Intensive care management of the term neonate: are there regional differences in outcome?

The objective of this study was to evaluate the patterns of hospitalization of term infants in 3 major metropolitan areas. We hypothesized that regional practice variation occurred in the care of term infants and that these differences would be reflected in the hospitalization patterns of infants. All infants cared for in an Intensive Care Nursery (ICN) after maternal discharge in 1 of 3 major metropolitan areas followed up by the same neonatal management company were compared (n=4,487). Term infants were grouped into 1 of 2 categories based on illness severity: Group 1 (G1) infants-those who required supplemental oxygen or ventilation for 24 hours or more (n=611); and Group 2 (G2) infants-those infants without an oxygen or ventilation requirement (n=1,549). Excluded were infants in the following categories: birth weight <2,500 grams, major congenital anomalies, surgical patients, extracorporeal membrane oxygenation (ECMO) support, or babies who died before discharge. The number of infants in each of these categories was compared as a percentage of the total number of infants cared for in that region. The average length of stay (ALOS) and percentage of patient days attributed to infants in each category were compared across regions using multiple comparison tests (Tukey). The total ALOS was greatest in City A, as was the ALOS for sick term infants. Patient days for sick term infants were lowest in City C, and healthier term infants comprised the lowest percentage of patient days in City A. This difference resulted in the lowest percentage of patient days for all term admissions in City A. These data demonstrated that significant variation existed in the delivery of care to term neonates among major metropolitan regions. Cities that admitted fewer term infants for observation periods (G2) tended to have sicker term neonates with higher acuity hospitalizations (GI) and longer lengths of stay (LOS). These findings suggested that a conservative admission policy for this population can decrease overall LOS.