Hospitals have failed to increase neonatal intensive care services in areas that need it most, according to the first comprehensive examination of U.S. neonatal care.
The Dartmouth Atlas of Neonatal Intensive Care released a report Wednesday that found the number of neonatal intensive care beds in the U.S. grew by 65% from 1995 to 2013 while the number of neonatologists grew 75% from 1996 to 2013. Babies born at normal birth weight accounted for 48% of all NICU admissions in 2017 while babies with very low birth weight—less than 3lbs, 5 ounces—made up just 12.7% of NICU admissions in 2017. But researchers found regions of the country with a high proportion of premature newborns, low levels of maternal education, and higher rates of cesarean sections that did not have more NICU beds or neonatologists.
"The most common NICU patient in 2019 is a baby of normal birth weight," said report co-author Dr. David Goodman, professor of pediatrics at Dartmouth's Geisel School of Medicine. "At the same time, the location of NICU beds and neonatologists in no way is associated with perinatal risk."
Researchers examined data from the National Center for Health Statistics, Texas Medicaid beneficiaries, and Anthem Blue Cross Blue Shield commercial and Medicaid plans. The number of newborns has remained relatively steady for more than a decade. Figures from the Centers for Disease Control and Prevention show the birth rate declined from 2007 through 2013, and then declined again in both 2015 and 2016 after seeing a slight uptick in 2014.
Since hospitals began opening neonatal intensive care units in the 1960s, rates of newborn mortality and morbidity caused by prematurity, congenital anomalies, and other neonatal health complications have fallen.
However, neonatal intensive care unit stays are expensive, with the cost for the average stay estimated at more than $56,000 for patients covered by commercial health plans and more than $39,000 among Medicaid beneficiaries, according to a 2017 study published in the journal Pediatrics.
That's led some hospitals to expand NICU services. A 2010 Health Affairs article that profiled how one academic medical center's efforts found that NICU care made up just for 4% of total hospital admissions but accounted for 69% of net profits.
Goodman said the growth of NICU services have not made a dent in the nation's top ranking for infant and maternal mortality among developed countries. The U.S. greatly falls behind other nations when it comes to providing comprehensive perinatal care.
"We underinvest upstream in terms of ensuring that mothers are in good health and that they can make choices about the timing of their pregnancies and we invest a very disproportionate amount compared to other countries that have much better perinatal statistics in caring for the bad birth outcomes when they occur," Goodman said. "We have really a distorted investment pattern in terms of reproductive and perinatal care in the U.S."