence of and development of levels of maternal comorbidities of preeclampsia and diabetes. neonatal care. In response, Other notable findings highlighted by Shah et al were that Related article page 358 health care systems created women delivered in hospitals without level III NICU access were regional perinatal networks to facilitate antenatal transfer of more likely to be non-Hispanic black or Hispanic, more likely women at risk for preterm birth in the hopes of improving neo- to receive Medicaid, and less likely to have college degrees than natal outcome and maternal care. In the 1990s, with the ad- those women who presented and delivered at level III hospi- vent of managed care and expansion of Medicaid reimburse-

Journal

JAMA PediatricsAmerican Medical Association

Published: Apr 17, 2020

References