A perinatal audit of neonatal deaths in three Danish counties.

A perinatal audit of 109 neonatal deaths was carried out in three Danish counties (A, B and C) in order to investigate whether differences in the structure of antenatal care, delivery, and neonatal service had any influence on neonatal outcome and whether departure from generally accepted standards of satisfactory perinatal and neonatal care might have contributed to neonatal deaths. In the county (C) characterised by having no intensive neonatal care unit, significantly fewer liveborn infants with a gestational age of less than 28 weeks were reported to the Birth Register. County C had also significantly more potentially avoidable deaths compared with the county (B) which had a neonatal intensive care unit with specially trained staff available around the clock. The neonatal department in county A did not have specially trained doctors available in the hospital around the clock, and some cases of suboptimal care were caused by inadequate staffing and inappropriate decisions made by inexperienced junior doctors. The results indicate that it should be possible to improve the quality by having obstetric departments with access to neonatal intensive care units staffed with qualified personnel around the clock and by intensifying the postgraduate training of professionals performing peri- and neonatal care.