Is it the baby or the beds?

Abstract

Since the 1960s, reductions in neonatal mortality in the United States track closely with the increased availability of neonatal intensive care unit beds. Not surprisingly, as the number of intensive care unit beds have increased, the number of babies admitted to these units to fill these beds has increased. While there is no doubt that the large proportion of these admissions are necessary and result in improved outcomes, there is also the possibility that the mere prospect of bed availability drives NICU admission. In this volume of The Journal, Harrison et al use large national data sets to determine the relationship between NICU admission and regional bed supply. Importantly, the authors have uncovered regional variation in NICU bed availability that is not explained by validated markers of need. Furthermore, it appears that bed availability may drive NICU admission rates, especially for larger (potentially “less sick”) babies. The implications for resource allocation and utilization are staggering. These results scratch the surface of a complex set of issues and reveal important questions that we must begin to answer in order to provide responsible, appropriate, and effective health care. We must do better in deciding where to provide services, and work hard and continually re-evaluate whether the services we provide are safe, necessary, beneficial, and cost-effective. Article page 73 ▶ Regional Variation in Neonatal Intensive Care Admissions and the Relationship to Bed SupplyThe Journal of PediatricsVol. 192PreviewTo characterize geographic variation in neonatal intensive care unit (NICU) admission rates across the entire birth cohort and evaluate the relationship between regional bed supply and NICU admission rates. Full-Text PDF