Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category

J Perinatol. 2021 Mar;41(3):468-477. doi: 10.1038/s41372-020-00775-z. Epub 2020 Aug 14.


Objective: To examine interhospital variation in admissions to neonatal intensive care units (NICU) and reasons for the variation.

Study design: 2010-2012 linked birth certificate and hospital discharge data from 35 hospitals in California on live births at 35-42 weeks gestation and ≥1500 g birth weight were used. Hospital variation in NICU admission rates was assessed by coefficient of variation. Patient/hospital characteristics associated with NICU admissions were identified by multivariable regression.

Results: Among 276,489 newborns, 6.3% were admitted to NICU with 34.5% of them having mild diagnoses. There was high interhospital variation in overall risk-adjusted rate of NICU admission (coefficient of variation = 26.2) and NICU admission rates for mild diagnoses (coefficient of variation: 46.4-74.0), but lower variation for moderate/severe diagnoses (coefficient of variation: 8.8-14.1). Births at hospitals with more NICU beds had a higher likelihood of NICU admission.

Conclusion: Interhospital variation in NICU admissions is mostly driven by admissions for mild diagnoses, suggesting potential overuse.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Birth Weight
  • Gestational Age
  • Hospitalization*
  • Hospitals
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal*