Transport of the Critically Ill Newborn

Regionalized Care of Newborns

The concept of regionalized care for neonates was first introduced in the 1976 March of Dimes Report Toward Improving the Outcome of Pregnancy. This report and future revisions stress the importance of providing regionalized care for infants in facilities with adequate personnel and equipment for an infant's severity of illness. Ideally, mothers deliver infants at a facility with the appropriate level of expertise and resources to care for the degree of prematurity and illness of the infant. Many studies have shown that very-low-birthweight (VLBW) infants, or infants <1,500 g at birth, have decreased morbidity and mortality when delivered at an appropriate level of care center ( Level III hospitals). In a meta-analysis, neonatal or predischarge death occurred in 38% of VLBW infants receiving care at a non–Level III hospital and 23% of those receiving care at a Level III hospital. A main objective of Healthy People 2020 addresses this issue, with a goal of increasing the proportion of VLBW infants born at Level III hospitals or subspecialty perinatal centers to 83.7%. Where this is not possible, the infant should be transported to an appropriate level of care hospital after birth.