Perinatal care regionalization and low birth weight infant mortality rates in Alaska

Objective: The purpose of this study was to determine the extent to which the failure of non–tertiary care hospitals to appropriately triage and refer pregnant women and newborns contributes to low birth weight infant death in Alaska. Study Design: Birth certificates from 1993 to 1997 were reviewed for all 2809 infants who were born at less than 2500 g. Death certificates and maternal and infant medical charts were reviewed for all 168 infant deaths that occurred during this time. Results: Mother-infant pairs who received all care at Alaska’s single tertiary care center had a lower mortality rate than those who received some care at a non–tertiary care center (risk ratio, 1.5; 95% confidence interval, 0.86-2.6). Despite this, only 4% of deaths among low birth weight infants (all <1500 g) were associated with care decisions at non–tertiary centers; none of these deaths involved intentional inappropriate retention of infants or mothers. Conclusion: Further emphasizing perinatal care regionalization (including for infants 1500-2499 g birth weight) is unlikely to substantially decrease low birth weight infant mortality rates. (Am J Obstet Gynecol 2001;185:623-8.)