Israeli study notes drawbacks of neonatal intensive care units

A new study shows that full-term infants admitted into neonatal intensive care (NICU) units have an elevated risk of long-term childhood mortality, according to a team of researchers led by Shahar Talisman and Sorina Grisaru Granovsky.

The study, published in the journal Pediatrics, investigated the association between NICU admission and childhood mortality throughout a 15-year follow-up period, including all in-hospital, full-term (greater than 37 weeks gestation)  NICU patients between 2005 and 2019 at a single center in Israel. The study was believed to be the first of its kind for full-term infants, as most NICU mortality studies involve premature infants, the study stated.

"NICU admission for term neonates is a pondering event for the risk of long-term childhood mortality," the study stated. "This group of term neonates may benefit from focused health care."

The medical center where the study was conducted was linked with the birth and death certificate registries of the Israeli Ministry of Internal Affairs. Of the 192,527 term infants included in the study, 5,292 (2.75%) were admitted to NICU, the authors wrote.

The study found that the infant mortality risk for full-term babies admitted to the NICU remained elevated throughout the follow-up period, with a hazard ratio (HR) of over 19%. The mortality rate for all full-term infants was 0.16%, with 47.9% of those who died having records of a NICU admission. 

The mortality risk related to the NICU admission event remained significant after adjusting for admission diagnoses, with an HR of 8.21.

The mortality rate was highest in the first week of life (29 per 10,000 births), followed by the period from 28 days to 6 months (20 per 10,000 births). The mortality risk remained markedly elevated, even after age 4, with an HR of 7.1. 

After excluding congenital malformations and chromosomal abnormalities, NICU admission remained the most significant risk factor associated with mortality of those studied, with HRs of 364.4 for mortality in the first seven days of life and 19.6 for mortality from 28 days through six months.

The authors wrote that full-term infants admitted to the NICU may benefit from focused health care. The study highlighted the need for continued monitoring and follow-up care for full-term infants, who who have been admitted to the NICU, to reduce the risk of long-term childhood mortality, the study read.