Interhospital referral of high-risk newborns in a rural regional perinatal program

In light of increased competition for patients among hospitals, a trend toward deregionalization for perinatal programs and expansion of level II hospital neonatal intensive care services has been noted. This study investigates the determinants of the decision to transport very low birthweight (VLBW) babies born live at primary care community hospitals to a regional tertiary NICU or to a level II hospital in a semirural regional perinatal program. Data were collected from medical records of mothers and their newborns at 18 level I hospitals (primary care only), three level II hospitals (intermediate care), and the one tertiary hospital in the region. The sample includes all newborns with birthweights between 500 g and 1750 g born in 1983 (299). Despite dramatic increases in the proportion of very low birthweight deliveries at the tertiary center in the past decade, one third of the VLBW babies continue to be delivered at community hospitals in the study region. Although 25% of all transports from level I are to level II hospitals rather than to the level III hospital, birthweight and need for assisted ventilation were statistically significant determinants of transport of newborns from level I to level III hospitals rather than to a level II hospital. While both level I and level II hospitals are likely to transport newborns who need assisted ventilation to the level III hospital, the odds of transport are significantly higher for newborns born at level I as opposed to level II hospitals. Nontransported babies who were born at very low birthweight (less than 1000 g) died within 24 hours. The nontransported babies who survived had birthweights of greater than 1000 g, and fewer required assisted ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)