Performance of a level II nursery in a neonatal regional program: part II. Analysis of transferred patients and criteria for maternal transfer.

Our review of deliveries at a level II hospital for a 30-month period showed 3,851 live births and 23 deaths (NMR 6/1,000 LB); 527 neonates (13.7%) required admission to the Special Care Unit, and 70 (1.8%) required transfer to a level III nursery. The 70 transferred patients received 1,592 days of care in the level III facility, the mean stay was 22.7 +/- 26.3 (+/- 1 SD) days, and the rate was 413 days of care per 1,000 live births. However, only 59 of the transferred patients required care in a neonatal ICU. These infants were hospitalized a total of 554 days in the ICU, the mean stay was 9.4 +/- 9.7 days, and the rate was 143.9 days per 1,000 live births. There were 20 infants with birth weights of 1,250 gm or less. Seven died without transfer and 13 were transferred to a level III nursery. Ten of the transferred infants required mechanical ventilation during their hospital course, two infants required continuous positive airway pressure (CPAP), and one infant, neither. Of the 24 infants of less than 30 weeks' gestation, seven died at the level II nursery and 16 were transferred. Of the transferred infants, 11 required mechanical ventilation. Only two infants required neither CPAP nor mechanical ventilation. These data suggest that level II nurseries can reduce the need for neonatal ICU beds. They also suggest that the majority of newborns weighing 1,250 gm or less and/or of less than 30 weeks' gestation will require care in a neonatal ICU and that their mothers should be referred when possible to a level III facility for delivery.