Evidence map›Paper›PMID 42608443›Full record

ArticleJournal of perinatology : official journal of the California Perinatal Association2026

Level III neonatal intensive care unit heterogeneity in patients, services, and outcomes.

Nicolas P Goldstein Novick, Scott A Lorch, Joshua K Radack, Molly Passarella, Timothy D Nelin, Elizabeth G Salazar, Sara C Handley

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In one paragraph

Article in Journal of perinatology : official journal of the California Perinatal Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Nicolas P Goldstein NovickDivision of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. novickn@chop.edu.ORCID http://orcid.org/0009-0000-3938-7490
Scott A LorchDivision of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Joshua K RadackDivision of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.ORCID http://orcid.org/0000-0002-5463-379X
Molly PassarellaDivision of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.ORCID http://orcid.org/0009-0000-8037-152X
Timothy D NelinDivision of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.ORCID http://orcid.org/0000-0002-7435-2610
Elizabeth G SalazarDivision of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.ORCID http://orcid.org/0000-0001-6998-5977
Sara C HandleyDivision of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.ORCID http://orcid.org/0000-0001-8436-4351

Funding

Effect of Changing NICU Patient Volumes and Levels of Care on Neonatal OutcomesR01HD084819 · NICHD · STANFORD UNIVERSITY · PI LORCH, SCOTT A, PHIBBS, CIARAN S. · 2016 to 2018
$1.1M
The impact of delivery hospital organizational structure and culture on perinatal outcomesK23HD109426 · NICHD · CHILDREN'S HOSP OF PHILADELPHIA · PI Sara Christine Handley · 2023 to 2026
$621k
Hospital Financial Health, NICU Strain, and Neonatal Outcome Variation and Subpopulation DisparitiesK23HD115872 · NICHD · CHILDREN'S HOSP OF PHILADELPHIA · PI Elizabeth G Salazar · 2025 to 2026
$319k
NICHD NIH HHS K23 HD109426NICHD NIH HHS K23 HD115872NICHD NIH HHS R01 HD084819U.S. Department of Health & Human Services | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) K23 HD109426U.S. Department of Health & Human Services | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) K23 HD115872U.S. Department of Health & Human Services | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) R01 HD084819
6 · The paper itself

Abstract

objectivesLevel III NICUs share one AAP level of care designation. We characterized variation, identified sub-classes, and compared sub-class outcomes. STUDY

designThis retrospective cohort analysis of level III NICUs in Florida, Michigan, Oregon, Pennsylvania, and South Carolina used linked hospital discharge-vital statistics data (2010-2020). Included hospitals had ≥10 births annually and infants had gestational age <32 weeks and/or birth weight <1500 g. We characterized NICU-level heterogeneity; used latent class analysis (LCA) to obtain sub-classes; and compared risk-adjusted outcomes with multivariable Poisson regression.

resultsAmong 163 NICUs (1518 hospital-years) there was significant variation. LCA identified five sub-classes (3a-e). Preterm volume and procedural intensity rose with acuity (3a lowest, 3d/3e highest). Higher acuity was associated with lower mortality but higher morbidity (3d vs. 3a: death: IRR 0.59 [95% CI 0.54-0.65]; morbidity: 2.84 [2.43-3.31]).

conclusionsLevel III NICUs are heterogeneous and comprise five sub-classes with divergent outcomes. Sub-classification may facilitate risk-appropriate care.

Identifiers

PMID42608443

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.