Variation in Use by NICU Types in the United States

Proportions of admissions, days hospitalized, high-acuity infants, and short stays vary between NICUs even when compared with other units of the same type. BACKGROUND:Increased admissions of higher birth weight and less acutely ill infants to NICUs suggests that intensive care may be used inappropriately in these populations. We describe variation in use of NICU services by gestational age and NICU type.METHODS:Using the Vermont Oxford Network database of all NICU admissions, we assessed variation within predefined gestational age categories in the following proportions: admissions, initial NICU hospitalization days, high-acuity cases 34 weeks' gestation, and short-stay cases 34 weeks' gestation. High acuity was defined as follows: death, intubated assisted ventilation for 4 hours, early bacterial sepsis, major surgery requiring anesthesia, acute transport to another center, hypoxic-ischemic encephalopathy or a 5-minute Apgar score 3, or therapeutic hypothermia. Short stay was defined as an inborn infant staying 1 to 3 days with discharge from the hospital.RESULTS:From 2014 to 2016, 486741 infants were hospitalized 9657508 days at 381 NICUs in the United States. The median proportions of admissions, initial hospitalized days, high-acuity cases, and short stays varied significantly by NICU types in almost all gestational age categories. Fifteen percent of the infants 34 weeks were high acuity, and 10% had short stays.CONCLUSIONS:There is substantial variation in use among NICUs. A campaign to focus neonatal care teams on using the NICU wisely that addresses the appropriate use of intensive care for newborn infants and accounts for local context and the needs of families is needed.