Regional Growth in US Neonatal Intensive Care Capacity and Mortality, 1991-2020

IF 24.7 1区医学 Q1 PEDIATRICS

JAMA Pediatrics Pub Date : 2025-03-24 DOI:10.1001/jamapediatrics.2024.7133

Gwenyth M. Gasper, Patrick M. Stuchlik, Therese A. Stukel, David C. Goodman

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引用次数: 0

Abstract

ImportanceThe effectiveness of neonatal intensive care in very ill newborns has led to rapid growth in US neonatal intensive care unit (NICU) capacity that is uncorrelated with regional perinatal risk. It is not known if there is an association between growth of regional capacity and newborn mortality.ObjectiveTo estimate the association between change in NICU capacity and neonatal mortality across 246 neonatal intensive care regions.Design, Setting, and ParticipantsIn this repeated cross-sectional study of US infants, the association between change in regional capacity and mortality was estimated in the years 1991, 2003, 2007, 2012, 2017, 2018, 2019, and 2020 using Poisson generalized estimating equations models adjusted for maternal and newborn characteristics, with newborns as the units of analysis. Data were analyzed June 30, 2024. This study used a 25% sample of all US infants born live with a birth weight of 400 g or more and gestational age of between 22 and less than 45 weeks (N = 30 902 221 newborns).ExposureChange in regional NICU capacity, measured as both counts of neonatologists and staffed NICU beds per 1000 live births (LBs) from 1991 to the birth year.Main Outcomes and MeasuresThe primary outcome was neonatal (&lt;28 days) mortality and the secondary outcome was 180-day mortality.ResultsFrom 1991-2020, total adjusted neonatologists and NICU beds per 1000 LBs increased from 0.44 to 1.44 (227%) and 5.43 to 8.02 (48%), respectively, while neonatal mortality decreased from 3.87 to 2.21 (−43%) and 180-day mortality decreased from 6.27 to 3.19 (−49%) per 1000 LBs. There was no meaningful correlation between change in regional capacity (neonatologists: r, −0.12; 95% CI, −0.25 to 0.00; NICU beds: r, −0.07; 95% CI, −0.19 to 0.06) and change in regional neonatal mortality. No meaningful associations with capacity were observed in multilevel models (neonatologists: adjusted relative rate [aRR], 1.01; 95% CI, 0.93-1.01; NICU beds: aRR, 1.00; 95% CI, 0.99-1.00) nor was 180-day mortality associated with capacity. No associations were observed in birth cohorts stratified by relative need based on gestational age, maternal education, or maternal race or ethnicity.Conclusions and RelevanceIn this cross-sectional study, growth in regional NICU capacity was not associated with observable mortality benefit. Additional studies are needed to investigate the costs and benefits associated with NICU care expansion.

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1991-2020年美国新生儿重症监护能力和死亡率的区域增长

重症新生儿重症监护的有效性导致美国新生儿重症监护病房（NICU）容量的快速增长，这与区域围产期风险无关。目前尚不清楚区域能力的增长与新生儿死亡率之间是否存在关联。目的评估246个新生儿重症监护地区新生儿重症监护病房容量变化与新生儿死亡率之间的关系。设计、环境和参与者在这项针对美国婴儿的重复横断面研究中，使用泊松广义估计方程模型，以新生儿为分析单位，对1991年、2003年、2007年、2012年、2017年、2018年、2019年和2020年的区域容量变化与死亡率之间的关系进行了估计。数据于2024年6月30日进行分析。本研究选取了25%的美国出生体重在400克或以上、胎龄在22周至45周以内的婴儿（N = 30902221名新生儿）作为样本。区域新生儿重症监护病房容量的变化，以1991年至出生年度每1000例活产新生儿（LBs）的新生儿科医生和新生儿重症监护病房配备床位的数量来衡量。主要结局和指标主要结局是新生儿（28天）死亡率，次要结局是180天死亡率。结果1991-2020年，调整后的新生儿医师总数和NICU床位/ 1000 LBs分别从0.44张增加到1.44张（227%）和5.43张增加到8.02张（48%），新生儿死亡率从3.87张下降到2.21张（- 43%），180天死亡率从6.27张下降到3.19张（- 49%）。区域能力的变化之间没有显著的相关性(新生儿：r， - 0.12；95% CI,−0.25 ~ 0.00；NICU床位：r，−0.07；95% CI, - 0.19至0.06)和区域新生儿死亡率的变化。在多水平模型中未观察到与能力有意义的关联(新生儿：调整相对率[aRR]， 1.01；95% ci, 0.93-1.01；新生儿重症监护病房床位：1.00澳元；95% CI, 0.99-1.00)， 180天死亡率也与容量无关。在根据胎龄、母亲教育程度或母亲种族或民族的相对需求分层的出生队列中未观察到关联。结论和相关性在这项横断面研究中，地区新生儿重症监护病房容量的增加与可观察到的死亡率降低无关。需要进一步的研究来调查与新生儿重症监护室护理扩展相关的成本和收益。

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来源期刊

JAMA Pediatrics PEDIATRICS-

CiteScore

31.60

自引率

1.90%

发文量

357

期刊介绍： JAMA Pediatrics, the oldest continuously published pediatric journal in the US since 1911, is an international peer-reviewed publication and a part of the JAMA Network. Published weekly online and in 12 issues annually, it garners over 8.4 million article views and downloads yearly. All research articles become freely accessible online after 12 months without any author fees, and through the WHO's HINARI program, the online version is accessible to institutions in developing countries. With a focus on advancing the health of infants, children, and adolescents, JAMA Pediatrics serves as a platform for discussing crucial issues and policies in child and adolescent health care. Leveraging the latest technology, it ensures timely access to information for its readers worldwide.