The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH.
University of Colorado School of Medicine, Aurora, CO.
Med Care. 2023 Nov 1;61(11):729-736. doi: 10.1097/MLR.0000000000001893. Epub 2023 Jul 14.
The supply of US neonatal intensive care unit (NICU) beds and neonatologists is known to vary markedly across regions, but there have been no investigation of patterns of recent growth (1991-2017) in NICUs in relation to newborn need.
The objective of this study was to test the hypothesis that greater growth in NICU capacity occurred in neonatal intensive care regions with higher perinatal risk.
A longitudinal ecological analysis with neonatal intensive care regions (n=246) as the units of analysis. Associations were tested using linear regression.
All US live births ≥400 g in 1991 (n=4,103,528) and 2017 (n=3,849,644).
Primary measures of risk were the proportions of low-birth weight and very low-birth weight newborns and mothers who were Black or had low educational attainment.
Over 26 years, the numbers of NICU beds and neonatologists per live birth increased 42% and 200%, respectively, with marked variation in growth across regions (interquartile range: 0.3-4.1, beds; neonatologists, 0.4-1.0 per 1000 live births). A weak association of capacity with perinatal risk in 1991 was absent in 2017. There was no meaningful (ie, clinical or policy relevant) association between regional changes in capacity and regions with higher perinatal risk or lower capacity in 1991; higher increases in perinatal risk were not associated with higher capacity growth.
The lack of association between newborn medical needs and the supply of NICU resources raises questions about the current effectiveness of newborn care at a population level.
美国新生儿重症监护病房（NICU）床位和新生儿科医生的供应在不同地区差异显著，但尚未有研究调查 NICU 床位的最近增长情况（1991-2017 年）与新生儿需求之间的关系。
本研究旨在检验以下假设，即围产期风险较高的新生儿重症监护地区 NICU 容量的增长幅度更大。
这是一项具有纵向生态学分析的研究，以新生儿重症监护地区（n=246）为分析单位。采用线性回归检验关联。
1991 年（n=4103528）和 2017 年（n=3849644）所有出生体重≥400 克的美国活产儿。
主要风险指标为低出生体重儿和极低出生体重儿的比例以及黑人和受教育程度低的母亲的比例。
在 26 年期间，NICU 床位和新生儿科医生的数量分别增加了 42%和 200%，各地区的增长幅度差异显著（四分位距：床位 0.3-4.1；新生儿科医生 0.4-1.0/每 1000 活产儿）。1991 年，容量与围产期风险之间的微弱关联在 2017 年时已经不存在。在 1991 年，区域容量变化与围产期风险较高或容量较低的区域之间没有明显的（即临床或政策相关）关联；围产期风险的增加与容量的增长并不相关。
新生儿医疗需求与 NICU 资源供应之间缺乏关联，这引发了人们对当前人群层面新生儿护理效果的质疑。
