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The goal of perinatal regionalization is to provide high-risk infants with the most specialized care at level III centers. Initially, this system was associated with significantly improved infant survival rates in the U.S. However, in the 1980s, many non–level III hospitals built smaller neonatal intensive care units, resulting in more high-risk infants being delivered outside level III hospitals. Researchers conducted a meta-analysis of 41 studies published between 1976 and May 2010 on the association between hospital level at birth and neonatal mortality in very low birth weight (VLBW) infants (<1500 g) and very preterm infants (≤32 weeks' gestation).
In 37 studies involving nearly 105,000 VLBW infants, those born in non–level III hospital…