More Specialists May Not Be Better for Neonates

A study has found that adding more hospital specialty services and doctors who are specialists does not always lead to better outcomes for newborns. The study was published in the May 16, 2002, issue of The New England Journal of Medicine.

US researchers found wide regional differences in the availability of newborn specialists and intensive care nursery beds that do not correlate well with improved neonate survival. This finding has led them to reassess the allocation of resources designed to improve newborn health. The basic determinant of neonatal outcomes is whether a baby is born premature, a factor not influenced by neonatal specialists. When a sick baby is born, survival may be more related to the organization and use of existing resources than to the number of doctors or other resources, the investigators found.

The research team studied almost 3.9 million infants born in 1995 with a weight of at least 500 grams. The overall mortality rate was 3.4% per 1,000 live births. Different US regions were grouped according to the supply of neonatologists per newborn: very low, low, medium, high, and very high. The investigators found no difference in the mortality once the supply of neonatologists exceeded the "low” supply category. While the death rate was 7% lower in regions with 4.3 neonatologists per 10,000 births than in those with 2.7 neonatologists, further increases in neonatologists made no difference in the death rate. The team also looked at the supply of neonatal intensive care beds and found no reduction in mortality as the number of beds increased.

"A few regions of the country appear to be underserved in neonatologists, in that neonatal mortality rates are worse in the areas of very lowest supply,” said David Goodman, M.D., associate professor of pediatrics at Dartmouth Medical School (Hanover, NH, USA). "However, beyond the numbers found in the low-supply areas, there are no further benefits of more neonatologists.”

In an editorial in the same issue, Kevin Grumback of the University of California, San Francisco (USA), says these results represent how a market-driven health-care system lacking public planning can produce too much of a good thing.