Trends in Neonatal Intensive Care Unit Utilization in a Large Integrated Health Care System

Abstract

IMPORTANCE There are few population-based studies addressing trends in neonatal intensive care unit (NICU) admission and NICU patient-days, especially in the subpopulation that, by gestational age (GA) and birth weight (BW), might otherwise be able to stay in the room with their mothers. OBJECTIVE To describe population-based trends in NICU admissions, NICU patient-days, readmissions, and mortality in the birth population of a large integrated health care system. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data extracted from electronic medical records at Kaiser Permanente Southern California (KPSC) health care system. Participants included all women who gave birth at KPSC hospitals and their newborns from January 1, 2010, through December 31, 2018. Data extraction was limited to data entry fields whose contents were either numbers or fixed categorical choices. Rates of NICU admission, NICU patient-days, readmission rates, and mortality rates were measured in the total population, in newborns with GA 35 weeks or greater and BW 2000 g or more (high GA and BW group), and in the remaining newborns (low GA and BW group). Admissions to the NICU and NICU patient-days were risk adjusted with a machine learning model based on demographic and clinical characteristics before NICU admission. Changes in the trends were assessed with 2-sided correlated seasonal Mann-Kendall test. Data analysis was performed in August 2019. EXPOSURES Admission to the NICU and NICU patient-days among the birth cohort. MAIN OUTCOMES AND MEASURES The primary outcomes were NICU admission and NICU patient-days in the total neonatal population and GA and BW subgroups. The secondary outcomes were readmission and mortality rates. RESULTS Over the study period there were 320 340 births (mean [SD] age of mothers, 30.1 [5.7] years; mean [SD] gestational age, 38.6 [1.97] weeks; mean [SD] birth weight, 3302 [573] g). The riskadjusted NICU admission rate decreased from a mean of 14.5% (95% CI, 14.2%-14.7%) to 10.9% (95% CI, 10.7%-11.7%) (P for trend = .002); 92% of the change was associated with changes in the care of newborns in the high GA and BW group. The number of risk-adjusted NICU patient-days per birth decreased from a mean of 1.50 patient-days (95% CI, 1.43-1.54 patient-days) to 1.40 patientdays (95% CI, 1.36-1.48 patient-days) (P for trend = .03); 70% of the change was associated with newborns in the high GA and BW group. The unadjusted 30-day readmission rates and mortality rates did not change. CONCLUSIONS AND RELEVANCE Admission rates to the NICU and numbers of NICU patient-days decreased over the study period without an increase in readmissions or mortality. The observed decrease was associated with the high GA and BW newborn population. How much of this decrease (continued) Key Points Question How are neonatal intensive care unit (NICU) admission rates and NICU patient-days changing over time for various birth weight, gestational age, and acuity subgroups? Findings In this cohort study of neonates in a large integr...

Newborn Transport Practices: Influence on Newborn Survival in Benin City, Nigeria

“…The development of an integrated system of care to address newborn transport systems in the context of tertiary newborn care services may be the way forward, linking tertiary care with communities through the Primary Health Care Centers (PHC). Ideally, in developed countries, neonatal transport teams are a component of larger system of perinatal care associated with a tertiary care neonatal intensive care unit [5][6][7]. The situation is not the same in the study environment or in most LRS.…”

“…As a result, infants requiring more intensive supportive care need to be transferred to a center capable of higher-level of neonatal care. Prompt attention to the need for transfer might avert the 50% of newborn deaths occurring on the first day of life [5][6][7]. Many newborn deaths results from lack of contact with the health system or lack of transfer systems to improve access to higher-level facilities [8][9][10][11].…”

Evaluation of Plasma Amino Acid Levels in Preterm Infants and Their Potential Correlation with Retinopathy of Prematurity

“…Infants with birth weight (BW) ≤1500 grams or gestational age ≤32 weeks (GA) and prematurity with BW > 1500 grams or GA > 32 weeks with a history of admission to a neonatal intensive care unit (NICU) due to an unstable clinical course were eligible to participate in this study. The admission criteria for NICU consist of prematures having respiratory distress requiring ventilatory support, seizures, congenital heart disease, or cardiac arrhythmias requiring cardiac services, with severe hypoxic–ischemic injury, birth weight between 1000 grams and 2000 grams, gestational age between 32 and 36 weeks, prematurity and/or birth weight of less than 1500 g, and severe intrauterine growth restriction [ 11 ].…”

Using Neonatal Intensive Care Units More Wisely for At-Risk Newborns and Their Families

“…In the study by Braun et al, 3 investigators from Kaiser Permanente share a population-based study describing a decline in NICU utilization-both admission rates and patient days-during a 9-year period. This is an important study, as it describes a trend that is counter to several recent reports of unexplained increasing NICU utilization, particularly for more mature and higher birth-weight infants, using a clinical rather than administrative data set.…”

“…In the study by Braun et al, 3 12% of more than 300 000 liveborn infants were admitted to the NICU. Contrary to public perceptions of NICUs as prematurity colonies, more than two-thirds of these admissions were infants born after 34 weeks gestational age with birth weights more than 2000 g.…”