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Does Growth in Neonatal Intensive Care Occur Where its Most Needed? Temporal Trends in Regional Neonatal Intensive Care Capacity and Association with Perinatal Risk and Outcomes

Funding Agency: Kettering Family Foundation
Funding Period: July 1, 2022 - June 30, 2024
PI: David Goodman, MD, MS

Background

Over forty years ago, the advent of neonatal intensive care units (NICU) brought about extraordinary reductions in mortality and morbidity, particularly in very preterm and severely ill newborns. This success led to robust growth in the number of NICUs, NICU beds, and neonatologists accompanied by further improvements in risk-adjusted outcomes. Yet, overall perinatal outcomes in the United States lag behind other high income countries, even when controlling for our higher rates of prematurity. These persistent discrepancies in newborn health outcomes raises important questions about the organization and quality of U.S. newborn care, including what is termed capacity.

In NICU care, capacity is usually measured as the number and type of NICU beds and neonatal clinicians (e.g., neonatologists) in relation to newborn populations. We first reported in 2001 that 1998 NICU capacity was not located in accordance with perinatal risk in a Pediatrics publication.[1] This analysis laid the foundation for a second study reported the following year in the New England Journal of Medicine which reported an inconsistent and weak relationship with NICU capacity and 28- and 180-day mortality.[2] In the twenty years since these publications, the number of NICU beds and neonatologists has continued to grow at rates much higher than the number of births. There have been no studies examining the consequences, favorable or unfavorable, of this growth.

Motivation and Aims

This study will address important knowledge gaps in NICU capacity by answering three questions:

  1. Did greater growth in NICU capacity over the past 30 years occur in regions with higher perinatal risk?
  2. By the end of the study period, most likely 2017, was there a higher association between regional perinatal risk and capacity than observed in 1991?
  3. Did populations of newborns in regions with more rapid capacity growth rates experience faster declines in neonatal mortality?

References

  1. Goodman DC, Fisher ES, Little GA, Stukel TA, Chang CH. (2001) Are neonatal intensive care resources located according to need? Regional variation in neonatologists, beds, and low birth weight newborns. Pediatrics. 108(2):426-431. PMID 11483810
  2. Goodman DC, Fisher ES, Little GA, Stukel TA, Chang CH, Schoendorf KS. (2002) The relation between the availability of neonatal intensive care and neonatal mortality. N Engl J Med. 346(20):1538-1544. PMCID 12015393