The Interhospital Transfer Network for Very Low Birth Weight Infants in the United States.

Very low birth weight (VLBW) infants require specialized care in neonatal intensive care units. In the United States (U.S.), such infants frequently are transferred between hospitals. Although these neonatal transfer networks are important both economically and in terms of infant morbidity and mortality, the national-level pattern of neonatal transfers is largely unknown. Using data on 44,753 infants, 2,122 hospitals, and 9,722 inter-hospital infant transfers from 2015, we performed the largest analysis to date on the inter-hospital transfer network for VLBW infants in the U.S. We found that transfers are organized around regional communities, that, despite being largely within state boundaries, most often contain at least two hospitals in different states. Applying a spectral measure of hierarchy, we find a positive correlation between our measure and information about infants in the detected communities. Our results have a practical implication of characterizing neonatal care in the U.S. and may broadly apply to the role of hierarchical forces in organizing complex adaptive systems.