The Relationship Between Regional Growth in Neonatal Intensive Care Capacity and Perinatal Risk.
The Relationship Between Regional Growth in Neonatal Intensive Care Capacity and Perinatal Risk.
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DOI：
10.1097/mlr.0000000000001893
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发表时间：
2023-11-01
期刊：
影响因子：
3
通讯作者：
Goodman, David C.
中科院分区：
文献类型：
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作者：
Davis, Rebekah;Stuchlik, Patrick M.;Goodman, David C.
众所周知，美国新生儿重症监护病房(NICU)床位和新生儿医生的供应因地区而异，但没有调查NICU最近(1991-2017)与新生儿需求有关的增长模式。这项研究的目的是检验这一假设，即新生儿重症监护病房容量的更大增长发生在围产期风险较高的新生儿重症监护区。以新生儿重症监护区(n=246)为分析单元的纵向生态分析。使用线性回归检验关联性。1991年所有美国活产婴儿≥(n=4,103,528)和2017年(n=3,849,644)。风险的主要衡量标准是低出生体重和极低出生体重新生儿的比例，以及黑人或低教育程度的母亲。26年来，每个活产儿的NICU床位和新生儿医生数量分别增加了42%和200%，各地区的增长差异显著(四分位数范围：0.3-4.1张床位；新生儿医生，每1000个活产儿0.4-1.0个)。1991年的能力与围产期风险之间的弱关联在2017年是不存在的。1991年，在能力的区域变化与围产期风险较高或能力较低的地区之间没有有意义的关联(即，临床或政策相关)；围产期风险较高的增加与较高的能力增长无关。新生儿医疗需求与新生儿重症监护病房资源的供应之间缺乏联系，使人对目前人口一级新生儿护理的有效性提出了疑问。
The supply of US neonatal intensive care unit (NICU) beds and neonatologists is known to vary markedly across regions, but there have been no investigation of patterns of recent growth (1991–2017) in NICUs in relation to newborn need. The objective of this study was to test the hypothesis that greater growth in NICU capacity occurred in neonatal intensive care regions with higher perinatal risk. A longitudinal ecological analysis with neonatal intensive care regions (n=246) as the units of analysis. Associations were tested using linear regression. All US live births ≥400 g in 1991 (n=4,103,528) and 2017 (n=3,849,644). Primary measures of risk were the proportions of low–birth weight and very low–birth weight newborns and mothers who were Black or had low educational attainment. Over 26 years, the numbers of NICU beds and neonatologists per live birth increased 42% and 200%, respectively, with marked variation in growth across regions (interquartile range: 0.3–4.1, beds; neonatologists, 0.4–1.0 per 1000 live births). A weak association of capacity with perinatal risk in 1991 was absent in 2017. There was no meaningful (ie, clinical or policy relevant) association between regional changes in capacity and regions with higher perinatal risk or lower capacity in 1991; higher increases in perinatal risk were not associated with higher capacity growth. The lack of association between newborn medical needs and the supply of NICU resources raises questions about the current effectiveness of newborn care at a population level.
DOI：
10.1136/bmj.f549
发表时间：
2013-02-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Wennberg JE;Staiger DO;Sharp SM;Gottlieb DJ;Bevan G;McPherson K;Welch HG
通讯作者：
Welch HG