title: The validity of the variable "NICU admission" as an outcome measure for neonatal morbidity: a retrospective study.
abstract: OBJECTIVE
  To determine whether "neonatal intensive care unit (NICU) admission" is a valid surrogate outcome measure to assess neonatal condition in clinical studies.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary hospital in the Netherlands.
  
  
  METHODS
  Neonates admitted to NICU during a 10-year period. Inclusion was restricted to singletons born beyond 37 weeks of gestation, and admitted to NICU in the first 24 h for delivery-related morbidity.
  
  
  METHODS
  Patient characteristics and admission data were compared for four groups based on the line of care during delivery, i.e. home birth (Ia), midwife-led hospital delivery (Ib), secondary care (II), tertiary care (III).
  
  
  METHODS
  Percentage of neonates/infants that died during NICU admission, diagnosis on admission, treatment received and a Neonatal Therapeutic Intervention Score System (NTISS).
  
  
  RESULTS
  We studied 776 newborns (Ia 52, Ib 25, II 160, III 512, 27 unknown). The mortality rate differed significantly (Ia 15%, Ib 12%, II 22%, III 1%, p < 0.01), as did the NTISS morbidity scores at admission [Ia 12.0 (6.0-23.0), Ib 8.5 (6.3-10.0), II 21.0 (15.0-30.0), III 6.0 (4.0-9.0); p < 0.01], diagnosis at admission, received treatment and the duration of admission.
  
  
  CONCLUSIONS
  The severity of neonatal illness after 37 weeks of gestation differed depending on the line of care in which they were born, with neonates born in secondary care consistently having the highest morbidity, and those born in tertiary care having the lowest. NICU admission should not be used as an outcome measure for neonatal morbidity, specifically not when comparing different birth settings.
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands.
authors.forename: Melanie M J
authors.initials: MM
authors.lastname: Wiegerinck
authors.forename: Nora A
authors.initials: NA
authors.lastname: Danhof
authors.forename: Anton H
authors.initials: AH
authors.lastname: Van Kaam
authors.forename: Pieter
authors.initials: P
authors.lastname: Tamminga
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015931:Intensive Care, Neonatal; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
keywords: Neonatal morbidity; birth setting; neonatal intensive care unit; outcome measure; validation