Are Neonatal Intensive Care Resources Located According to Need? Regional Variation in Neonatologists, Beds, and Low Birth Weight Newborns

Despite marked growth in neonatal intensive care during the past 30 years, it is not known if neonatologists and beds are preferentially located in regions with greater newborn risk. This study reports the relationship between regional measures of intensive care capacity and low birth weight infants...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2001-08, Vol.108 (2), p.426-431
Main Authors: Goodman, David C, Fisher, Elliott S, Little, George A, Stukel, Therese A, Chang, Chiang-hua
Format: Article
Language:English
Subjects:
Biological and medical sciences
Birth Weight
Cross-Sectional Studies
Demographic aspects
Diseases of mother, fetus and pregnancy
Gynecology. Andrology. Obstetrics
Health Services Needs and Demand - statistics & numerical data
Health Services Research
Hospital Bed Capacity - statistics & numerical data
Humans
Infant, Low Birth Weight
Infant, Newborn
Intensive Care Units, Neonatal - supply & distribution
Intensive Care, Neonatal - statistics & numerical data
Intensive Care, Neonatal - trends
Medical sciences
Neonatal intensive care
Neonatologists
Neonatology - statistics & numerical data
Pregnancy. Fetus. Placenta
Supply and demand
United States
Workforce
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Summary:Despite marked growth in neonatal intensive care during the past 30 years, it is not known if neonatologists and beds are preferentially located in regions with greater newborn risk. This study reports the relationship between regional measures of intensive care capacity and low birth weight infants using newly developed market-based regions of neonatal intensive care. Cross-sectional small-area analysis of 246 neonatal intensive care regions (NICRs). 1996 American Medical Association and American Osteopathic Association masterfiles data of clinically active neonatologists; 1999 American Academy of Pediatrics Section on Perinatal Pediatrics survey of directors of neonatal intensive care units in the United States with 100% response rate; 1995 linked birth/death data. The number of total births per neonatologist across NICRs ranged from 390 to 8197 (median: 1722) and the number of total births per intensive care bed ranged from 72 to 1319 (median: 317). The associations between capacity measures and low birth weight rates across NICRs were statistically significant but negligible (R(2): 0.04 for neonatologists; 0.05 for beds). NICRs in the quintile with the greatest neonatologist capacity (average of only 863 births per neonatologist) had very low birth weight (VLBW) rates of 1.5% while those in the quintile of lowest neonatologist capacity (average of 3718 births per neonatologist) had VLBW rates of 1.3%; a similar lack of meaningful difference in VLBW rates was noted across quintiles of intensive care bed capacity. Including midlevel providers and intermediate care beds to the analyses did not alter the findings. Neonatal intensive care capacity is not preferentially located in regions with greater newborn need as measured by low birth weight rates. Whether greater capacity affords benefits to the newborns remains unknown.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.108.2.426