Abstract
Chicago has shown a decrease in PM over the past decade more gradual than the Nation as a whole. We looked for an explanation to PM data over the past decade 1973-83 for our Perinatal Center (74,589 deliveries) which serves a large high-risk population. In 1979, maternal transfers/transports began to impact on delivery populations, a trend which has accelerated to the present. Crude PM rate dropped from 39 to 30. Deliveries <1500g (VLBW) increased from 3.2% to 4.9%; PM <1500g has dropped from 708 to 469. Deliveries <750g increased from 1.4 to 2.0%, while their contribution to PM rose from 36% to 58%; for every higher weight category the contribution to PM decreased. In particular between 750-1500g PM decreased from 542 to 170. Neonatal mortality improved for each 250g weight group <1500g while each group contributed a larger fraction to the delivery population. The net effect on crude neonatal mortality, 16.2 to 16.9, is less dramatic considering the improvements in perinatal care. In contrast, in our network of hospitals neonatal mortality went from 19.5 in 1978 to 14.5 in 1983. There has been a dramatic redistribution of VLBW deliveries with the Center increasing from 2.8 to 3.5% of live births while the Network has decreased from 2.6 to 1.2% with a System wide decrease of less than 0.5% VLBW. These data demonstrate that improved perinatal care and regionalization can affect weight-specific outcome; a major impact on overall survival awaits significant reduction of VLBW rates.
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Paton, J., Fisher, D., Myers, S. et al. 574 PERSISTENCE OF HIGH PERINATAL MORTALITY (PM) IN AN URBAN PERINATAL CENTER. Pediatr Res 19, 206 (1985). https://doi.org/10.1203/00006450-198504000-00604
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DOI: https://doi.org/10.1203/00006450-198504000-00604