Managed clinical networks in neonatal care

A large body of evidence supports the concept of regionalising neonatal intensive care. Both mortality and serious morbidity are significantly reduced for high risk infants who are born in hospitals that have a high volume of cases, tertiary level obstetric services, and neonatal intensive care units (NICUs).1 2 Although these benefits are most pronounced for the highest risk infants, such as those with extreme prematurity or major congenital anomalies, evidence suggests that benefits extend to all at risk deliveries and possibly to low risk ones as well.3 It is also much better to move women with high risk deliveries to these high volume tertiary centres than to move critically ill neonates after delivery.4 5

In a linked paper (doi:10.1136/bmj.e2105), Gale and colleagues study the effects of the reorganisation of neonatal services in England that occurred as a result of this evidence.6 In 2003, neonatal services in England were formed into managed clinical networks. The changes improved access to …