Impact of Neonatal Intensive Care Technology on Neonatal Mortality

Objective: To analyze the association between the level of complexity of neonatal intensive care units (NICUs) and neonatal mortality in Brazil, as well as the geographical distribution of NICU beds and variations in mortality rates over time. Materials and Methods: Data were extracted from two national databases: the National Registry of Healthcare Facilities (CNES) and the Hospital Information System of the Brazilian Unified Health System (SIH/SUS). CNES data were used to identify healthcare facilities with NICUs in Brazil, their classification by level (Type I, II, or III), and their distribution by state. These data were organized into a descriptive table. SIH data were used to analyze the following variables: NICU type, sex, age, length of hospital stay, hospitalization outcome (discharge or death), and admission date. All records of neonatal intensive care admissions in Brazil between January 1, 2008, and December 31, 2023, were included, while incomplete records were excluded. Descriptive analysis included absolute and relative frequencies for categorical variables and measures of central tendency and dispersion for numerical variables. Associations between categorical variables and neonatal death were assessed using the chi-square test, Mantel–Haenszel test, and G-test. Results: Type III NICUs had a lower neonatal mortality rate (10.6%) than Type II (11.2%) and Type I (12.0%) NICUs (p < 0.001). The study identified 10,244 neonatal intensive care beds in Brazil, including 1,632 (15.9%) Type I beds, 6,988 (68.2%) Type II beds, and 1,624 (15.9%) Type III beds. Geographical analysis revealed regional disparities, with Type III NICUs concentrated in the Southeast and South and a shortage of these beds in the North and Northeast. Graphical analysis suggested a downward trend in neonatal mortality rates between 2008 and 2021, particularly in Type II and III NICUs. Conclusion: Neonatal intensive care units with greater technological complexity (Type III) are associated with lower mortality rates. Regional inequalities in the distribution of these beds may contribute to disparities in neonatal outcomes, highlighting the importance of public policies aimed at promoting greater equity in access to neonatal intensive care in Brazil.