Stanford University School of Medicine, Stanford, California.
Division of Neonatology, Department of Pediatrics.
Hosp Pediatr. 2023 Nov 1;13(11):976-983. doi: 10.1542/hpeds.2023-007190.
Previous research suggests increasing numbers of and variation in NICU admissions. We explored whether these trends were reflected in California by examining NICU admissions and birth data in aggregate and among patient and hospital subpopulations more susceptible to variations in care.
In this retrospective cohort study, we evaluated NICU utilization between 2008 and 2018 for all live births at hospitals that provide data to the California Perinatal Quality Care Collaborative. We compared hospital- and admission-level data across birth weight (BW), gestational age (GA), and illness acuity categories. Trends were analyzed by using linear regression models.
We identified 472 402 inborn NICU admissions and 3 960 441 live births across 144 hospitals. Yearly trends in NICU admissions remained stable among all births and higher acuity births (mean admission rates 11.9% and 4.1%, respectively). However, analysis of the higher acuity births revealed significant increases in NICU admission rates for neonates with higher BW and GA (BW ≥ 2500g: 1.8% in 2008, 2.1% in 2018; GA ≥ 37 weeks: 1.5% in 2010, 1.8% in 2018). Kaiser hospitals had a decreasing trend of NICU admissions compared to non-Kaiser hospitals (Kaiser: 13.9% in 2008, 10.1% in 2018; non-Kaiser: 11.3% in 2008, 12.3% in 2018).
Overall NICU admission rates in California were stable from 2008-2018. However, trends similar to national patterns emerged when stratified by infant GA, BW, and illness acuity as well as Kaiser or non-Kaiser hospitals, with increasing admission rates for infants born at higher BW and GA and within non-Kaiser hospitals.
先前的研究表明，新生儿重症监护病房（NICU）的入院人数不断增加，且存在差异。我们通过研究加利福尼亚州的 NICU 入院和分娩数据，探讨了这些趋势是否存在，该研究对所有在向加利福尼亚围产期质量护理合作组织提供数据的医院分娩的活产儿进行了汇总，并对更易受护理差异影响的患者和医院亚人群的 NICU 利用情况进行了分析。
在这项回顾性队列研究中，我们评估了 2008 年至 2018 年期间所有在向加利福尼亚围产期质量护理合作组织提供数据的医院分娩的活产儿的 NICU 利用情况。我们比较了不同出生体重（BW）、胎龄（GA）和疾病严重程度类别的医院和入院数据。使用线性回归模型分析趋势。
我们在 144 家医院中确定了 472402 例院内 NICU 入院和 3960441 例活产儿。所有出生儿和高危儿的 NICU 入院率呈稳定趋势（平均入院率分别为 11.9%和 4.1%）。然而，对高危儿的分析显示，BW 和 GA 较高的新生儿的 NICU 入院率显著增加（BW≥2500g：2008 年为 1.8%，2018 年为 2.1%；GA≥37 周：2010 年为 1.5%，2018 年为 1.8%）。与非 Kaiser 医院相比，Kaiser 医院的 NICU 入院人数呈下降趋势（Kaiser：2008 年为 13.9%，2018 年为 10.1%；非 Kaiser：2008 年为 11.3%，2018 年为 12.3%）。
2008 年至 2018 年期间，加利福尼亚州的整体 NICU 入院率保持稳定。然而，当按婴儿 GA、BW 和疾病严重程度以及 Kaiser 或非 Kaiser 医院进行分层时，出现了类似于全国趋势的趋势，BW 和 GA 较高以及非 Kaiser 医院出生的婴儿的入院率增加。
