Their study, published May 16 in The New England Journal of Medicine, documents a wide regional disparity in the availability of newborn specialists and intensive care nursery beds that correlates poorly with improved survival. It lays the groundwork for reassessing the allocation of resources to improve newborn health and prevent disease and death, and raises questions about the continued growth of specialty medical services in the United States.
The advent of neonatal intensive care servicesthe neonatologists who care for premature and sick newborns and the intensive care nurseries where they are hospitalizedhas dramatically improved the outlook for infants once considered too tiny or ill to survive. The growth in neonatal intensive care, driven by technological and clinical success over the past three decades, continues unabated, while its distribution across the country is more varied than other medical care resources.
Now health analysts and planners are beginning to reassess the ramifications of this growth in medical resources. In particular, they ask: are neonatal resources located where the sick babies are; does a greater supply translate into better outcomes for newborns; will further growth in supply continue to be beneficial?
The answers so far, says David Goodman, MD, associate professor of pediatrics, who led the DMS team, paint a disturbing picture of the landscape of neonatal intensive care. "Supply of neonatologists and intensive care beds is almost idiosyncratic in the way they are located; greater numbers are not found in the regions with more high risk newborns. A few regions of the country appear to be underserved in neonatologists, in that neonatal mortality rates are worse in the ar
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