The association of regional perinatal risk factors and neonatal intensive care capacity for Military Health System-insured newborns

Goodman, David C.; Romano, Celeste J; Hall, Clinton; Bukowinski, Anna T; Mu, Thornton; Gumbs, Gia R; Conlin, Ava Marie S; Vereen, Rasheda J.; Leyenaar, JoAnna K

doi:10.1038/s41372-023-01633-4

Cited by 2 publications

(3 citation statements)

References 19 publications

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“…While these associations have been well-studied in adult populations, investigation in perinatal populations has been hindered by poor availability of population-based data. One known characteristic of NICU capacity is that in the past 3 decades, it has varied widely across health service regions but is unrelated to indicators of medical need . The supply of NICU beds does, however, appear to affect newborn utilization.…”

Section: Discussionmentioning

confidence: 99%

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Hospital-Level NICU Capacity, Utilization, and 30-Day Outcomes in Texas

Goodman,

Stuchlik,

Ganduglia-Cazaban

et al. 2024

JAMA Netw Open

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ImportanceRisk-adjusted neonatal intensive care unit (NICU) utilization and outcomes vary markedly across regions and hospitals. The causes of this variation are poorly understood.ObjectiveTo assess the association of hospital-level NICU bed capacity with utilization and outcomes in newborn cohorts with differing levels of health risk.Design, Setting, and ParticipantsThis population-based retrospective cohort study included all Medicaid-insured live births in Texas from 2010 to 2014 using linked vital records and maternal and newborn claims data. Participants were Medicaid-insured singleton live births (LBs) with birth weights of at least 400 g and gestational ages between 22 and 44 weeks. Newborns were grouped into 3 cohorts: very low birth weight (VLBW; &lt;1500 g), late preterm (LPT; 34-36 weeks’ gestation), and nonpreterm newborns (NPT; ≥37 weeks’ gestation). Data analysis was conducted from January 2022 to October 2023.ExposureHospital NICU capacity measured as reported NICU beds/100 LBs, adjusted (ie, allocated) for transfers.Main Outcomes and MeasuresNICU admissions and special care days; inpatient mortality and 30-day postdischarge adverse events (ie, mortality, emergency department visit, admission, observation stay).ResultsThe overall cohort of 874 280 single LBs included 9938 VLBW (5054 [50.9%] female; mean [SD] birth weight, 1028.9 [289.6] g; mean [SD] gestational age, 27.6 [2.6] wk), 63 160 LPT (33 684 [53.3%] female; mean [SD] birth weight, 2664.0 [409.4] g; mean [SD] gestational age, 35.4 [0.8] wk), and 801 182 NPT (407 977 [50.9%] female; mean [SD] birth weight, 3318.7 [383.4] g; mean [SD] gestational age, 38.9 [1.0] wk) LBs. Median (IQR) NICU capacity was 0.84 (0.57-1.30) allocated beds/100 LB/year. For VLBW newborns, NICU capacity was not associated with the risk of NICU admission or number of special care days. For LPT newborns, birth in hospitals with the highest compared with the lowest category of capacity was associated with a 17% higher risk of NICU admission (adjusted risk ratio [aRR], 1.17; 95% CI, 1.01-1.33). For NPT newborns, risk of NICU admission was 55% higher (aRR, 1.55; 95% CI, 1.22-1.97) in the highest- vs the lowest-capacity hospitals. The number of special care days for LPT and NPT newborns was 21% (aRR, 1.21; 95% CI,1.08-1.36) and 37% (aRR, 1.37; 95% CI, 1.08-1.74) higher in the highest vs lowest capacity hospitals, respectively. Among LPT and NPT newborns, NICU capacity was associated with higher inpatient mortality and 30-day postdischarge adverse events.Conclusions and RelevanceIn this cohort study of Medicaid-insured newborns in Texas, greater hospital NICU bed supply was associated with increased NICU utilization in newborns born LPT and NPT. Higher capacity was not associated with lower risk of adverse events. These findings raise important questions about how the NICU is used for newborns with lower risk.

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Section: Discussionmentioning

confidence: 99%

“…One known characteristic of NICU capacity is that in the past 3 decades, it has varied widely across health service regions but is unrelated to indicators of medical need. 1 , 31 , 32 , 33 The supply of NICU beds does, however, appear to affect newborn utilization.…”

Section: Discussionmentioning

confidence: 99%

Hospital-Level NICU Capacity, Utilization, and 30-Day Outcomes in Texas

Goodman,

Stuchlik,

Ganduglia-Cazaban

et al. 2024

JAMA Netw Open

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“…Once stabilized, the infant may be transported to a neonatal intensive care unit for surgical evaluation and definitive care. There is variation in the availability of high‐risk neonatal care at military hospitals (Goodman et al, 2023), therefore transfers to civilian hospitals with appropriate levels of care may be common. Generalizability of study findings was further limited by other differences between military and civilian hospitals, such as diagnostic and coding practices that may vary between these healthcare settings.…”

Section: Discussionmentioning

confidence: 99%

Investigation of a transient increase in omphalocele prevalence in a birth cohort of TRICARE beneficiaries

Lanning,

Magallon,

Bukowinski

et al. 2024

Birth Defects Research

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BackgroundThe Department of Defense Birth and Infant Health Research (BIHR) program leverages medical encounter data to conduct birth defect surveillance among infants born to military families. Omphalocele is a major abdominal wall defect with an annual prevalence of ~2 per 10,000 births in BIHR data, but an unexpected increase was observed during 2017–2019, reaching 6.4 per 10,000 births in 2018. To investigate this transient increase in prevalence, this study aimed to validate the omphalocele case algorithm among infants born 2016–2021.MethodsOmphalocele cases were identified by ICD‐10 code Q79.2 (exomphalos) on one inpatient or two outpatient infant encounter records and validated using parental and infant electronic health records. Characteristics of true and false positive cases were assessed using bivariate analyses and compared over time.ResultsOf 638,905 live births from 2016 to 2021, 230 met the ICD‐10 case definition for omphalocele; 138 (60.0%) cases were eligible for validation, of which 68 (49.3%) were true positives. The geometric mean time from birth to first ICD‐10 omphalocele diagnosis was 1.1 (standard error [SE] 0.1) days for true positives and 11.9 (SE 3.1) days for false positives. Among the 70 false positives, 36 (51.4%) were cases of confirmed umbilical hernia; rates of umbilical hernia and delayed omphalocele diagnoses (>30 days after birth) were elevated among false positives during 2017–2019.ConclusionsHigher misuse of ICD‐10 code Q79.2 during 2017–2019 likely influenced the associated increase in omphalocele prevalence. Timing of diagnosis should be considered for omphalocele case definitions using medical encounter data.

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The association of regional perinatal risk factors and neonatal intensive care capacity for Military Health System-insured newborns

Cited by 2 publications

References 19 publications

Hospital-Level NICU Capacity, Utilization, and 30-Day Outcomes in Texas

Hospital-Level NICU Capacity, Utilization, and 30-Day Outcomes in Texas

Investigation of a transient increase in omphalocele prevalence in a birth cohort of TRICARE beneficiaries

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