Level III neonatal intensive care unit heterogeneity in patients, services, and outcomes.

IF 2.3 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Journal of Perinatology Pub Date : 2026-08-17 DOI:10.1038/s41372-026-02846-z

Nicolas P Goldstein Novick, Scott A Lorch, Joshua K Radack, Molly Passarella, Timothy D Nelin, Elizabeth G Salazar, Sara C Handley

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引用次数: 0

Abstract

Objectives: Level III NICUs share one AAP level of care designation. We characterized variation, identified sub-classes, and compared sub-class outcomes.

Study design: This retrospective cohort analysis of level III NICUs in Florida, Michigan, Oregon, Pennsylvania, and South Carolina used linked hospital discharge-vital statistics data (2010-2020). Included hospitals had ≥10 births annually and infants had gestational age <32 weeks and/or birth weight <1500 g. We characterized NICU-level heterogeneity; used latent class analysis (LCA) to obtain sub-classes; and compared risk-adjusted outcomes with multivariable Poisson regression.

Results: Among 163 NICUs (1518 hospital-years) there was significant variation. LCA identified five sub-classes (3a-e). Preterm volume and procedural intensity rose with acuity (3a lowest, 3d/3e highest). Higher acuity was associated with lower mortality but higher morbidity (3d vs. 3a: death: IRR 0.59 [95% CI 0.54-0.65]; morbidity: 2.84 [2.43-3.31]).

Conclusions: Level III NICUs are heterogeneous and comprise five sub-classes with divergent outcomes. Sub-classification may facilitate risk-appropriate care.

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III级新生儿重症监护病房患者、服务和结果的异质性。

目的：III级新生儿重症监护病房共用一个AAP护理级别。我们描述了变异，确定了亚类，并比较了亚类结果。研究设计：本回顾性队列分析采用2010-2020年相关医院出院-生命统计数据，对佛罗里达州、密歇根州、俄勒冈州、宾夕法尼亚州和南卡罗来纳州的III级新生儿重症监护病房进行分析。结果：163个新生儿重症监护病房（1518医院年）存在显著差异。LCA确定了五个子类（3a-e）。早产儿体积和手术强度随视力的增加而增加（3a最低，3d/3e最高）。较高的视力与较低的死亡率相关，但与较高的发病率相关（3d vs 3a：死亡率：IRR 0.59 [95% CI 0.54-0.65]；发病率：2.84[2.43-3.31]）。结论：III级新生儿重症监护病房是异质性的，包括5个亚类，结果不同。分类可促进风险适宜的护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Perinatology 医学-妇产科学

CiteScore

5.40

自引率

6.90%

发文量

284

审稿时长

3-8 weeks

期刊介绍： The Journal of Perinatology provides members of the perinatal/neonatal healthcare team with original information pertinent to improving maternal/fetal and neonatal care. We publish peer-reviewed clinical research articles, state-of-the art reviews, comments, quality improvement reports, and letters to the editor. Articles published in the Journal of Perinatology embrace the full scope of the specialty, including clinical, professional, political, administrative and educational aspects. The Journal also explores legal and ethical issues, neonatal technology and product development. The Journal’s audience includes all those that participate in perinatal/neonatal care, including, but not limited to neonatologists, perinatologists, perinatal epidemiologists, pediatricians and pediatric subspecialists, surgeons, neonatal and perinatal nurses, respiratory therapists, pharmacists, social workers, dieticians, speech and hearing experts, other allied health professionals, as well as subspecialists who participate in patient care including radiologists, laboratory medicine and pathologists.