Perinatal levels of care: The Challenges
In 1976, the March of Dimes published the report Toward Improving the Outcome of Pregnancy. The report highlighted the value of regionalized systems of perinatal care—the idea that perinatal health systems should be developed stratifying maternal and neonatal care such that care of the highest risk women and sickest infants occurs in facilities especially equipped to manage them. In response to the report, hospitals developed relationships with other hospitals that supported levels of perinatal care.
The availability of neonatal intensive care has clearly improved the outcomes of infants born either preterm or with significant medical or surgical conditions.1 Over the past 25 years, there has been significant growth in the number of neonatal intensive care units, but this growth has not been associated with uniform improvements in neonatal outcomes.
A regionalized system that focuses on integrated delivery of graded levels of hospital-based perinatal care has been shown to be effective and to result in improved outcomes for women and their newborns. Guidelines for Perinatal Care, 7th Edition.
In 2004, the American Academy of Pediatrics (AAP) defined three distinct neonatal levels of care and the services and personnel that should be available to meet the recommendations for those levels. The AAP updated the neonatal levels of care in 2012. Currently, compliance with the recommendations at each level of care is voluntary.
1 Committee on Fetus and Newborn. (2012). Levels of Neonatal Care. Pediatrics, 130(3), 587-597.
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Regionalized systems are recommended to ensure that each newborn is delivered and cared for in a facility appropriate for his or her health care needs and to facilitate the achievement of optimal outcomes. Guidelines for Perinatal Care, 7th Edition