Regionalization of perinatal care has long been known to improve neonatal outcomes.¹ The March of Dimes, in their original iteration of Toward Improving the Outcome of Pregnancy in 1976, strongly advocated for regionalized perinatal care and development of levels of neonatal care. In response, health care systems created regional perinatal networks to facilitate antenatal transfer of women at risk for preterm birth in the hopes of improving neonatal outcome and maternal care. In the 1990s, with the advent of managed care and expansion of Medicaid reimbursement, hospitals sought to control costs within systems. These changes led to an increase in the number of community neonatal intensive care units, which have outpaced local acuity and volume and contributed to the relative disintegration of regionalized perinatal networks.² With variable definitions of levels of neonatal care, smaller neonatal intensive care units (NICUs) may not be able to offer the same resources as larger units, and lower daily volumes of NICU census can be associated with poorer outcomes.³ For women with pregnancies requiring very preterm deliveries, receiving care at the right hospital with the right resources can be a matter of survival or normal development for their children.

长期以来，围产期护理的区域化可以改善新生儿结局。^1个1976年，“一角钱”进行了最初的“改善妊娠结局”，强烈主张区域化围产期保健和发展新生儿保健水平。作为回应，卫生保健系统建立了区域围产期网络，以促进有早产风险的妇女的产前转移，希望改善新生儿结局和产妇保健。在1990年代，随着管理式护理的出现和医疗补助费用的扩大，医院试图控制系统内的费用。这些变化导致社区新生儿重症监护病房的数量增加，已经超过了当地的视力和数量，并导致区域性围产期网络的相对瓦解。²由于新生儿护理水平的定义不一，较小的新生儿重症监护病房（NICU）可能无法提供与较大病房相同的资源，而较低的新生儿重症监护病房普查每天可能与较差的结局有关。³对于有孕妇需要极早分娩的妇女，在适当的医院以适当的资源接受护理可能是其子女的生存或正常发育的问题。