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Oversupply of Neonatologists?
The Relation between the Availability of Neonatal Intensive Care and Neonatal Mortality. Goodman DC, Fisher ES, Little GA, et al. New Engl J Med (May 16, 2002); 346:1538-44.
We used the 1996 master files of the American Medical Association and the American Osteopathic Association and 1998 and 1999 surveys of neonatal intensive care units to calculate the supply of neonatologists and neonatal intensive care beds in 246 neonatal intensive care regions. We used linked birth and death records from the 1995 U.S. birth cohort to assess associations between the supply of both neonatologists and neonatal intensive care beds per capita (in quintiles) and the risk of death within the first 27 days of life.
Results: Among 3,892,208 newborns with a birth weight of 500 g or greater, the mortality rate was 3.4 per 1000 births. After adjustment for neonatal and maternal characteristics associated with an increased risk of neonatal death, the rate was lower in the regions with 4.3 neonatologists per 10,000 births than in those with 2.7 neonatologists per 10,000 births (odds ratio for death, 0.93; 95 percent confidence interval, 0.88 to 0.99). Further increases in the number of neonatologists were not associated with greater reductions in the risk of death. There was no consistent relation between the number of neonatal intensive care beds and neonatal mortality.
Comment. Watch out … the New York Times and USA Today have already covered this article today. The data suggests that increasing the supply of neonatologists beyond 4.3 per 10,000 live births does not increase the chances of infant survival. The authors further concluded that regions with a greater supply of NICU beds and neonatologists might be harming infants since "infants with less serious illness might be more likely to be admitted to a neonatal intensive care unit and might be subjected to more intensive diagnostic and therapeutic measures." The study provides no data to support this latter conclusion. I suspect that if we look closely at the practice patterns in regions where there is a higher density of neonatologists we will find that neonatologists spend more of their time with teaching, clinical research, well-baby care and attendance at deliveries, in addition to patient care in the NICUs. The benefits of this higher level of neonatal care may not be obvious when the only outcome measure you consider is the mortality rate. For an additional article concerning optimal numbers of neonatologists, see 3-030. ABK
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