Are neonatal intensive care resources located according to need? Regional variation in neonatologists, beds, and low birth weight newborns

Objective. Despite marked growth in neonatal intensive care during the past 30 years, it is not known if neonatologists and beds are preferentially lo cated in regions with greater newborn risk. This study reports the relation ship between regional measures of intensive care capacity and low birth wei ght infants using newly developed market-based regions of neonatal intensiv e care. Design. Cross-sectional small-area analysis of 246 neonatal intensive care regions (NICRs). Data Sources. 1996 American Medical Association and American Osteopathic As sociation masterfiles data of clinically active neonatologists; 1999 Americ an Academy of Pediatrics Section on Perinatal Pediatrics survey of director s of neonatal intensive care units in the United States with 100% response rate; 1995 linked birth/death data. Results. The number of total births per neonatologist across NICRs ranged f rom 390 to 8197 (median: 1722) and the number of total births per intensive care bed ranged from 72 to 1319 (median: 317). The associations between ca pacity measures and low birth weight rates across NICRs were statistically significant but negligible (R-2 : 0.04 for neonatologists; 0.05 for beds). NICRs in the quintile with the greatest neonatologist capacity (average of only 863 births per neonatologist) had very low birth weight (VLBW) rates o f 1.5% while those in the quintile of lowest neonatologist capacity (averag e of 3718 births per neonatologist) had VLBW rates of 1.3%; a similar lack of meaningful difference in VLBW rates was noted across quintiles of intens ive care bed capacity. Including midlevel providers and intermediate care b eds to the analyses did not alter the findings. Conclusions. Neonatal intensive care capacity is not preferentially located in regions with greater newborn need as measured by low birth weight rates . Whether greater capacity affords benefits to the newborns remains unknown .