Neonatal Intensive Care Utilization and Post-Discharge Newborn Outcomes: A Population-based Study of Texas Medicaid Insured Infants.

Objective To test the hypothesis that newborn infants cared for in hospitals with greater utilization of neonatal intensive care experienced fewer post-discharge adverse events. Study design We developed three retrospective population-based cohorts of Texas Medicaid insured singletons born in 2010-2014 [very low birth weight (VLBW n=11,139), late preterm (n=57,509), and non-preterm (n=664,447)] who received care in higher volume hospitals with Level III/IV neonatal intensive care units (NICUs). Measures of NICU care were hospital-level risk adjusted NICU admission rates, special care days (days of non-routine care) per infant, and the percent of intensive (highest billable care code) SCDs. The units of analysis were hospitals (n=80) and the primary outcome was an adverse event (AE), (defined as admission, ER visit, or death) within 30 days post-discharge. Results Higher use of NICU care at a hospital level was not associated with lower post-discharge 30-day AE. Infants cared for in hospitals with above vs below median SCD rates experienced slightly higher post-discharge AE per 100 infants [VLBW: 14.01 (95% CI:12.74-15.27) vs. 11.84 (10.52-13.16), p Conclusion Higher utilization of NICU care was not associated with lower rates of short term events suggesting that there may be opportunities to safely decrease admission rates and length of NICU stays.