Table 3.
Effects of perinatal regionalisation/high case-volumes on birth outcomes
| Ref. | Intervention/ exposure | Reported outcomes | Studies per outcome | Design | Results |
| SRs without meta-analysis | |||||
| Rashidian et al18 | Perinatal regionalisation | Neonatal mortality | 7 | 3× ITS, 1× CBA, 3× BA | Significant decrease: 1× ITS, 2× BA Non-significant decrease: 2× ITS, 1× CBA, 1× BA |
| Perinatal mortality | 3 | 2× ITS, 1× BA | Non-significant decrease: 1× ITS, 1× BA | ||
| Fetal mortality | 2 | 1× ITS, 1× BA | Significant decrease: 1× BA Non-significant descriptive decrease: 1× ITS |
||
| Stillbirth | 2 | 1× ITS, 1× BA | Non-significant decrease: 1× ITS, 1× BA | ||
| Intraventricular haemorrhage | 1 | 1× BA | Significant decrease: 1× BA | ||
| Infant mortality | 1 | 1× ITS | Significant decrease: 1× ITS | ||
| Low 5-min Apgar Score | 2 | 2× BA | Significant decrease: 2× BA | ||
| Low birth weight | 3 | 1× ITS, 2× CBA | Significant decrease: 2× BA Non-significant decrease: 1× ITS |
||
| Motor development, mental status | 1 | 1× BA | Non-significant increase: 1× BA | ||
| Maternal sensitivity | 1 | 1× BA | Significant increase: 1× BA | ||
| Neogi et al19 | Perinatal regionalisation | Neonatal mortality | 8+2 | 7±2× RC, 1× BA | Significant decrease: 3±1× RC Non-significant decrease: 4±1× RC, 1× BA |
| Fetal mortality/stillbirth | 2 | 2× RC | No difference: 1× RC not interpretable: 1× RC | ||
| Unspecified infant mortality | 2+2 | 2±2× RC | Descriptive decrease in 2±1× RC not interpretable in +1× RC | ||
| Outborn mortality | 1 | 1× PC | Not interpretable in 1× PC | ||
| Neogi et al19 | Unit size/ case-volume | Neonatal mortality | 6 | 6× RC | Significant decrease in higher care-volumes: 3× RC Non-significant decrease in higher care-volumes: 3× RC |
| SRs with meta-analysis | |||||
| Lasswell et al20 | Perinatal regionalisation | Neonatal mortality: VLBW | 9 | 7× RC, 1× PC, 1x C–C | Pooled estimate significantly higher when born in lower level hospitals: adjusted OR 1.60; (95% CI, 1.33–1.92) |
| Neonatal mortality: ELBW | 5 | 4× RC, 1× C–C | Pooled estimate significantly higher when born in lower level hospitals: adjusted OR 1.80; (95% CI, 1.31–2.46) | ||
| Neonatal mortality: VPT | 3 | 2× RC, 1× RCT | Pooled estimate significantly higher when born in lower level hospitals: adjusted OR 1.42; (95% CI, 1.06–1.88) | ||
(+…) study were extracted by authors of the present umbrella review.
BA, before–after; CBA, controlled before–after; C–C, case–control; CI, confidence interval; ELBW, extremely low birth weight; ITS, interrupted time series; OR, odds ratio; PR, perinatal regionalisation; RC, retrospective cohort; RCT, randomised controlled trial; SRs, systematic reviews; VLBW, very low birth weight; VPT, very preterm.