Trends in centralization of very preterm deliveries and neonatal survival in Finland in 1987–2017

Kjell Helenius, Mika Gissler, Liisa Lehtonen


Very preterm infants are at high risk of death and complications of prematurity. Optimal outcomes are achieved if these infants are delivered in hospitals with the highest level of neonatal expertise. Centralization of very preterm deliveries to such hospitals has been recommended for decades, and is supported by a large body of literature. However, centralization may not be easy to implement due to financial, organizational and workforce-related issues. In this review, we present the scientific background for centralization, how it has been successfully implemented in Finland and how neonatal survival has changed following this implementation.