1. Introduction Extremely low birth weight (ELBW) infants are those with birth weight of <1000 grams. Neonatal morbidity and mortality are highest among this group and has a huge short-term and long-term economic burden on society. In 2004, the AAP issued a policy statement titled “Levels of Neonatal Care”, which supported the perinatal regionalization where infants with extreme prematurity (<28 weeks of gestation or <1000 grams) should be delivered to a Level III NICU. Over the past decade multiple studies showed that even Very low birth weight infants (< 1500 grams) have improved outcome when managed in level III NICU (2012 AAP policy guideline). The Nueces county service area in South Texas has a widely distributed health care having no Level III NICU with birthing facility within 140 miles radius. Driscoll Children’s Hospital (DCH) is the only Level III NICU within the area. “Efficacy of Adopting The 2004 AAP Perinatal Regionalization Policy within a Single Healthcare Plan". Ioannis Livaditis MD 1, Katrina Visenio MD 2, Sanjeet Panda MD 2, Ajay Pratap Singh MD 2, Ernest Buck MD 3, Mary Peterson MD 3 Driscoll Children’s Hospital, Pediatric Residents 1 Level II, 2 Level III, 3 Driscoll Health Plan. Results Methods Conclusions 1.As per the initial analysis(Chart 1) the patients in NT group were significantly different from the other two groups (larger(p-0.0035) and older preemies(p-0.0001)) possibly accounting for the decreased morbidity and LOS seen in that group. 2.The two group distribution distributed evenly. Among those transferred, general trend was seen that those transferred within 48hrs had lower morbidity, LOS (reaching significance) and ventilator days. 3.Mortality seems to increase for ELBW babies, if not transferred to a higher level within 48hrs. 4.No events noted in neonatal transfers within 48hrs, and hence deemed safe. 5.From our study, average savings of around $51000 (average stay $ 3000/day ) per ELBW transferred within 48hrs, due to decreased LOS. More importantly for morbidity, lifelong health care cost and economic burden should be taken into account. 6.Our study is ongoing and we expect to reach significance with respect to morbidity, as our sample size increases. 7.As of now our study supports regionalization, for ELBW babies even in unique South Texas neonatal care situation and emphasizes the importance of further evaluation of 2012 AAP guideline in our local health care setting. References 1. Levels of Neonatal Care 2012, 2. Levels of Neonatal Care 2004 3. Level and Volume of Neonatal Intensive Care and Mortality in VLBW infants 4. Can Changes in Clinical Practice Decrease the Incidence of Severe Retinopathy of Prematurity in Very Low Birth Weight Infants? 5. Effect of Opening Midlevel Neonatal Intensive Care Units on the Location of Low Birth Weight Births in California 6. Increasing VLBW Deliveries at Subspecialty Perinatal Centers via Perinatal Outreach 7. The Effect of Birth Hospital Type on the Outcome of Very Low Birth Weight Infants 8. Hospital Volume and Neonatal Mortality Among Very Low Birth Weight Infants 9. NICU Practices and Outcomes Associated With 9 Years of Quality Improvement Collaboratives 10. Neonatal Intensive Care Unit Council Annual Report 2013 Texas Pediatric Society Electronic Poster Contest Retrospective Cohort study, within a single health plan. Charts from DCH and 8 other hospitals, that included Level I and II NICUs were reviewed. Population: Infants born <1000g or <28 weeks age of gestation under the DHP between December 2009 and March 2013. This period was chosen because the policy was adopted on February 2011, after which the transfers of this high risk neonates were expedited within the first 48 hrs. Patients with insufficient or incomplete data were excluded. Primary outcomes: Mortality Morbidity in terms of development of ROP, IVH, NEC and chronic lung disease. Secondary outcomes: Length of stay(LOS) in NICU and number of days on mechanical ventilator, HFNC/CPAP and nasal cannula. Objective The Driscoll Health Plan (DHP), a Medicaid Managed Care Organization implemented a regionalization policy based on the 2004 AAP guideline on 1st February 2011. All infants <28 wks AND <1000 g should be transferred to a level III NICU soon after stabilization, ideally within 48 hrs. Our study seeks to determine the efficacy of adopting the 2004 AAP perinatal regionalization guideline in this unique setting on neonatal mortality, morbidity and health care utilization. Results After data collection and exclusion of patients with insufficient data, we were left with 77 infants. We further stratified the results as follows: 1.As per AAP policy, where all infants either <28 wks OR <1000 g, were included and divided into 3 groups: a)Transferred to Level III within 48hrs,b)Transferred after 48hrs & c)Never transferred. 2.As per DHP, included only those infants both <28 wks AND <1000 g, that gave us a more comparable case distribution and divided them into 2 groups: a)Transferred within 48hrs and b)Transferred after 48hrs or Never transferred. 3.We excluded mortality for the comparison of morbidity and continuous variables like LOS and ventilator days. 4.SAS 7.2 was used for statistics, for multivariate regression analysis. The <48hr group was taken as reference. Variables <48 hours N=29 >48 hours and NT N=30 P-value Infant Sex n(%) Female Male 13(44.8) 16(55.2) 12(40.0) 18(60.0) 0.7075 Birth Weight Mean (STD) 778.3±171.0 732.8±126.9 0.1509 Gestational Age Mean(STD) 25.2±1.4 25.0±1.6 0.4424 Variables <48 hours N=32 >48 hours N=24 NT N=21 P-value Infant Sex n(%) Female Male 15(46.8) 17(53.1) 7(29.2) 17(70.8) 12(57.1) 9(42.9) 0.1557 Birth weight Mean (STD) 806.3±186.8 749±213.5 966.2±251.3 0.0035 Gestational Age Mean(STD) 25.3±1.4 25.0±1.7 27.8±2.6 0.0001 Chart 3. Case Distribution Between 2 groups on infants who are <28 weeks AND <1000 grams. Chart 1. Case Distribution Between 2 groups on infants who are <28 weeks OR <1000 grams. 87 Infants <1000 g or <28 weeks AOG < 48 hours 77 infants included in the study (NT) > 48 hours Total (32 – 2) 30 Total (21-2) 19 Total (24-4) 20 10 excluded: insufficient data (NT group) Mortalities excluded Using “AND” criteria < 48h Total (30-3) 27 > 48 + NT Total (29-3) 26