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新生儿重症监护能力的区域增长与围产期风险之间的关系

Rebekah Davis^1,2, Patrick M Stuchlik¹, David C Goodman^1,3

¹The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH.

|July 14, 2023

概括

新生儿重症监护室 (NICU) 的容量在全国范围内显著增长,但不是新生儿需求最大的地区. 这表明目前的资源分配可能无法有效地解决人口层面的新生儿护理需求.

科学领域:

新生儿科学新生儿科学
公共卫生公共卫生
医疗保健资源分配医疗保健资源分配

背景情况:

美国新生儿重症监护室 (NICU) 的病床和新生儿医生供应因地区而异.
之前的研究没有检查NICU资源相对于新生儿需求的最近增长模式 (1991-2017年).

研究的目的:

为了测试NICU容量增长是否在具有更高周围风险的地区更大.
研究随着时间的推移,新生儿重症监护室资源的变化与区域围产期风险之间的关系.

主要方法:

美国246个新生儿重症监护区的纵向生态分析.
线性回归用于测试NICU容量与围产期风险因素 (低出生体重,母亲教育,种族) 之间的关联.
分析包括1991年和2017年美国所有活产婴儿>=400g.

主要成果:

从1991年到2017年,NICU床位和新生儿科医生每活产分别增加了42%和200%.
观察到资源增长的区域差异很大.
区域NICU容量增长与更高的围产期风险或更低的初始容量之间没有发现有意义的关联.

结论:

新生儿重症监护室资源的增长并不与新生儿医疗需求最大的地区保持一致.
这种脱节引发了人们对当前新生儿护理资源分配在人口层面的有效性的担忧.
需要进一步的研究,以确保公平和基于需求的新生儿重症监护服务的分配.

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