{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:19:01Z","timestamp":1780510741782,"version":"3.54.1"},"reference-count":31,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,13]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To analyse the impact of selected neonatal care interventions on regional care capacity.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Design<\/jats:bold>\n                    <\/jats:p>\n                    <jats:p>Discrete event simulation modelling based on clinical data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Neonatal care in the southwest of the Netherlands, consisting of one tertiary-level neonatal intensive care unit (NICU), four hospitals with high-care neonatal (HCN) wards and six with medium-care neonatal (MCN) wards.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>44\u2009461 neonates admitted to at least one hospital within the specified region or admitted outside of the region but with a residential address inside the region between 2016 and 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The impact of three interventions was simulated: (1) home-based phototherapy for hyperbilirubinaemia, (2) oral antibiotic switch for culture-negative early onset infection and (3) changing tertiary-level NICU admission guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measure<\/jats:title>\n                    <jats:p>Regional neonatal capacity defined as: (1) occupancy per ward level, (2) required operational beds per ward level to provide care to all inside region patients at maximum 85% occupancy, (3) proportion rejected, defined as outside region transfers due to no capacity to provide local care and (4) the weekly rejections in relation to occupancy to provide a combined analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the current situation, with many operational beds closed due to nurse shortages, occupancy was extremely high at the NICU and HCNs (respectively 91.7% (95% CI 91.4 to 92.0) and 98.1% (95% CI 98.0 to 98.2)). The number of required beds exceeded available beds, resulting in &gt;20% rejections for both NICU and HCN patients. Although the three interventions individually demonstrated effect on capacity, clinical impact was marginal. In combination, NICU occupancy was reduced below the 85% government recommendation at the cost of an increased burden for HCNs, highlighting the need for redistribution to MCNs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our model confirmed the severity of current neonatal capacity strain and demonstrated the potential impact of three interventions on regional capacity. The model showed to be a low-cost and easy-to-use method for regional capacity impact assessment and could provide the basis for making informed decisions for other interventions and future scenarios, supporting data-driven neonatal capacity planning and policy development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104688","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T12:25:40Z","timestamp":1765369540000},"page":"e104688","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Impact assessment of neonatal care interventions on regional neonatal care capacity: a simulation study based on clinical data in the Netherlands"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0428-2685","authenticated-orcid":false,"given":"Josephine H L","family":"Wagenaar","sequence":"first","affiliation":[{"name":"Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia, Rotterdam, the Netherlands"},{"name":"Faculty of Technology Policy and Management, Delft University of Technology, Delft, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Dietz","sequence":"additional","affiliation":[{"name":"Faculty of Technology Policy and Management, Delft University of Technology, Delft, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4396-1990","authenticated-orcid":false,"given":"Yilin","family":"Huang","sequence":"additional","affiliation":[{"name":"Faculty of Technology Policy and Management, Delft University of Technology, Delft, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irwin K M","family":"Reiss","sequence":"additional","affiliation":[{"name":"Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper V","family":"Been","sequence":"additional","affiliation":[{"name":"Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia, Rotterdam, the Netherlands"},{"name":"Obstetrics and Gynaecology, Erasmus MC Sophia, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie","family":"Spaan","sequence":"additional","affiliation":[{"name":"Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9 F","family":"Kornelisse","sequence":"additional","affiliation":[{"name":"Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7300-4577","authenticated-orcid":false,"given":"Hendrik Rob","family":"Taal","sequence":"additional","affiliation":[{"name":"Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9043-8847","authenticated-orcid":false,"given":"Saba","family":"Hinrichs-Krapels","sequence":"additional","affiliation":[{"name":"Faculty of Technology Policy and Management, Delft University of Technology, Delft, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"2026010703462454000_15.12.e104688.1","unstructured":"NOS Nieuws . 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