Neonatal Intensive Care Admissions Increased For All Birth Weight Newborns

MedicalResearch.com Interview with:
Wade Harrison, MPH
The Dartmouth Institute for Health Policy & Clinical Practice
Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire

Medical Research: What is the background for this study? What are the main findings?

Dr. Harrison: This study used national birth certificate data to examine time trends in Neonatal Intensive Care Unit (NICU) admission rates for all U.S. newborns and the composition of the cohort of admitted newborns.  Most of the existing studies of neonatal intensive care are limited in examining specific groups of newborns (e.g. those <1500 g, those with a specific complication, within limited geographies, etc.) or only looking at how care is delivered after a baby is admitted, leaving aside the question of whether to admit them in the first place.  This is an important area to study because the newborn period is a critical time for babies and their families to establish good feeding practices and increase bonding among other important needs; also, neonatal intensive care is very expensive and like all medical interventions can carry certain risks.  We found that NICU admission rates increased for all newborns across the birth weight spectrum.  Additionally, although NICUs were initially developed to care for very small and premature newborns, just under half of current NICU admissions are for normal birth weight and full term infants, who are likely to be less ill.

Medical Research: What should clinicians and patients take away from your report?

Dr. Harrison: This study was descriptive and so it is unable to answer the question of why these increased admissions are occurring (beyond showing that it is not due to increases in the number of premature births, twins, etc.) but we believe it raises questions about how we are using this intensive and costly resource.  This includes questions about the potential for overuse.  It is our hope that it stimulates further reflection and discussion among pediatricians and neonatologists about how to best match the level of care to our patients’ needs, and that health services researchers examine what factors from patient need and maternal health to healthcare system and physician practice patterns might explain these trends as well as the potential outcomes.

For patients, I think it is always good that parents ask questions, understand, and are informed of the care their children receive, and that it is our responsibility as physicians to always educate and explain what we are doing and the reasons for our treatment decisions.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Harrison: As noted above, I hope there is further research into the causes of these trends – whether they are based on patient need, patient preferences, or physician and health system factors – and into the costs and outcomes of care whether beneficial or not.  Some of this will need to be done using other data sources as well such as registries or claims data sets.

Citation:

 

Wade Harrison, MPH (2015). Neonatal Intensive Care Admissions Increased For All Birth Weight Newborns 

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