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Updated: Dec 14, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Improving perinatal regionalization: 10 years of experience with an Arkansas initiative
Janet M Bronstein1, Songthip Ounpraseuth2, Curtis L Lowery3
1University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA. JBRONSTEIN@UAB.EDU.
Objective:
To examine the impact of Antenatal and Neonatal Guidelines, Education and Learning Systems (ANGELS) on neonatal intensive care unit (NICU) preterm delivery rates.
Study Design:
In this longitudinal observational study, linked vital records and Medicaid claims records for 29,124 preterm births (April 2001-December 2012) to Medicaid covered women were used to examine factors predicting whether deliveries occurred at hospitals with neonatology-staffed NICUs. The factors associated with delivery are estimated and compared for baseline and three post-implementation periods.
Results:
Rates for NICU preterm deliveries increased from 28 to 37% over the time period. Compared to baseline, adjusted NICU delivery rates in the middle and late implementation periods were statistically significant (p < 0.001). Negative impacts of long travel times were reduced, while impacts of obstetrician prenatal care changed from negative to positive association.
Conclusion:
Findings validate the ANGELS initiative premise: academic specialists, working with community-based care providers, can improve perinatal regionalization.
