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© 1994 Oxford University Press

research-article

Neonatal Intensive Care Units: Is the Level of Utilization Still Paralleled by Infant Mortality?

BRIGITTE SANTOS-EGGIMANN* and SAM SHAPIRO{dagger}

*Health Services Research Division, University of Lausanne, Institute of Social and Preventive Medicine 17 rue du Bugnon, CH-1005 Lausanne, Switzerland
{dagger}Department of Health Policy and Management, Johns Hopkins Universaty, School of Hygiene and Public Health 624 N Broadway, Baltimore, MD 21205, USA

Background. This research investigated the relationship of maternal place 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 sante tertiary NICU. Previous works have shown that Infant mortality is close to the Swiss rate in Vaud, but elevated in Valals.

Methods. Analyses were based on linked birth arid death certificates relating to the 57962 single Fivebirths to mothers resident in Vaud or Valais delivered in hospitals over the 1979–1985 period. Data on utilization were retrospectively collected from NICU admissions registers and linked to birth certificates.

Results. Results of logistic regression models pointed to a large difference for all blrthweight groups, in NICU utilization between Vaud and Valais after adjustment for risk factors abstracted from the birth certificate, when tertiary NICIJ beds were considered. When the definition of NICU utilization was enlarged to all beds of an Identified NICU, irrespective of the location of the unit and of the intensity of care provided to admitted newborns, there was a clear reduction in geographical variations. Neonatal and infant mortality were significantly higher in the lower NICU utilization region only among newborns weighing >> 2500 g at birth.

Conclusion. We found no difference in infant mortality (odds ratio 1.0) among < 2500 g newborns residing in regions characterized by a large difference in tertiary NICU utilization. Nevertheless, the limited sample size did not permit specific analyses of lower birthweight (e.g. < 1500 g) newborns. Replication of such research in other settings based on larger samples is needed.

Received 1 November 1993


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