PEDIATRICS Vol. 108 No. 2 August 2001, pp. 426-431
Are Neonatal Intensive Care Resources Located According to Need? Regional Variation in Neonatologists, Beds, and Low Birth Weight Newborns
Received Jan 22, 2001; accepted Mar 30, 2001.
, §, 
,
From the * Department of Pediatrics, Objective. Despite marked growth in
neonatal intensive care during the past 30 years, it is not known if
neonatologists and beds are preferentially located in regions with
greater newborn risk. This study reports the relationship between
regional measures of intensive care capacity and low birth weight
infants using newly developed market-based regions of neonatal
intensive care.
Design. Cross-sectional small-area analysis of 246 neonatal intensive care regions (NICRs).
Data Sources. 1996 American Medical Association and
American Osteopathic Association masterfiles data of clinically active
neonatologists; 1999 American Academy of Pediatrics Section on
Perinatal Pediatrics survey of directors of neonatal intensive care
units in the United States with 100% response rate; 1995 linked
birth/death data.
Results. The number of total births per neonatologist
across NICRs ranged from 390 to 8197 (median: 1722) and the number of
total births per intensive care bed ranged from 72 to 1319 (median:
317). The associations between capacity measures and low birth weight
rates across NICRs were statistically significant but negligible
(R2: 0.04 for neonatologists; 0.05 for
beds). NICRs in the quintile with the greatest neonatologist capacity
(average of only 863 births per neonatologist) had very low birth
weight (VLBW) rates of 1.5% while those in the quintile of lowest
neonatologist capacity (average of 3718 births per neonatologist) had
VLBW rates of 1.3%; a similar lack of meaningful difference in VLBW
rates was noted across quintiles of intensive care bed capacity.
Including midlevel providers and intermediate care beds to the analyses
did not alter the findings.
Conclusions. Neonatal intensive care capacity is not
preferentially located in regions with greater newborn need as measured
by low birth weight rates. Whether greater capacity affords benefits to
the newborns remains unknown.
Department of Medicine,
§ Department of Community and Family Medicine and Center for the
Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New
Hampshire; and VA Outcomes Group, White River Junction, Vermont.
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