We appreciate the comments by Attar and Bratton. Transfer of high-risk premature infants from community hospital nurseries to a tertiary-level NICU for acute care has been associated with improved clinical outcomes. Also, in utero transfer of the high-risk fetus improves survival and clinical outcome. However, with increasing demands on the tertiary NICU, the process of back transfer has also become important. Our study showed that extremely low birth weight infants who were back transferred to level I or II nurseries from a NICU had similar growth and neurodevelopmental outcomes to infants who remained in the NICU until discharged from the hospital.

However, we did identify some differences. Although, a comparison of hospital readmissions between the NICU group and the back-transferred group revealed no differences in hospital readmission rates in the first year of life, rehospitalizations in the back-transfer group were increased by 18 to 22 months. Readmission...

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