Determinants of Interhospital Transfer of Low-Birth-Weight Newborns

In a single year in New York City, we identified 1413 neonates who were transferred for medical care from their hospitals of birth; 83% of transferred infants were sent from Level 1 hospitals (no special facilities for sick infants) to Level 3 hospitals (newborn intensive care units). Level 2 hospit...

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Bibliographic Details
Published in:Medical care 1988-05, Vol.26 (5), p.462-473
Main Authors: Marcus, Michele, Paneth, Nigel, Kiely, John L., Susser, Mervyn W.
Format: Article
Language:English
Subjects:
Adult
Apgar Score
Birth Weight
Delivery, Obstetric
Diabetes complications
Female
Gestational Age
Humans
Infant, Low Birth Weight
Infant, Newborn
Infants
Intensive care
Intensive Care Units, Neonatal
Male
Maternal Age
Medical Record Linkage
Mortality
New York City
Newborns
Patient Transfer
Sex Factors
Transfer rates
Vivipary
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Summary:In a single year in New York City, we identified 1413 neonates who were transferred for medical care from their hospitals of birth; 83% of transferred infants were sent from Level 1 hospitals (no special facilities for sick infants) to Level 3 hospitals (newborn intensive care units). Level 2 hospitals (those with an intermediate level of care) participated little in the transfer process as either senders or receivers. Infants weighing more than 2250 g were rarely transferred. Among low-birth-weight infants born at Level 1 hospitals, the major determinants of transfer were birth weight, gestational age, and Apgar score. Peak transfer rates were for infants weighing 1000-1750 g (84% transferred), those with gestational ages of 28-31 weeks (79% transferred), and those with Apgar scores of 4-6 (68% transferred). Infants with values either above or below these modes were transferred less frequently. Transfer from Level 2 hospitals was also significantly related to birth weight and Apgar score. Socioeconomic indicators such as race, maternal education, ward/private status, and financial coverage for the delivery had no effect on transfer rates. Transferred low-birth-weight infants were a highly selected sample of low-birth-weight infants. Infants transferred from Level 1 hospitals were those in better condition (higher Apgar scores) when weighing less than 1750 g, and those in worse condition (lower Apgar scores) when weighing more than 1750 g.
ISSN:0025-7079
1537-1948
DOI:10.1097/00005650-198805000-00003