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NICU: Tiny Patients, Big Concerns

Joe Cantlupe, for HealthLeaders Media, October 13, 2011
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This article appears in the October 2011 issue of HealthLeaders magazine.

A hospital’s neonatal intensive care unit is designed for the most vulnerable of patients and certainly the tiniest, with premature infants mostly the focus. More health systems are adopting innovative approaches, technological improvements, and clinical changes to improve outcomes while participating in educational campaigns to reduce a rising trend of late-term premature births and resultant complications.

More than 70% of premature babies are born between 34 and 36 weeks gestation, before a full 40-week term. They represent 12% to 15% of live births, according to the March of Dimes, which monitors child births. A 2008 study found that cesarean sections account for nearly all of the increase in U.S. single premature births, with late preterms the largest of those deliveries.

“Premature babies are on the rise; these small babies are less than three pounds, and they consume a lot of our workload,” says Alex Espinoza, MD, medical director of the NICU at the Alta Bates Summit Medical Center in Berkeley, CA, which has a 55-bed NICU. “These are the kids who take the largest number of patient days,” he says, noting that some may stay in the NICU for 100 days or more.

The NICU has become more complex over time, says Whit Walker, MD, a neonatologist at the 79-licensed-bed NICU at Children’s Hospital of Greenville (SC) Health System University Medical Center. “The very low birth weight babies stay in the hospital a long time. The late-term premature babies are increasing, and the number of moms having diabetes and hypertension is increasing, and the number of moms having twins or triplets is increasing,” Walker says. “It keeps our numbers higher than what the third-party payers would like to see.

“Delivering early is always the issue,” Walker adds. “We’re going to need the help and support from family practitioners and obstetricians about educating families and parents about premature births.”

In a state like South Carolina where many mothers are on Medicaid, and with the advent of healthcare reform, insurers “are ramping up the pressure” regarding payments related to NICU units, Walker says. “Now the NICUs are profitable, but if they start losing that profit margin, there’s a question of how it will impact other services in the hospitals,” Walker says.

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