A national survey of pediatric surgical care coverage models to outlying neonatal intensive care units

The delivery of pediatric surgical care to newborns varies based on neonatal intensive care unit (NICU) coverage. We aimed to describe the current national coverage landscape and assess pediatric surgeons' perspectives on the optimal management of infants at outlying NICUs.

The AAP Delivery of Surgical Care Committee administered a web-based survey to pediatric surgery division chiefs at Children's Hospital Association practices. Responses were analyzed using appropriate nonparametric and categorical statistical tests, with significance set at p < 0.05.

Fifty-two division chiefs responded (28.9%); 26 (50% reporting covering one or more outlying NICUs. Of these outlying NICUS, 76% were Level III. Just over half (51%) had no affiliation with the surgeons' primary hospital. Case volumes were low, with only 5 NICUs (15%) performing more than 25 operations annually. Factors influencing decisions to operate at outlying NICUs included rapport with neonatologists, NICU level designation, transfer capability, and availability of pediatric anesthesiology. The capacity of outlying NICUs to care for infants with index surgical diagnoses varied based on specific diagnosis. Over half of respondents endorsed transfer to the primary center as the optimal location for care for all procedures except gastrostomy tube placement and central venous access.

Half of surveyed pediatric surgery groups provide coverage to one or more outlying NICUs despite low reported case volumes. A clear disconnect exists between pediatric surgeons' views on location for optimal care and sites of current care provision. These findings underscore the need for regionalized strategies to optimize surgical care of these infants.