Delivery unit volume and neonatal mortality — A nationwide register study in Finland from 2008 to 2023

This nationwide study analyzed neonatal mortality in Finland from 2008 to 2023, focusing on the impact of annual delivery volumes and their changes across hospitals. Data from 819,465 liveborn neonates, including 46,906 preterm births, were analyzed using the Finnish Medical Birth Register. While neonatal mortality rates showed an overall decline-driven by improved preterm survival-term neonatal mortality remained stable. The lowest neonatal mortality rate was recorded in 2020-2021 at 0.88 per 1000 live births, with preterm mortality at 9.85 per 1000. No clear associations were identified between delivery volume, volume changes, and neonatal outcomes in tertiary or secondary units. Despite declining birth volumes and increasing small-volume hospitals, neonatal outcomes remained consistent. Conclusion: These findings challenge arguments for further centralization of births based on volume thresholds in Finland. Continuous monitoring of neonatal outcomes is essential amid decreasing fertility rates and evolving healthcare systems to sustain Finland's excellence in neonatal care.