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More Newborns of All Weights Being Admitted to U.S. NICUs

LEBANON, NH – Neonatal intensive care units (NICUs) originally were developed in the United States to provide optimal treatment of very low-birth-weight infants, but admission rates now are increasing for newborns of all weights.

An article published online by JAMA Pediatrics reports that, from 2007 to 2012, NICUs increasingly admitted term infants of higher birth weights and, by 2012, nearly half of all NICU admissions were for normal-birth-weight infants or for those born at 37 weeks gestation or older.

Dartmouth Institute for Health Policy and Clinical Practice researchers looked at data for nearly 18 million live births to U.S. residents from January 2007 through December 2012 in 38 states and the District of Columbia. They found that overall admission rates increased from 64.0 to 77.9 per 1,000 live births and that admission rates had increased for all birth weight categories.

NICUs have been a significant success story for hospitals: The neonatal mortality rate is less than a quarter of what it was 55 years ago – from 18.73 per 1,000 live births to 4.04 per 1,000 live births in 2012 – when the first ward opened in the United States to provide highly specialized care to premature and sick infants.

Because a 2003 revision to the U.S. Standard Certificate of Live Birth includes a new field to indicate whether a newborn was admitted to the NICU, researchers now are able to study trends in neonatal intensive care for the majority of the U.S. newborn population across time.

In 2012, the researchers identified 43 NICU admissions per 1,000 normal-birth-weight infants, defined as 2,500 to 3,999 grams, while the admission rate for very low-birth weight infants, less than 1,500 grams, was 844.1 per 1,000 live births. From 2007 to 2012, however, NICUs increasingly admitted term infants of higher birth weights.

In fact, by 2012, the study found that nearly half of all NICU admissions were for normal-birth-weight infants or for those born at 37 weeks gestation or older.

"Newborns in the United States are increasingly likely to be admitted to a NICU, and these units are increasingly caring for normal-birth-weight and term infants,” the authors write. “The implications of these trends are not clear, but our findings raise questions about how this high-intensity resource is being used.”

In a related commentary, Aaron E. Carroll, MD, MS, of the Indiana University School of Medicine, emphasizes that the study does not suggest that the admissions of higher birth weight babies is fraudulent or wasteful.

“It is entirely possible that the admissions are justified,” Carroll argues. “However, there is no doubt that they are expensive and carry potential harm. If hospitals want to argue that NICUs are necessary, they will need to prove that the need exists, especially in light of the increasing share of infants admitted who are at or near full term. If hospitals are unable to demonstrate that NICUs are necessary, then it is very likely that, at some point in the near future, policies will force them to reduce those admissions, which will have major implications for NICU and hospital finances."