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Sir, as an interested Obstetrician I read your editorial ‘Managed clinical networks in neonatal care’ BMJ 2012;344:e2423 and wondered how applicable it was to the UK. The opening paragraph gives us the background and reading the references reveals that none of the data considered come from the UK:
• Ref 1. Lasswell SM, Barfield WD, Rochat RW, Blackmon L. Perinatal regionalization for very low-birth-weight and very preterm infants: a meta-analysis. JAMA2010;304:992-1000. Data from USA/Canada/Sweden
• Ref 2. Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med2007;356:2165-75 Data from USA
• Ref 3. Heller G, Richardson DK, Schnell R, Misselwitz B, Kunzel W, Schmidt S. Are we regionalized enough? Early-neonatal deaths in low-risk births by the size of delivery units in Hesse, Germany 1990-1999. Int J Epidemiol2002;31:1061-8 Data from Germany
Furthermore
• Ref 4. Bowman E, Doyle LW, Murton LJ, Roy RN, Kitchen WH. Increased mortality of preterm infants transferred between tertiary perinatal centres. BMJ 1988;297:1098-100
actually reads
“As the requirement for neonatal intensive care is episodic and unpredictable more flexibility has to be built into the perinatal health care system to enable preterm infants delivered in tertiary perinatal centres to be cared for where they are born.”
Which sounds as if babies ought to be looked after where they are born and the obstetric services improved.
and
• Ref 5. Lee SK, Zupancic JA, Pendray M, Thiessen P, Schmidt B, Whyte R, et al. Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatr2001;139:220-6
Describes a system for categorizing patients but does not evaluate one in a trial setting, it doesn’t necessarily support Mr. Phibbs’s statement “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”
In addition Gale’s paper, in the current paper BMJ, Impact of managed clinical networks on NHS specialist neonatal services in England: population based study. BMJ 2012;344:e2105. Doesn’t tell us anything about outcomes but (rightly) concerns itself with crude numbers.
In my opinion none of this adds up to a ringing endorsement of the reorganization of neonatal and consequently obstetric services (known to those in them as the perinatal services) in the UK and serious and accurate thought needs to be given to further upheaval without understanding the wider consequences.
Re: Managed clinical networks in neonatal care
Sir, as an interested Obstetrician I read your editorial ‘Managed clinical networks in neonatal care’ BMJ 2012;344:e2423 and wondered how applicable it was to the UK. The opening paragraph gives us the background and reading the references reveals that none of the data considered come from the UK:
• Ref 1. Lasswell SM, Barfield WD, Rochat RW, Blackmon L. Perinatal regionalization for very low-birth-weight and very preterm infants: a meta-analysis. JAMA2010;304:992-1000. Data from USA/Canada/Sweden
• Ref 2. Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med2007;356:2165-75 Data from USA
• Ref 3. Heller G, Richardson DK, Schnell R, Misselwitz B, Kunzel W, Schmidt S. Are we regionalized enough? Early-neonatal deaths in low-risk births by the size of delivery units in Hesse, Germany 1990-1999. Int J Epidemiol2002;31:1061-8 Data from Germany
Furthermore
• Ref 4. Bowman E, Doyle LW, Murton LJ, Roy RN, Kitchen WH. Increased mortality of preterm infants transferred between tertiary perinatal centres. BMJ 1988;297:1098-100
actually reads
“As the requirement for neonatal intensive care is episodic and unpredictable more flexibility has to be built into the perinatal health care system to enable preterm infants delivered in tertiary perinatal centres to be cared for where they are born.”
Which sounds as if babies ought to be looked after where they are born and the obstetric services improved.
and
• Ref 5. Lee SK, Zupancic JA, Pendray M, Thiessen P, Schmidt B, Whyte R, et al. Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatr2001;139:220-6
Describes a system for categorizing patients but does not evaluate one in a trial setting, it doesn’t necessarily support Mr. Phibbs’s statement “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”
In addition Gale’s paper, in the current paper BMJ, Impact of managed clinical networks on NHS specialist neonatal services in England: population based study. BMJ 2012;344:e2105. Doesn’t tell us anything about outcomes but (rightly) concerns itself with crude numbers.
In my opinion none of this adds up to a ringing endorsement of the reorganization of neonatal and consequently obstetric services (known to those in them as the perinatal services) in the UK and serious and accurate thought needs to be given to further upheaval without understanding the wider consequences.
Yours faithfully
Mark Selinger
Competing interests: No competing interests