Referrals to a regional neonatal intensive care unit

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Healthcare Management

Background:

• Neonatal transfer requests for acute medical problems are common.
• Despite resource increases, intensive care provision in the North Western Health Region was inadequate.
• A significant percentage of neonatal transfer requests were declined.

Purpose of the Study:

• To evaluate the adequacy of neonatal intensive care unit (NICU) bed availability.
• To compare the survival rates of transferred neonates versus those remaining at their birth hospital.
• To identify factors influencing NICU admission decisions and outcomes.

Main Methods:

• Retrospective analysis of 444 neonatal transfer requests over three years.
• Comparison of outcomes (survival rates) between transferred and non-transferred neonates.
• Analysis of demographic and clinical data (gestational age, birth weight, diagnosis) for accepted and declined admissions.

Main Results:

• 38% of neonatal transfer requests were declined due to inadequate resources.
• Survival rate for babies transferred to the regional NICU was 71%, significantly higher than 49% for those remaining at the birth hospital.
• Babies declined admission had lower gestational ages and birth weights.
• For neonates with respiratory failure and birth weight <1500g, transfer was associated with significantly better survival despite similar demographics.

Conclusions:

• The regional NICU's capacity is insufficient to meet the demand for neonatal intensive care.
• Timely transfer to a specialized NICU significantly improves survival rates for critically ill neonates.
• Multiple pregnancies pose unique challenges for neonatal transfer and require specific management strategies.