More and more newborns are going to the neonatal intensive care unit. Between 2007 and 2012, NICU admission rates in the U.S. rose 23%, a new study has found.
In raw numbers, that means that NICUs in 2012 likely admitted about 58,000 more babies than they did in 2007. Intriguingly, most of the increase came from babies who were born full-term and at a normal weight, the researchers say.
"With an increase of this magnitude, over the course of just six years, it's a signal that something's happening here," Wade Harrison, a research scholar at the Dartmouth Institute for Health Policy and Clinical Practice and one of the study's authors, told BuzzFeed News.
This NICU boom is almost certainly due to a combination of many factors. It could be because of an increase in mothers who are diabetic or addicted to opiates, for instance, or because doctors are simply getting better at identifying and treating babies with infections, feeding difficulties, and jaundice.
But Harrison and his colleagues worry that part of the increase comes from an overuse of expensive NICU facilities, which have been growing steadily over the past four decades.
"We may be admitting too many babies to NICUs who might be healthier than they previously were," Harrison said.
And those admissions come with risks: Babies in NICUs get less bonding time with their parents, perhaps making it more difficult to learn to eat, and they will also go through potentially unnecessary medical procedures.
"It's an eye-opening study," Annemarie Stroustrup, a neonatologist at the Mount Sinai Hospital in New York City who was not involved in the work, told BuzzFeed News.
Stroustrup pointed out that the study does not give any information about how often babies were readmitted to the hospital after going home. So it could be that the increase in NICU admissions is being offset by a decrease in future readmissions.
"Were these kids who would have previously gone home and then come back?" she asked. "Or were they kids who would have gone home and stayed home?"
Even so, the numbers are big enough that some part of the increased admissions are probably unnecessary, Stroustrup said. "It probably is true that, as we have built more NICUs across the United States and trained more neonatologists who can recognize early life medical issues, there is a great potential for overuse."
The first American NICU opened in 1960, at the Yale-New Haven Hospital in Connecticut.
By the 1970s, regional NICUs began cropping up all across the country to help care for extremely premature and low-birth-weight babies.
There's no question that these centers have saved thousands of babies: The neonatal death rate plummeted over that period, from 1.9% to 0.4%.
"Too often, though, when something works in the United States we start to overuse it," wrote Aaron Carroll, a doctor and health policy scholar at Indiana University, in a commentary about the new study. (The commentary is subtitled, "If You Build Them, They Will Come.")
NICUs are expensive, costing upwards of $3,000 to $5,000 per day, according to Harrison. And because the NICU tends to be one of the hospital's most profitable departments, there's little pressure from the top to decrease a patient's length of stay.
"I don't think there has been, from the administration on down, a push to decrease the length of stay or decrease the number of of admissions," Stroustrup said. "It's sort of the opposite. It's that subtle positive feedback — if we have a busy unit, we make money."
Carroll made a similar point in his commentary. "The amount of money to be made by providing more care," he wrote, "is much, much larger than the amount gained by providing usual care."
