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Neonatal Intensive Care Utilization and Postdischarge Newborn Outcomes: A Population-based Study of Texas Medicaid Insured Infants
- Source :
- The Journal of Pediatrics. 236:62-69.e3
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- To test the hypothesis that newborn infants cared for in hospitals with greater utilization of neonatal intensive care experienced fewer postdischarge adverse events.We developed 3 retrospective population-based cohorts of Texas Medicaid insured singletons born in 2010-2014 (very low birth weight [VLBW n = 11 139], late preterm [n = 57 509], and non-preterm [n = 664 447]) who received care in higher volume hospitals with level III/IV neonatal intensive care units (NICUs). Measures of NICU care were hospital-level risk adjusted NICU admission rates, special care days (days of nonroutine care) per infant, and the percent of intensive (highest billable care code) special care days. The units of analysis were hospitals (n = 80) and the primary outcome was an adverse event, (defined as admission, emergency department visit, or death) within 30 days postdischarge.Higher use of NICU care at a hospital level was not associated with lower postdischarge 30-day adverse event. Infants cared for in hospitals with above vs below median special care day rates experienced slightly higher postdischarge adverse event per 100 infants (VLBW: 14.01 [95% CI 12.74-15.27] vs 11.84 [10.52-13.16], P .05; late preterm: 7.33 [6.68-7.97] vs 6.28 [5.87-6.69], P .01; non-preterm: 4.47 [4.17-4.76] vs 3.97 [3.75-4.18], P .01). Weak positive associations (Pearson correlations of 0.31-0.37, P .01) were observed for adverse event with special care days; in no instance was a negative association observed between NICU utilization and adverse event.Higher utilization of NICU care was not associated with lower rates of short-term events suggesting that there may be opportunities to safely decrease admission rates and length of NICU stays.
- Subjects :
- Male
medicine.medical_specialty
Population
03 medical and health sciences
0302 clinical medicine
030225 pediatrics
Intensive care
Late preterm
medicine
Humans
Infant, Very Low Birth Weight
030212 general & internal medicine
Neonatology
education
Adverse effect
Perinatal Mortality
Retrospective Studies
education.field_of_study
Medicaid
business.industry
Infant, Newborn
Emergency department
Texas
United States
Hospitalization
Low birth weight
Pediatrics, Perinatology and Child Health
Emergency medicine
Intensive Care, Neonatal
Female
medicine.symptom
Emergency Service, Hospital
business
Facilities and Services Utilization
Infant, Premature
Subjects
Details
- ISSN :
- 00223476
- Volume :
- 236
- Database :
- OpenAIRE
- Journal :
- The Journal of Pediatrics
- Accession number :
- edsair.doi.dedup.....678c7fb2fd1f6da3a37b067923780ab0