Dartmouth Study Raises Questions About Use of Neonatal Intensive Care

Aug 11, 2015

When babies are born sick or underweight, they’re often moved to neonatal intensive care units. A new study by the Dartmouth Institute for Health Policy and Clinical Practice has found that admission rates for to intensive care units, or NICUs, are increasing for newborns of all weights. That's raising questions about whether babies are receiving expensive medical care they do not need. 

NHPR's Peter Biello spoke with Wade Harrison, the lead author of this study.

Audio will be available after 6 p.m., Tuesday, August 11, 2015.

Your study looked at 18 million live births to United States residents from January of 2007 until December of 2012—so, six years of data—from 38 states and Washington, D.C. What did the numbers show you?

Our results are in two sections. Our primary finding was that NICU admissions increased overall by about 22 percent or 23 percent in those six years. That was across all birth rate ranges.

And then our second finding was that all the newborns admitted to the NICU, they were increasingly likely to be larger, normal birth weight or full-term, than they were in 2007. And so really it comes down to this question of—we’re seeing more admissions for newborns who are often less ill, though not necessarily, and we don’t know why. So we hope it stimulates further research into these questions so we can try to figure out what’s going wrong here.

So your study isn’t necessarily asserting that NICUs are being overused.

Correct. I think that’s one question that it raises.

The other possibility is that this care is absolutely needed, that newborns are becoming sicker. We found no evidence of that, based on the variables we were able to look at. I think our findings are really preliminary, and I hope it spurs further discussion.

When a baby is born and it’s not underweight or unhealthy, can parents still choose to place the baby in the neonatal intensive care unit, or does a doctor make that decision?

Usually, it’s physicians making that decision. Now these decisions are made in discussion with the families, but it’s often physicians who are assessing the infant and making recommendations based on the level of care that they feel they need.

No matter who decides to put the baby in the NICU, it’s not necessarily the kind of decision that couldn’t hurt. As you’ve pointed out, the first few days are a critical time in a child’s life, and it’s a critical bonding time for the baby and the new parents.

Correct. There are different models on how NICU care is provided, but generally it means at least an initial separation from the mother, and that adds stress and it adds worry to a situation. So there’s certainly downsides there. There’s the cost, as were mentioned.

And then often, as we’ve seen in other areas of medicine, when you get more intensive care, that can often mean increased interventions and whether it’s an ID, imaging, or anything else, often these things are safe, but they do have downsides.

The study points out that since the first NICU was established in the U.S., there’s been a dramatic fall in the number of infant deaths. Has the increase in admissions to NICU across the population continued to contribute to the drop in infant deaths?

It’s a little hard to say based on the study period we looked at. Based on the birth certificate data we have, we weren’t able to link it to neonatal mortality rates. There’s a little bit of a lag in mortality data from the CDC. Without a doubt, as we pointed out and as you just mentioned, from the 1960s, much of that is attributable.

We hope further research does look into this and say: “What are the results of these increased admissions we’ve seen more recently? Is the neonatal mortality rate dropping?” But there are other important measures as well. What are the effects on morbidity and outcomes other than just neonatal care.