Evaluation of a regionalized perinatal care system through linked infant birth and death certificates: Puerto Rico 1980-84.

The birth weight-specific neonatal mortality rates for Puerto Rico are among the highest rates reported in the United States. Furthermore, since 1979, Puerto Rico's neonatal mortality rate has been higher than the neonatal mortality rate for blacks in the United States. Since the proportion of births less than 2,500 grams has remained relatively unchanged in the past 10-15 years in Puerto Rico and in the continental United States, those findings suggest problems of either access or quality of the neonatal care in Puerto Rico. Therefore, we used linked infant birth-death certificates from 1980 through 1984 to evaluate the regionalization of perinatal health services operating on the island. We found that 41.6% of all births less than 1,500 grams were delivered at hospitals without Neonatal Intensive Care Units (NICUs). In addition, delivery at hospitals with NICUs did not confer a survival advantage for infants less than 2,500 grams. The lack of survival advantage in most hospitals with NICUs persisted after we adjusted simultaneously for birth weight, Apgar score at 5 minutes, and history of pregnancy complications. We conclude that the regionalization plan operating on the island needs reevaluation and recommend that preventive measures at the primary, secondary, and tertiary levels be implemented.