{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:02:26Z","timestamp":1789970546166,"version":"4.0.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize temporal changes in neonatal inpatient case mix, resource utilization, and hospitalization costs from 2020 to 2024, with particular attention to cost-structure changes around the January 2022 payment reform, and to identify key clinical factors associated with hospitalization costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective study enrolled neonates admitted between January 2020 and December 2024 with valid total hospitalization costs and length of stay (LOS). Descriptive statistics characterized annual case mix and cost trends. Gestational age (GA)-standardized cost indices and daily cost intensity were calculated to assess resource consumption across different case mixes. With January 2022 designated as the reform index point, interrupted time series (ITS) analysis was applied to evaluate temporal changes in the proportions of procedural fees and Western medicine fees. Gamma generalized linear models (GLM), quantile regression, and ordinary least squares (OLS) regression were performed to examine factors associated with hospitalization costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 12,011 neonates were included. Annual admissions declined from 2,986 in 2020 to 1,952 in 2024 (a 34.6% decrease), while the proportion of extremely preterm infants rose from 0.7% to 2.4% and the proportion requiring mechanical ventilation increased from 27.1% to 39.3%. The overall median annual hospitalization cost remained relatively stable (9,588 to 10,498 CNY), but the GA-standardized cost index consistently exceeded the unadjusted level (12,811 to 15,136 CNY). After the January 2022 reform index point, the proportion of procedural fees increased immediately by 32.30 percentage points (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), while no concurrent significant change was observed in the proportion of Western medicine fees. Costs were highly concentrated, with the top 5% of patients across all study years accounting for 31.4% of total costs. Daily cost intensity was highest in extremely preterm infants (1,997 CNY\/d). Multivariable analysis showed that LOS (exp \u03b2\u2009=\u20091.045) and mechanical ventilation (exp \u03b2\u2009=\u20091.81) were the most important factors associated with increased hospitalization costs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Neonatal admissions declined over the study period, while proportions of high-risk cases and cost concentration increased. LOS and mechanical ventilation were strongly associated with higher hospitalization costs, indicating that risk adjustment is essential in neonatal payment policies and resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1943786","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:36:39Z","timestamp":1789968999000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in neonatal inpatient resource utilization and cost drivers under payment reform: a five-year retrospective real-world data study"],"prefix":"10.3389","volume":"14","author":[{"given":"Jinhui","family":"Hu","sequence":"first","affiliation":[{"name":"Neonatal Medical Center, Affiliated Hospital of Yang Zhou University Medical College Huai'an maternal and Child health care Center","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Liu","sequence":"additional","affiliation":[{"name":"Neonatal Medical Center, Affiliated Hospital of Yang Zhou University Medical College Huai'an maternal and Child health care Center","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Finance, Affiliated Hospital of Yang Zhou University Medical College Huai'an maternal and Child health care Center","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaojun","family":"Pan","sequence":"additional","affiliation":[{"name":"Neonatal Medical Center, Affiliated Hospital of Yang Zhou University Medical College Huai'an maternal and Child health care Center","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e2118904","DOI":"10.1001\/jamanetworkopen.2021.18904","article-title":"Assessment of neonatal intensive care unit practices, morbidity, and mortality among very preterm infants in China","volume":"4","author":"Cao","year":"2021","journal-title":"Jama Netw Open"},{"key":"B2","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1186\/s12916-026-04963-0","article-title":"Gut microbiota dysbiosis and host metabolite-immune crosstalk drives the pathogenesis of neonatal lupus erythematosus: a multi-omics analysis","volume":"24","author":"Sun","year":"2026","journal-title":"Bmc Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1038\/s41372-021-01213-4","article-title":"The financial burden experienced by families of preterm infants after NICU discharge","volume":"42","author":"Lakshmanan","year":"2022","journal-title":"J Perinatol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"4059","DOI":"10.7189\/jogh.13.04059","article-title":"Determining resuscitation threshold for extremely preterm infants based on the survival rates without severe neurological injury","volume":"13","author":"Dong","year":"2023","journal-title":"J Glob Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1585279","DOI":"10.3389\/fpubh.2025.1585279","article-title":"Effects of DRG\/DIP payment reform on hospital pharmacy administration and pharmaceutical services in China: a multicenter cross-sectional study","volume":"13","author":"Wang","year":"2025","journal-title":"Front