Rationale: Despite intense interest in allocation of resources to neonatal intensive care, no description exists of resource use by the large numbers of newborns admitted for short term(“triage”) evaluation.

Methods: Data were collected prospectively on 2486 inborn infants admitted to two NICUs for less than 24 hours and subsequently discharged to routine care. Over the eleven month study period, these two hospitals delivered 15,097 live births and admitted 1837 additional infants for NICU care. On a 50% random subsample, we calculated severity of illness using the Score for Neonatal Acute Physiology (SNAP) and applied a NICU resource checklist. Daily NICU workload was estimated according to the number and labor intensity of NICU admissions using Medicus (nursing workload) and SNAP. Length of stay (LOS) for triage was correlated with diagnoses, perinatal descriptors, severity of illness, and markers of concurrent NICU workload using stepwise regression.

Results: Mean birthweight for triage infants was 3367g(>2500g: 91%, 2000-2500g: 9%) and mean gestational age 39.1 weeks (>37 weeks: 75%, 35-37 weeks: 17%). 72% were admitted from the delivery room and 28% from the post-partum wards. 23% had respiratory distress, 3% required cardiac evaluation, and 34% underwent sepsis evaluation. Median LOS was 102 minutes, corresponding over the study period to 2% of total NICU hours but 7% of NICU days charged. In the 50% subsample, antibiotics were administered to 34%, a peripheral IV to 40%, cardiac monitoring to 53% and incubator warming to 26%. 4% required oxygen, and non-invasive oximetry was performed in 31%. In the multivariate model, LOS was increased by a respiratory diagnosis or hypoglycemia, severity of illness, lower gestational age, the need for intravenous placement, daytime shift, hospital, and lower acuity for concurrent NICU admissions (p = 0.0001, R2 = 0.24).

Conclusions: Neonatal triage is a low-acuity but time-intensive process which contributes significantly to total resource use by newborns because of the large numbers of infants involved. The length of stay is affected not only by infant medical requirements but also by markers of unit workload and shift, which may be amenable to change. This source of resource consumption should be recognized in future assessments of costs associated with neonatal intensive care.