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The association of regional perinatal risk factors and neonatal intensive care capacity for Military Health System-insured newborns



To characterize hospitals where military-insured newborns received care and test the association of regional perinatal risk with neonatal intensive care unit (NICU) capacity.

Study design

We identified birth hospitals for live newborns October 2015–December 2018 (n = 296,568) and assigned newborns to health service areas (HSAs). Perinatal risk factors and the number of neonatal special care beds and neonatologists were calculated at HSA levels. Cross-sectional correlation analyses assessed perinatal risk factors and capacity across HSAs.


27.0% (n = 10) of military birth hospitals had special care beds (intermediate and intensive) compared with 44.3% of civilian hospitals (n = 1224; p < 0.05). The number of special care beds and neonatologists per newborn varied more than twofold across regions and were only weakly associated with the proportion of higher risk newborns (R2 < 0.05).


The lack of meaningful association of regional perinatal risk with NICU capacity poses challenges for effective specialized care among military-associated newborns.

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Fig. 1: Associations of regional NICU capacity and perinatal risk measures among MHS-insured singletons (n = 296,568), DoD BIHR program data, October 2015–December 2018.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to security protocols and privacy regulations, but they may be made available on reasonable request by the Naval Health Research Center Institutional Review Board (contact phone +1 619 553 8400).


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The authors would like to thank the expert research support of Julie Doherty and Jordan Taylor of the Geisel School of Medicine at Dartmouth. Kathy Snell and Sandra Magallon at the Naval Health Research Center provided invaluable assistance in the analyses.


This study was funded by the US Department of Defense, Defense Health Agency Research Program.

Author information

Authors and Affiliations



DCG conceptualized and designed the study, obtained the funding, drafted the paper, and edited the paper according to author’s comments. CJR, CH, and ATB obtained the administrative data, conducted the analyses, and drafted the Methods section. TSM obtained the military treatment facility capacity data. CJR, CH, ATB, TSM, GRG, ASC, and RJV critically reviewed the paper for important intellectual content. JKL collaborated in obtaining the funding and provided critical review and editing of the manuscript.

Corresponding author

Correspondence to David C. Goodman.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by the Institutional Review Board at the Naval Health Research Center (protocol number NHRC.1999.0003) and the Committee for the Protection of Human Subjects at Dartmouth College (protocol number STUDY00032167). The study was performed in accordance with the Declaration of Helsinki and informed consent was waived in accordance with criteria set forth by 32 CFR § 219.116(d).

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Goodman, D.C., Romano, C.J., Hall, C. et al. The association of regional perinatal risk factors and neonatal intensive care capacity for Military Health System-insured newborns. J Perinatol (2023).

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