Public Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1392239","DOI":"10.3389\/fphar.2024.1392239","article-title":"Does China's National volume-based drug procurement policy promote or hinder pharmaceutical innovation?","volume":"15","author":"Li","year":"2024","journal-title":"Front Pharmacol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e5519","DOI":"10.1136\/bmjgh-2021-005519","article-title":"Lowering drug prices and enhancing pharmaceutical affordability: an analysis of the national volume-based procurement (NVBP) effect in China","volume":"6","author":"Yuan","year":"2021","journal-title":"Bmj Glob Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1563204","DOI":"10.3389\/fpubh.2025.1563204","article-title":"The impact of DRG payment reform on inpatient costs for different surgery types: an empirical analysis based on Chinese tertiary hospitals","volume":"13","author":"Luo","year":"2025","journal-title":"Front Public Health"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1661995","DOI":"10.3389\/frhs.2025.1661995","article-title":"Impact analysis of DRG payment reform on hospitalization expenses and length of stay for lung cancer inpatients (2019\u22122023)","volume":"5","author":"Chen","year":"2025","journal-title":"Front Health Serv"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1610","DOI":"10.1080\/13696998.2020.1839272","article-title":"Hospitalization charges for extremely preterm infants: a ten-year analysis in Shanghai, China","volume":"23","author":"Zhu","year":"2020","journal-title":"J Med Econ"},{"key":"B11","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1186\/s13052-025-02043-2","article-title":"A comprehensive benchmark of very preterm and extremely preterm infant care in Shenzhen: insights from the triple aim framework","volume":"51","author":"Ding","year":"2025","journal-title":"Ital J Pediatr"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e20344","DOI":"10.7717\/peerj.20344","article-title":"Variations in length of stay among surviving preterm infants admitted to neonatal intensive care units in Shenzhen, China","volume":"13","author":"Rao","year":"2025","journal-title":"Peerj"},{"key":"B13","volume-title":"Practical Neonatology","author":"Shao","year":"2019"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ije\/24.1.1","article-title":"Basic models for disease occurrence in epidemiology","volume":"24","author":"Flanders","year":"1995","journal-title":"Int J Epidemiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e338409","DOI":"10.1371\/journal.pone.0338409","article-title":"Impact of Chinese national centralized volume-based drug procurement policy on health costs and utilization: an interrupted time series analysis using panel data (2009\u22122022)","volume":"20","author":"Jiang","year":"2025","journal-title":"PLoS One"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e336584","DOI":"10.1371\/journal.pone.0336584","article-title":"The impact of diagnosis-intervention packet (DIP) payment on cost structure of inpatient care-evidence from a tertiary hospital in China","volume":"20","author":"Zhu","year":"2025","journal-title":"PLoS One"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1689969","DOI":"10.3389\/fcimb.2025.1689969","article-title":"Elevated DUOX2 levels correlate with necrotizing enterocolitis development","volume":"15","author":"Sun","year":"2025","journal-title":"Front Cell Infect Microbiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"7724","DOI":"10.34172\/ijhpm.2023.7724","article-title":"Impact of China's National volume-based procurement on drug procurement price, volume, and expenditure: an interrupted time series analysis in Tianjin","volume":"12","author":"Zhao","year":"2023","journal-title":"Int J Health Policy Manag"},{"key":"B19","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.jpeds.2020.09.045","article-title":"Costs of neonatal intensive care for Canadian infants with preterm birth","volume":"229","author":"Rios","year":"2021","journal-title":"J Pediatr"},{"key":"B20","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s12887-021-02600-8","article-title":"Regional variation in cost of neonatal intensive care for extremely preterm infants","volume":"21","author":"Rolnitsky","year":"2021","journal-title":"Bmc Pediatr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1068367","DOI":"10.3389\/fped.2023.1068367","article-title":"The price of neonatal intensive care outcomes\u2014in-hospital costs of morbidities related to preterm birth","volume":"11","author":"Rolnitsky","year":"2023","journal-title":"Front Pediatr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e1818","DOI":"10.1136\/bmjpo-2022-001818","article-title":"Neonatal health care costs of very preterm babies in England: a retrospective analysis of a national birth cohort","volume":"7","author":"Yang","year":"2023","journal-title":"Bmj Paediatr Open"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1038\/s41419-026-09144-8","article-title":"Sphingosine-1-phosphate ameliorates necrotizing enterocolitis by regulating mitochondrial redox homeostasis and gut microbiota","author":"Sun","year":"2026","journal-title":"Cell Death Dis"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1943786\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:36:40Z","timestamp":1789969000000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1943786\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":23,"alternative-id":["10.3389\/fped.2026.1943786"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1943786","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"article-number":"1943786"}}