In what appears to be a unique cooperative effort, the directors of the infant intensive care units at four local hospitals have agreed to establish a system to avoid over crowding the nurseries at the four institutions.

"We feel that beyond a certain point stretching to accommodate further admissions is not in the baby's interests," said Dr. Gordon Avery, chief of the newborn service at Children's Hospital.

Under the agreement, nursery directors at Fairfax, Georgetown, Children's will refer patients to another of the four institutions when they do not have either space, or necessary equipment, available to properly care for an incoming patient.

Children's, with 32 beds, has an intensive care nursery about twice the size of those at the other hospitals. But even Children's, because of its excellent reputation and its role as a referral center for a number of hospitals around the beltway, is sometimes overcrowded.

Doctors at the four institutions have been transferring patients for a number of years, according to Mary Kate Davit, director of the Georgetown University Medical Center nurseries.

But the earlier transfer arrangements weren't at all formalized, she said, "and I think at times it was difficult to facilitate a transfer when the usual . . . nursery" to which an outlying hospital transfers sick newborns was full.

The new transfer arrangement, which was reached by the nursery chiefs rather than the hospital administrators, has not been reduced to writing, but has been carefully worked out, according to Davit.

"The hospital or doctor referring a (newborn) would get hold of whatever hospital they usually transfer a patient to," said Davit. "If it was Sibley, they'd contact us (Georgetown). If we didn't have what they needed, say a respirator, we'd contact the others.

"It's just a matter of our knowing who their (specialist) on call is on their knowing who ours is," she said, explaining that the hospital without space would arrange for space in another hospital for the infant.

The agreement was reached, said Avery, as an almost incidental result of a two-day symposium held at Airlie House last month under the sponsorship of George Washington University Medical Center, Children's Hospital and a pharmaceutical firm.

The conference was arranged to foster cooperation among neonatologists - specialists in newborn medicine - in the Washington and Baltimore areas, said Avery, and included, hysicians from Baltimore City Hospital, Johns Hopkins and Washington area institutions.

One of the things discussed, said Avery, was th desirability of establishing regional cooperative efforts without legislative prodding.