Benefits of reorganising neonatal and obstetric services are unclear

I wonder how applicable Phibbs’s editorial was to the UK.1 From the references it can be seen that none of the data considered comes from the UK, but from the US, Canada, Sweden, and Germany.

In addition, one reference actually said: “As the requirement for neonatal intensive care is episodic and unpredictable more flexibility has to be built into the perinatal healthcare system to enable preterm infants delivered in tertiary perinatal centres to be cared for where they are born.” Surely this means that babies ought to be looked after where they are born and local obstetric services improved.

Another reference cited by Phibbs describes a system for categorising patients but does not evaluate one in a trial setting, and it doesn’t necessarily support Phibbs’s statement that: “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 and colleagues’ paper doesn’t tell us anything about outcomes but (rightly) concerns itself with crude numbers.2

In my opinion none of this adds up to a ringing endorsement of the reorganisation of neonatal and consequently obstetric services in the UK. Serious thought needs to be given to further upheaval without understanding the wider consequences.