Sir.—The anomalous position of level 2 hospitals is central to the problems described in Dr Kanto's1 valuable editorial on regionalized perinatal care. Their perinatal mortality rates are frequently excessive, and this is not restricted to urban areas as Dr Kanto seemed to imply. Rural level 2 units also have excessive perinatal mortality,2 the excellent results in Iowa and New Zealand3 notwithstanding.
I am personally familiar with up-state New York. From 1982 through 1984 the average perinatal mortality rates (period 2) for hospitals in our region with 100 to 500 live births annually ranged from 8.3 to 25.8 per 1000.4 The lowest rate occurred in a level 1 unit with 241 annual births, while the highest occurred 35 miles away in a level 2 unit with only 310 annual births. The former recently closed while the latter is anxious to expand. This anomalous situation resulted from