Performance of a level II nursery in a neonatal regional program: part I. Patient population and role of the general pediatrician.

We examined the performance of a level II nursery in a regional neonatal program during a 30-month period. Of 3,851 live-born infants, 527 (13.7%) were admitted to the special care nursery and 70 (1.8%) were transferred to a level III nursery. There were 23 neonatal deaths, ten of them in the level II facility; the other 13 infants had been transferred to a level III center and died there. Three hundred eleven (59%) of the admissions to the special care nursery were infants whose birth weights exceeded 2,500 gm, and 241 (46%) were of more than 37 weeks' gestation. There were 262 infants admitted with respiratory distress. In an additional 55 infants, respiratory distress was part of their clinical presentation. Procedures done by the professional staff reflected these needs. A total of 3,476 days of care were provided in the special care nursery, with a mean duration of 6.6 +/- 5.91 days (+/- 1 SD). Physician time required in the special care unit was 2,317.3 hours, an average of 4.4 hours per admission. These data support the contention that general pediatricians operating level II nurseries within a regionalized program can provide care of the majority of newborns, including care of the majority of ill neonates.