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Very low birth weight (VLBW) infants require specialized care in neonatalintensive care units. In the United States (U.S.), such infants frequently aretransferred between hospitals. Although these neonatal transfer networks areimportant, both economically and for infant morbidity and mortality, thenational-level pattern of neonatal transfers is largely unknown. Using datafrom Vermont Oxford Network on 44,753 births, 2,122 hospitals, and 9,722inter-hospital infant transfers from 2015, we performed the largest analysis todate on the inter-hospital transfer network for VLBW infants in the U.S. Wefind that transfers are organized around regional communities, but that despitebeing largely within state boundaries, most communities often contain at leasttwo hospitals in different states. To classify the structural variation intransfer pattern amongst these communities, we applied a spectral measure forregionalization and found an association between a community's degree ofregionalization and their infant transfer rate, which was not utilized indetecting communities. We also demonstrate that the established measures ofnetwork centrality and hierarchy, e.g., the community-wide entropy in PageRankor betweenness centrality and number of distinct `layers' within a community,correlate weakly with our regionalization index and were not significantlyassociated with metrics on infant transfer rate. Our results suggest that theregionalization index captures novel information about the structuralproperties of VLBW infant transfer networks, have the practical implication ofcharacterizing neonatal care in the U.S., and may apply more broadly to therole of centralizing forces in organizing complex adaptive systems.

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