Impact of neonatologist availability on preterm survival without morbidities

Objectiveswe assessed birth hospital level and neonatal outcomes within a model of regionalization featuring neonatologists at all levels of care, including well-baby nurseries without an accompanying neonatal intensive care unit.methodsdata were analyzed by ny state adaptation of american academy of pediatrics defined levels of care; n = 998, 23–30 weeks gestational age, 400–1250 g birth weight, and admitted to the regional center (2006–2015). primary outcomes were survival, neurologic survival, and intact survival.resultslevel iii hospitals transferred 82% of neonates ≥24 h of life compared to ≤2% at level i or ii hospitals (p < 0.05). primary outcomes were equivalent for levels i vs. ii born neonates with similar postnatal age at transfer and similar to inborn rates (levels i and ii vs. iv).conclusionswhen transferred within 24 h, levels i or ii born infants had equivalent outcomes to inborn level iv infants in a model of neonatologist availability at all deliveries.