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Regionalization Revisited

William P. Kanto Jr, MD
Am J Dis Child. 1987;141(4):403-404. doi:10.1001/archpedi.1987.04460040061012.
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During the past 15 years, the development of technology for the management of the high-risk perinatal patient and its application through regionalization of care have been the weapons by which we have attacked the unacceptably high rate of reproductive morbidity and mortality in this country.1 Initially utilized as a method of securing intensive care for sick newborns, regionalization has evolved into a system that also allows for the transfer of pregnant women who need specialized services or who are carrying high-risk fetuses so that delivery will occur in a center with the appropriate facilities. This availability of intensive care has been credited with substantial and significant reductions in neonatal mortality without an apparent increase in morbidity.2-4

Paneth et al5 recently described the effect of the level of the hospital of delivery on neonatal mortality, analyzing singleton births in an urban setting over a three-year period. A disturbing


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