Is Neonatal Special Care Overused?


  • M.P.M. Richards M.A., Ph.D.

    1. Martin Paul Meredith Richards is a Lecturer in Social Psychology at the University of Cambridge and Head of the Medical Psychology Unit, University of Cambridge, Free School Lane, Cambridge, England CB2 3RF.
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ABSTRACT: Among the health regions of Britain, admissions to special care baby units (SCBUs) vary from 15% to 27% of live born children. These variations in admission rates do not correlate with the percentage of low birth-weight babies born in each region, nor with the perinatal mortality rate. However, they correlate positively with the provision of cots for special newborn care and with how close the baby was to such a facility when born. A large number of full-term babies are admitted with no disease, but simply for observation. These babies come predominately from deliveries in consultant obstetric units which also have SCBUs, so that admissions for observation are most probable for the group of babies receiving the highest standards of care and therefore are least in need of it. Some of the disadvantages of unnecessary admissions are described.

A change in admission policy at one SCBU resulted in the number of full-term babies admitted to SCBU dropping from 928 in 1972 to 163 in 1975. The effects of pressures to fill the cots in such units, of competition between units, and of other factors influencing admission are discussed.