{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:00:54Z","timestamp":1788390054285,"version":"build-2803163510"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Risk-adjusted neonatal intensive care unit (NICU) utilization and outcomes vary markedly across regions and hospitals. The causes of this variation are poorly understood.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the association of hospital-level NICU bed capacity with utilization and outcomes in newborn cohorts with differing levels of health risk.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This population-based retrospective cohort study included all Medicaid-insured live births in Texas from 2010 to 2014 using linked vital records and maternal and newborn claims data. Participants were Medicaid-insured singleton live births (LBs) with birth weights of at least 400 g and gestational ages between 22 and 44 weeks. Newborns were grouped into 3 cohorts: very low birth weight (VLBW; &amp;lt;1500 g), late preterm (LPT; 34-36 weeks\u2019 gestation), and nonpreterm newborns (NPT; \u226537 weeks\u2019 gestation). Data analysis was conducted from January 2022 to October 2023.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Hospital NICU capacity measured as reported NICU beds\/100 LBs, adjusted (ie, allocated) for transfers.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n NICU admissions and special care days; inpatient mortality and 30-day postdischarge adverse events (ie, mortality, emergency department visit, admission, observation stay).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The overall cohort of 874\u202f280 single LBs included 9938 VLBW (5054 [50.9%] female; mean [SD] birth weight, 1028.9 [289.6] g; mean [SD] gestational age, 27.6 [2.6] wk), 63\u202f160 LPT (33\u202f684 [53.3%] female; mean [SD] birth weight, 2664.0 [409.4] g; mean [SD] gestational age, 35.4 [0.8] wk), and 801\u202f182 NPT (407\u202f977 [50.9%] female; mean [SD] birth weight, 3318.7 [383.4] g; mean [SD] gestational age, 38.9 [1.0] wk) LBs. Median (IQR) NICU capacity was 0.84 (0.57-1.30) allocated beds\/100 LB\/year. For VLBW newborns, NICU capacity was not associated with the risk of NICU admission or number of special care days. For LPT newborns, birth in hospitals with the highest compared with the lowest category of capacity was associated with a 17% higher risk of NICU admission (adjusted risk ratio [aRR], 1.17; 95% CI, 1.01-1.33). For NPT newborns, risk of NICU admission was 55% higher (aRR, 1.55; 95% CI, 1.22-1.97) in the highest- vs the lowest-capacity hospitals. The number of special care days for LPT and NPT newborns was 21% (aRR, 1.21; 95% CI,1.08-1.36) and 37% (aRR, 1.37; 95% CI, 1.08-1.74) higher in the highest vs lowest capacity hospitals, respectively. Among LPT and NPT newborns, NICU capacity was associated with higher inpatient mortality and 30-day postdischarge adverse events.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of Medicaid-insured newborns in Texas, greater hospital NICU bed supply was associated with increased NICU utilization in newborns born LPT and NPT. Higher capacity was not associated with lower risk of adverse events. These findings raise important questions about how the NICU is used for newborns with lower risk.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.55982","type":"journal-article","created":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T11:01:16Z","timestamp":1707908476000},"page":"e2355982","source":"Crossref","is-referenced-by-count":15,"title":["Hospital-Level NICU Capacity, Utilization, and 30-Day Outcomes in Texas"],"prefix":"10.1001","volume":"7","author":[{"given":"David C.","family":"Goodman","sequence":"first","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire"},{"name":"The Children\u2019s Hospital at Dartmouth, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Stuchlik","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Ganduglia-Cazaban","sequence":"additional","affiliation":[{"name":"Center for Health Care Data and Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon E.","family":"Tyson","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research and Learning Health Care, McGovern Medical School at The University of Texas Health Science Center at Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoAnna","family":"Leyenaar","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire"},{"name":"The Children\u2019s Hospital at Dartmouth, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elenir B. C.","family":"Avritscher","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research and Learning Health Care, McGovern Medical School at The University of Texas Health Science Center at Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew","family":"Rysavy","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research and Learning Health Care, McGovern Medical School at The University of Texas Health Science Center at Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanekal S.","family":"Gautham","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Nemours Children\u2019s Health, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Lynch","sequence":"additional","affiliation":[{"name":"The University of Texas at Austin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Therese 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