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Tiny babies, big bills: the vital role of the NICU in sustaining lives and health systems

Journal of Perinatology (2026)Cite this article

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Neonatal intensive care units (NICUs) embody one of modern medicine’s most striking paradoxes: they are both sanctuaries of survival for society’s most vulnerable patients and among the most resource-intensive environments in health care. The recent study by Vance et al., “Trends in Admissions and Costs for Neonatal Intensive Care in US Children’s Hospitals, 2017–2022,” in this issue of the Journal offers a timely reflection on how these dual realities have evolved [1]. Their analysis reveals rising admissions, increasing clinical complexity, and sharply escalating costs within the context of children’s hospitals and departments of Pediatrics that rely heavily on NICU services to deliver both life-saving care and financial stability.

While extremely preterm infants (<27 weeks, especially 22–23-week gestational age) remain disproportionately resource-intensive, the study found that term infants—often overlooked in cost analyses—comprise nearly half of NICU admissions and account for about one-quarter of total NICU costs. Within tertiary/quaternary children’s hospitals, these infants are increasingly admitted for complex congenital surgical conditions. Their inclusion underscores how neonatal intensive care has become a hub not only for fragile preemies but also for full-term infants with sophisticated medical and surgical multidisciplinary needs. Copyright Satyan Lakshminrusimha, used with permission.

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Fig. 1: The benefit-risk proposition is a fine balance between the value of neonatal intensive care unit (NICU) care versus risks, cost and burden.

References

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Authors and Affiliations

  1. Department of Pediatrics, UC Davis Children’s Hospital, Sacramento, CA, USA

    Satyan Lakshminrusimha

  2. Nemours Children’s Health, Wilmington, DE, USA

    Ashleigh B. Harlow

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  1. Satyan Lakshminrusimha
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  2. Ashleigh B. Harlow
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SL-first draft of the article. ABH-critical review and editing.

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Correspondence to Satyan Lakshminrusimha.

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Lakshminrusimha, S., Harlow, A.B. Tiny babies, big bills: the vital role of the NICU in sustaining lives and health systems. J Perinatol (2026). https://doi.org/10.1038/s41372-026-02559-3

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