Regional Growth in US Neonatal Intensive Care Capacity and Mortality, 1991-2020
Bibliographic record
Abstract
Importance: The effectiveness of neonatal intensive care in very ill newborns has led to rapid growth in US neonatal intensive care unit (NICU) capacity that is uncorrelated with regional perinatal risk. It is not known if there is an association between growth of regional capacity and newborn mortality. Objective: To estimate the association between change in NICU capacity and neonatal mortality across 246 neonatal intensive care regions. Design, Setting, and Participants: In this repeated cross-sectional study of US infants, the association between change in regional capacity and mortality was estimated in the years 1991, 2003, 2007, 2012, 2017, 2018, 2019, and 2020 using Poisson generalized estimating equations models adjusted for maternal and newborn characteristics, with newborns as the units of analysis. Data were analyzed June 30, 2024. This study used a 25% sample of all US infants born live with a birth weight of 400 g or more and gestational age of between 22 and less than 45 weeks (N = 30 902 221 newborns). Exposure: Change in regional NICU capacity, measured as both counts of neonatologists and staffed NICU beds per 1000 live births (LBs) from 1991 to the birth year. Main Outcomes and Measures: The primary outcome was neonatal (<28 days) mortality and the secondary outcome was 180-day mortality. Results: From 1991-2020, total adjusted neonatologists and NICU beds per 1000 LBs increased from 0.44 to 1.44 (227%) and 5.43 to 8.02 (48%), respectively, while neonatal mortality decreased from 3.87 to 2.21 (-43%) and 180-day mortality decreased from 6.27 to 3.19 (-49%) per 1000 LBs. There was no meaningful correlation between change in regional capacity (neonatologists: r, -0.12; 95% CI, -0.25 to 0.00; NICU beds: r, -0.07; 95% CI, -0.19 to 0.06) and change in regional neonatal mortality. No meaningful associations with capacity were observed in multilevel models (neonatologists: adjusted relative rate [aRR], 1.01; 95% CI, 0.93-1.01; NICU beds: aRR, 1.00; 95% CI, 0.99-1.00) nor was 180-day mortality associated with capacity. No associations were observed in birth cohorts stratified by relative need based on gestational age, maternal education, or maternal race or ethnicity. Conclusions and Relevance: In this cross-sectional study, growth in regional NICU capacity was not associated with observable mortality benefit. Additional studies are needed to investigate the costs and benefits associated with NICU care expansion.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".