Impact of neonatologist availability on preterm survival without morbidities

We 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. Data 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. Level 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). When 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.