NEONATAL INTENSIVE-CARE UNITS - IS THE LEVEL OF UTILIZATION STILL PARALLELED BY INFANT-MORTALITY

Background. This research investigated the relationship of maternal pl ace of residence with the utilization of neonatal intensive care units (NICU) and whether maternal residence was related to infant mortality in two contiguous Swiss cantons, Vaud and Valais, relying on the same tertiary NICU. Previous works have shown that infant mortality is clo se to the Swiss rate in Vaud, but elevated in Valais. Methods. Analyse s were based on linked birth and death certificates relating to the 57 962 single livebirths to mothers resident in Vaud or Valais delivered in hospitals over the 1979-1985 period. Data on utilization were retr ospectively collected from NICU admissions' registers and linked to bi rth certificates. Results. Results of logistic regression models point ed to a large difference for all birthweight groups, in NICU utilizati on between Vaud and Valais after adjustment for risk factors abstracte d from the birth certificate, when tertiary NICU beds were considered. When the definition of NICU utilization was enlarged to all beds of a n identified NICU, irrespective of the location of the unit and of the intensity of care provided to admitted newborns, there was a clear re duction in geographical variations. Neonatal and infant mortality were significantly higher in the lower NICU utilization region only among newborns weighing greater than or equal to 2500 g at birth. Conclusion s. We found no difference in infant mortality (odds ratio 1.0) among < 2500 g newborns residing in regions characterized by a large differenc e in tertiary NICU utilization. Nevertheless, the limited sample size did not permit specific analyses of lower birthweight (e.g. <1500 g) n ewborns. Replication of such research in other settings based on large r samples is needed.