Variation in NICU utilization: a narrative review and path forward.

Area of Science:

• Neonatal Medicine
• Healthcare Management
• Health Services Research

Background:

• Neonatal Intensive Care Unit (NICU) utilization shows significant regional variation in the US.
• NICU growth has not correlated with changes in patient demand or illness severity.
• Unnecessary NICU admissions incur substantial costs, cause family stress, and may increase hospital-acquired morbidities.

Purpose of the Study:

• To analyze the wide variations in Neonatal Intensive Care Unit (NICU) utilization across the United States.
• To identify factors contributing to unnecessary NICU admissions, particularly for late preterm, early term, and term infants.
• To propose strategies for reducing unwarranted NICU admissions and associated negative consequences.

Main Methods:

• Analysis of national trends in NICU bed growth and utilization.
• Examination of factors influencing NICU admission decisions for vulnerable infant populations.
• Review of hospital-level characteristics and financial incentives potentially driving utilization.

Main Results:

• NICU growth has outpaced demand, with significant regional disparities.
• Most NICU utilization variation stems from the care of late preterm, early term, and term infants.
• Hospital-level factors, including financial incentives, appear to drive unnecessary NICU admissions.

Conclusions:

• Reducing unnecessary NICU admissions is crucial for optimizing resource allocation and improving patient outcomes.
• Strategies such as regionalization of care and revised discharge processes can mitigate variation.
• Alternative care models for conditions like Neonatal Opioid Withdrawal Syndrome or sepsis risk factors outside the NICU should be explored.