SynthesisBMJ open2020
Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review.
Synthesis in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 3 syntheses or guidelines pooled it, 28 citations in OpenAlex.
- Development of a core outcome set for studies on centralization of healthcare services.BMC health services research · 2026Pooled it
- Pooled it
- The impact of decentralisation on health systems: a systematic review of reviews.BMJ global health · 2023Pooled it
- Level III neonatal intensive care unit heterogeneity in patients, services, and outcomes.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Spatial analysis of cross-boundary hospitalizations of very low birth weight infants in Japan.Pediatric research · 2026Article
- Variations in survival outcomes of infants born at 22-23 weeks' gestation by neonatal intensive care quality level in Korea.Scientific reports · 2026Article
- Inequitable access to risk-appropriate neonatal care: evidence from a regionalized perinatal system in Arkansas.Frontiers in reproductive health · 2026Article
- Risk of moderate or severe hypoxic ischemic encephalopathy does not correlate with prenatally known risk factors.Zeitschrift fur Geburtshilfe und Neonatologie · 2025Article
- Impact of teleneonatology on time to goal temperature in outborn neonates with hypoxic-ischemic encephalopathy requiring therapeutic hypothermia.Journal of perinatology : official journal of the California Perinatal Association · 2025Observational
- Delivery unit volume and neonatal mortality - A nationwide register study in Finland from 2008 to 2023.European journal of pediatrics · 2025Article
- Comparing Italian versus European strategies and technologies for respiratory care in NICU: results of a survey of the Union of European Neonatal and Perinatal Societies (UENPS) and the Italian Society of Neonatology (SIN).Italian journal of pediatrics · 2025Article
- Ethical considerations regarding the treatment of extremely preterm infants at the limit of viability: a comprehensive review.European journal of pediatrics · 2025Review
- A Survey on the Organization and Operation of Level II/III Neonatal Intensive Care Units in Greece: A Comparison Between 2004 and 2022.Children (Basel, Switzerland) · 2025Article
- Intrapartum Quality of Care among Healthy Women: A Population-Based Cohort Study in an Italian Region.International journal of environmental research and public health · 2024Article
- [Perinatal Networks: Ensuring Regional Care of Pregnant Woman and Newborns].Zeitschrift fur Geburtshilfe und Neonatologie · 2024Article
- Evaluation of the telemedical health care network "SAFE BIRTH" for pregnant women at risk, premature and sick newborns and their families: study protocol of a cluster-randomized controlled stepped-wedge trial.BMC health services research · 2024Article
- NICUs in the US: levels of acuity, number of beds, and relationships to population factors.Journal of perinatology : official journal of the California Perinatal Association · 2023Article
- Using cluster analysis to describe phenotypical heterogeneity in extremely preterm infants: a retrospective whole-population study.BMJ open · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThis umbrella review summarises and critically appraises the evidence on the effects of regulated or high-volume perinatal care on outcome among very low birth weight/very preterm infants born in countries with neonatal mortality <5/1000 births. INTERVENTION/EXPOSITION: Perinatal regionalisation, centralisation, case-volume. PRIMARY OUTCOMES: Death. SECONDARY OUTCOMES: Disability, discomfort, disease, dissatisfaction.
methodsOn 29 November 2019 a systematic search in MEDLINE and Embase was performed and supplemented by hand search. Relevant systematic reviews (SRs) were critically appraised with A MeaSurement Tool to Assess systematic Reviews 2.
resultsThe literature search revealed 508 hits and three SRs were included. Effects of perinatal regionalisation were assessed in three (34 studies) and case-volume in one SR (6 studies). Centralisation has not been evaluated. The included SRs reported effects on 'death' (eg, neonatal), 'disability' (eg, mental status), 'discomfort' (eg, maternal sensitivity) and 'disease' (eg, intraventricular haemorrhages). 'Dissatisfactions' were not reported. The critical appraisal showed a heterogeneous quality ranging from moderate to critically low. A pooled effect estimate was reported once and showed a significant favour of perinatal regionalisation in terms of neonatal mortality (OR 1.60, 95% CI 1.33-1.92). The qualitative evidence synthesis of the two SRs without pooled estimate suggests superiority of perinatal regionalisation in terms of different mortality and non-mortality outcomes. In one SR, contradictory results of lower neonatal mortality rates were reported in hospitals with higher birth volumes.
conclusionsRegionalised perinatal care seems to be a crucial care strategy to improve the survival of very low birth weight and preterm births. To overcome the low and critically low methodological quality and to consider additional clinical and patient-reported results that were not addressed by the SRs included, we recommend an updated SR. In the long term, an international, uniformly conceived and defined perinatal database could help to provide evidence-based recommendations on optimal strategies to regionalise perinatal care. PROSPERO REGISTRATION NUMBER: CRD42018094835.
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Registered trials
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