Finland maintains world-leading neonatal outcomes despite falling birth rates

Finland remains a world-leader in neonatal care, despite the country's falling birth rate and, consequently, a decline in hospital delivery volumes, according to three recent studies from the University of Eastern Finland. The studies examine neonatal mortality and delivery outcomes both nationwide and specifically for twin pregnancies and smaller maternity hospitals. The results challenge the country's current trend of centralizing deliveries in large units solely on the basis of annual delivery volumes.

The first of the studies is an extensive registry study analysing all liveborn neonates in Finland from 2008 to 2023, totalling over 800,000 children. Neonatal mortality has decreased, particularly among preterm infants, despite a decline in total and hospital-specific delivery volumes. The mortality rate for full-term infants has remained very low throughout the follow-up period. The study found no clear association between hospitals' annual delivery volumes, changes in them, and neonatal mortality. The findings support the current view of it being sufficient to centralise high-risk deliveries to university hospitals in order to ensure safe births even in smaller hospitals.

The second study examined neonatal delivery outcomes in twin pregnancies from 2008 to 2023. The data included 23,588 twins and showed that neonatal mortality in twins has also significantly decreased. In 2022-2023, the neonatal mortality rate was only 0.09% for full-term twins and 0.46% for preterm twins. Although the proportion of full-term twins requiring intensive care has slightly increased, hospital stays have become shorter, suggesting an improvement in prenatal care and early diagnostics.

The third study compared delivery outcomes in small delivery units, i.e., those handling fewer than 1,000 deliveries per year, with large central hospitals in 2016-2023. The analysis included nearly 160,000 deliveries. While there were no differences in perinatal mortality, i.e., death during or shortly after birth, and full-term infant mortality between the delivery units, preterm infant mortality was slightly higher in smaller hospitals. However, it is important to note that the overall mortality rate in small delivery units remains one of the lowest in the Nordic countries and the world, indicating effective risk management and efficient delivery guidance.

All three studies are based on the open-access Finnish Medical Birth Register, enabling a comprehensive and up-to-date analysis. The results support Finland's current strategy of centralising high-risk deliveries to university hospitals but do not provide grounds for broader centralisation from the neonatal perspective.