Neonatal outcomes by hospital of birth in Nova Scotia between 1988 and 2012: improvements in mortality and morbidity

Objectives: (1) To describe differences in newborn outcomes with respect to hospital of birth, place of maternal residence, and time epoch for infants born in Nova Scotia between 1988 and 2012. (2) To examine the possible impacts that regionalization of maternal newborn health services between 1988 and 2012 have had on neonatal mortality rates in Nova Scotia. Methods: Data on all infants delivered in Nova Scotia between January 1, 1988 and December 31, 2012 was extracted from the Nova Scotia Perinatal Atlee Database. Infant perinatal mortality and neonatal morbidity rates were calculated in 5-year time epochs and examined by delivery hospital classification (community, regional or tertiary), and maternal driving distance from hospital. Trends by epoch, delivery hospital and driving distance were examined. Results: From 1988 to 2012 perinatal mortality rates per 1000 for all births improved at both regional (from 9.8 to 5.7/1000) and tertiary hospitals (from 12.3 to 8.1/1000). Perinatal mortality rates for low risk births remained low and did not change significantly during this time period. Overall, neonatal morbidity rates fell across the province. Neonatal outcomes did not vary with increasing maternal distance from obstetrical services. Conclusions: Overall, infant perinatal morbidity and mortality outcomes have improved in Nova Scotia between 1988 and 2012. Regionalization of obstetrical care may have played a role in improving neonatal mortality rates among high-risk births. Increasing rural maternal isolation from obstetrical services did not impact infant perinatal mortality and morbidity outcomes when services remained available regionally.