Once Scarce, Neonatal Intensive Care Proliferates
Once in short supply, neonatal intensive care units (NICU) are indispensable life savers for critically ill newborns, typically born premature with very low birth weight. But a new Dartmouth report finds that, following a robust national expansion of NICUs over the last two decades, nearly half of all newborns admitted to U.S. NICUs are of normal birth weight.
At the same time, nearly 15% of very low birth weight babies (less than 1500 grams/3.3 pounds) do not receive care in Level III or IV NICUs, despite evidence showing fewer deaths and complications for these newborns when they receive care in NICUs with the highest capabilities to treat very sick newborns, according to the report.
The Dartmouth Atlas of Neonatal Intensive Care offers the first comprehensive examination of U.S. neonatal care across large populations of newborns, using data from the National Center for Health Statistics of the Centers for Disease Control (CDC), Texas Medicaid, and Anthem Blue Cross Blue Shield commercial and Medicaid plans.
The report raises questions about how medical care is provided to our nation’s newborns, particularly to those born premature or with other health problems.
“Regardless of the infant population we studied, newborn and NICU care varied markedly across regions and hospitals. Little of the variation was explained by differences in newborn health needs. The care that similar newborns receive is strikingly different in one hospital compared to another,” said principal author David C. Goodman, MD, MS, of The Dartmouth Institute for Health Policy & Clinical Practice at the Geisel School of Medicine at Dartmouth.
The supply of neonatal intensive care beds grew 65% from 1995-2013, according to the report. The supply of neonatologists grew even faster, increasing 75% from 1996- 2013. At the same time, the number of newborns has remained relatively stable. This has led to increasing numbers of lower risk newborns being admitted to NICUs.
The study finds that the growth in NICU care has not occurred where it is most needed. Regions of the country with a high proportion of premature newborns, or other factors related to newborn illness, such as maternal education level or the rate of cesarean sections, are not the regions with higher supply of NICU beds or neonatologists.
“We should not spare a dollar in providing the best care for newborns. But spending more doesn’t help infants if they could receive the care they need in a maternity unit or home with their mothers.” Goodman said. “It is very troubling that such a valuable and expensive health care resource is not distributed where it is needed.”
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