REVIEW – November 2022

Evidence based approach to the organization of the neonatal care in Estonia

Authors: Liis Toome, Tuuli Metsvaht, Ülle Einberg, Vallo Tillmann, Pille Saik, Mari-Liis Ilmoja, Imbi Eelmäe, Mari Laan, Chris Pruunsild , Heili Varendi

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The outcome of peri- and neonatal care depends, besides the wealth and social development of the country, on the organizational structure of the service of peri- and neonatal care, availability of medical technology and competence of medical teams. The article provides an overview of the results, strengths and weaknesses of periand neonatal care in Estonia. Based on the study of the Estonian nationwide database and data from international cohort studies, the implementation of the practices of high evidence care into routine clinical practice has been good and the indicators of infant health are well comparable to those for other developed countries. While centralization and transport systems are working well,
the main weakness over decades and still at present is the separate locations of third level maternity and children’s hospitals. Hence, caretakers are confronted with the high rate of infants’ postnatal transfer between hospitals, difficulties in offering family-centred care, avoidable separation of mother and infant, as well as the suboptimal cooperation of ante- and postnatal medical teams. The authors believe that current restructuring of the medical system holds an excellent opportunity to overcome these problems by consolidating third level
maternity and paediatric care into two major regional centres in northern and southern Estonia, respectively.