{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:15:13Z","timestamp":1787022913055,"version":"build-2736575974"},"reference-count":48,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND AND OBJECTIVES<\/jats:title>\n                    <jats:p>Neonatal intensive care unit (NICU) aggregate service and outcome descriptions focus on high-illness-acuity neonates. We sought to describe the high-level landscape of lower-acuity inborn NICU admissions (LAINAs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This cross-sectional study of a nearly three-quarters population sample from 2022 describes 120 California hospitals with inborn NICU admissions. Binary illness acuity stratification was based on high-acuity criteria\u2014admission within 28\u00a0days of birth and either birthweight of 1500\u00a0g or less, gestation of 31\u00a0weeks 6\u00a0days or less, or more than 1500\u00a0g with at least 1 of the following: death, assisted ventilation for 4\u00a0hours or more whether intubated or not, early bacterial sepsis, major surgery requiring anesthesia, acute transport in or out, suspected encephalopathy\/perinatal asphyxia, active therapeutic hypothermia, or seizures. Exposure: inborn NICU admission; main outcomes: LAINA categorization, diagnostic categories, patient-days, length of stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 44\u2009330 total NICU admissions, 26\u2009257 (59.2%) were LAINAs and accounted for 31.2% of all NICU patient-days. Mean length of stay for all NICU admissions was 12.9\u00a0days, compared with 8.0\u00a0days for LAINAs. The most common LAINA diagnostic categories included respiratory distress (43.0%), suspected infection (39.6%), admission policy based only on birthweight\/gestational age (30.7%), hyperbilirubinemia (28.9%), and feeding difficulty (25.6%). NICUs varied widely in the diagnostic categories represented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>LAINAs outnumbered high-illness-acuity admissions in most NICUs, accounting for almost a third of NICU patient-days. These findings merit reflection and research on data elements needed to describe service provision and clinical outcome and on preferable hospital settings for clinical management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2024-067831","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T10:39:11Z","timestamp":1740393551000},"source":"Crossref","is-referenced-by-count":6,"title":["Neonatal Intensive Care Unit Use for Newborns With Relatively Lower Illness Acuity"],"prefix":"10.1542","volume":"155","author":[{"given":"Joseph","family":"Schulman","sequence":"first","affiliation":[{"name":"1California Department of Health Care Services, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey B.","family":"Gould","sequence":"additional","affiliation":[{"name":"2California Perinatal and Maternal Quality Care Collaboratives (CPQCC\/CMQCC), Palo Alto, California"},{"name":"3Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry C.","family":"Lee","sequence":"additional","affiliation":[{"name":"2California Perinatal and Maternal Quality Care Collaboratives (CPQCC\/CMQCC), Palo Alto, California"},{"name":"4University of California San Diego\/Rady Children\u2019s Hospital, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Profit","sequence":"additional","affiliation":[{"name":"2California Perinatal and Maternal Quality Care Collaboratives (CPQCC\/CMQCC), Palo Alto, California"},{"name":"3Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balaji","family":"Govindaswami","sequence":"additional","affiliation":[{"name":"1California Department of Health Care Services, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"issue":"3","key":"2025032616474381400_r1","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1542\/peds.68.3.313","article-title":"Newborn risk factors and costs of neonatal intensive care","volume":"68","author":"Phibbs","year":"1981","journal-title":"Pediatrics."},{"issue":"11","key":"2025032616474381400_r2","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1097\/MLR.0000000000001893","article-title":"The relationship between regional growth in neonatal intensive care capacity and perinatal risk","volume":"61","author":"Davis","year":"2023","journal-title":"Med Care."},{"issue":"1","key":"2025032616474381400_r3","doi-asserted-by":"crossref","first-page":"23795","DOI":"10.1038\/s41598-021-03183-1","article-title":"Trends in neonatal intensive care unit admissions by race\/ethnicity in the United States, 2008\u20132018","volume":"11","author":"Kim","year":"2021","journal-title":"Sci Rep."},{"issue":"2","key":"2025032616474381400_r4","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/s41372-023-01834-x","article-title":"Declining birth rates, increasing maternal age and neonatal intensive care unit admissions","volume":"44","author":"Gamber","year":"2024","journal-title":"J Perinatol."},{"key":"2025032616474381400_r5","volume-title":"The Dartmouth Atlas of Neonatal Intensive Care","author":"Goodman","year":"2019"},{"issue":"10","key":"2025032616474381400_r6","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1038\/s41372-024-02039-6","article-title":"Who\u2019s in the NICU? 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