The national birth rate is declining, but neonatal ICU admissions are increasing.
Several factors are at play, according to neonatology experts Kristina Reber, MD, and Jae Kim, MD, PhD.
Dr. Reber is executive vice chair of pediatrics and division chief of neonatology at Texas Children’s in Houston. Dr. Kim serves as co-director of the perinatal institute and director of neonatology at Cincinnati Children’s.
They told Becker’s that a combination of advancing maternal age and improved survival rates of premature infants are driving the upward trend in NICU admissions.
“We have seen a steady increase in the average number of babies being admitted,” Dr. Kim told Becker’s in June. “For example, in a month we will be increasing our beds to 108 acute NICU beds, a doubling in 10 years.”
At Texas Children’s, NICU admissions have averaged about 7,300 annually since 2014. The system saw its most significant growth in 2018, when it logged 7,551 NICU admissions — a 12.9% increase from 6,686 in 2017. Texas Children’s operates 215 NICU beds across three campuses.
Dr. Reber said multiple factors associated with environmental factors, such as climate change, and the growing use of fertility treatments like in vitro fertilization have increased the likelihood of premature births. At the same time, chronic maternal conditions such as obesity, diabetes and hypertension are more prevalent while contributing to complications.
On a more optimistic note, advances in neonatal care mean more premature infants are surviving — and thus, more require NICU care.
Nationally, NICU admissions rose from 8.7% of live births in 2016 to 9.8% in 2023, according to CDC data. This trend was seen across all races and ethnicities, maternal age groups, gestational age and birthweight categories.
Yet during that same time, pediatric inpatient capacity shrank. Nearly one-third of pediatric inpatient units closed between 2008 and 2022. U.S. hospitals reduced these units by 29.9%, and pediatric bed counts declined 19.5%, according to research.
Although NICU admissions aren’t directly tied to pediatric bed capacity, Dr. Kim said they share similar drivers.
“Pediatrics does not reimburse as well as adult medicine, does not compensate physicians as well as adult counterparts, has seen a reduction in admissions, [has] fewer doctors wanting to train in the specialty, and [has] been impacted by repurposing of beds for adult needs,” he said.
Dr. Reber added that lower pay and reimbursement in pediatric subspecialties have deterred some medical students and residents from pursuing them. Solutions, she said, include advocating for better reimbursement models, improving access to prenatal care and addressing social determinants of health.
