Hospital-Level NICU Capacity, Utilization, and 30-Day Outcomes in Texas

作者：David C. Goodman, Patrick Stuchlik, Cecilia Ganduglia‐Cazaban, Jon E. Tyson, JoAnna K. Leyenaar, Elenir B.C. Avritscher, Mathew Rysavy, Kanekal Suresh Gautham, David Lynch, Thérèse A. Stukel, Kristen K. Bronner, Youngran Kim, George A. Little, Joseph D. Schulman, Jordan Taylor · 发表于：JAMA Network Open · 年份：2024 · DOI：10.1001/jamanetworkopen.2023.55982 · 被引用次数：13 · 研究领域：Neonatal Respiratory Health Research、Infant Development and Preterm Care、Sepsis Diagnosis and Treatment

Importance: Risk-adjusted neonatal intensive care unit (NICU) utilization and outcomes vary markedly across regions and hospitals. The causes of this variation are poorly understood. Objective: To assess the association of hospital-level NICU bed capacity with utilization and outcomes in newborn cohorts with differing levels of health risk. Design, Setting, and Participants: This population-based retrospective cohort study included all Medicaid-insured live births in Texas from 2010 to 2014 using linked vital records and maternal and newborn claims data. Participants were Medicaid-insured singleton live births (LBs) with birth weights of at least 400 g and gestational ages between 22 and 44 weeks. Newborns were grouped into 3 cohorts: very low birth weight (VLBW; <1500 g), late preterm (LPT; 34-36 weeks' gestation), and nonpreterm newborns (NPT; ≥37 weeks' gestation). Data analysis was conducted from January 2022 to October 2023. Exposure: Hospital NICU capacity measured as reported NICU beds/100 LBs, adjusted (ie, allocated) for transfers. Main Outcomes and Measures: NICU admissions and special care days; inpatient mortality and 30-day postdischarge adverse events (ie, mortality, emergency department visit, admission, observation stay). Results: The overall cohort of 874 280 single LBs included 9938 VLBW (5054 [50.9%] female; mean [SD] birth weight, 1028.9 [289.6] g; mean [SD] gestational age, 27.6 [2.6] wk), 63 160 LPT (33 684 [53.3%] female; mean [SD] birth weight, 2664.0 ...