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. 2021 Mar;41(3):468-477.
doi: 10.1038/s41372-020-00775-z. Epub 2020 Aug 14.

Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category

Eman S Haidari  1 , Henry C Lee  2 , Jessica L Illuzzi  3 , Ciaran S Phibbs  2   4 , Haiqun Lin  5 , Xiao Xu  3
Affiliations

Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category

Eman S Haidari et al. J Perinatol. 2021 Mar.

Abstract

Objective: To examine interhospital variation in admissions to neonatal intensive care units (NICU) and reasons for the variation.

Study design: 2010-2012 linked birth certificate and hospital discharge data from 35 hospitals in California on live births at 35-42 weeks gestation and ≥1500 g birth weight were used. Hospital variation in NICU admission rates was assessed by coefficient of variation. Patient/hospital characteristics associated with NICU admissions were identified by multivariable regression.

Results: Among 276,489 newborns, 6.3% were admitted to NICU with 34.5% of them having mild diagnoses. There was high interhospital variation in overall risk-adjusted rate of NICU admission (coefficient of variation = 26.2) and NICU admission rates for mild diagnoses (coefficient of variation: 46.4-74.0), but lower variation for moderate/severe diagnoses (coefficient of variation: 8.8-14.1). Births at hospitals with more NICU beds had a higher likelihood of NICU admission.

Conclusion: Interhospital variation in NICU admissions is mostly driven by admissions for mild diagnoses, suggesting potential overuse.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Variation in neonatal intensive care admission rate across hospitals (N = 35).
Distribution of risk-adjusted NICU admission rate across hospitals for live singleton births with 35–42 weeks gestation and birth weight ≥1500 grams. NICU neonatal intensive care unit.
Fig. 2
Fig. 2. Distribution of diagnosis severity and category among infants admitted to neonatal intensive care unit in the overall sample.
a By severity of the conditions. “Other” includes infants with diagnoses not meeting the definition for severe, moderate or the five selected mild conditions. b By different categories of mild conditions (categories not mutually exclusive) and number of mild conditions. NAS neonatal abstinence syndrome.
See this image and copyright information in PMC

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