PC1069: Seasonal and Pandemic-related Trends in Births and Neonatal Intensive Care Unit Admissions in the United States: Potential for Enhancing Cost-effective Care?

Background: Neonatal intensive care units (NICU) have high acuity and require a high level of nurse staffing. Methods to predict NICU census throughout the year are needed, particularly as NICU admission rates and neonatal length of stay at tertiary/quaternary pediatric institutions are rising. While seasonal birth trends are well documented, the seasonality of NICU admissions are less understood. Understanding seasonal trends in NICU volumes may enable hospitals to adjust staffing more effectively, reduce costs and address workforce challenges. In addition, changes in birth and NICU admission rates during the initial lockdown during the COVID-19 pandemic may provide insight into reducing NICU utilization.

Methods: To evaluate seasonal and COVID-19 lockdown-induced trends, US births and NICU admission data were obtained from the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) Natality database for the years 2016 to 2020. Data was standardized to daily counts. Each time series was decomposed into seasonal and trend components for seasonally-adjusted trends and deviations from these trends.

Results: There is a consistent seasonality of births and NICU admissions in the US. While both births and NICU admissions peak in August each year (figure 1A,B), NICU admissions begin to increase earlier and more steeply in May-July (figure 1B). The NICU admission rate (proportion of all births admitted to the NICU) does not have a strong seasonal component (figure 2A) suggesting that the fluctuation in NICU admissions is predominantly a reflection of birth seasonality. There is a consistent downward trend in births throughout the study period, exacerbating in the second half of 2020 (figure 2B). The trend in rising NICU admissions continued through February 2020 but there was a significant decrease in NICU admissions in 2020 through the COVID-19 pandemic (figure 2C). The NICU admission rate has steadily increased from 2016-2020 except for a transient decrease during the initial lockdown in March-June 2020. Despite this decrease in NICU admission rate, there was no change in neonatal mortality in the US. All of the trends described above are statistically significant (p < 0.001).

Conclusion: There is a consistent seasonal trend among births in the US which correlates well with NICU admissions. The NICU admission rate increased gradually between 2016 and 2020 in the US. Despite a decrease in NICU admission rate during March-June 2020, there was no increase in neonatal mortality. Evaluating this trend with additional data such as gestational age may assist in creating cost-effective admission policies and staffing models for the NICU.