Layered Risk in the NICU: Utilization, Readmissions and Social Vulnerability Insights From the Vizient Clinical Data Base

Welcome to another installment of the Pediatric Research at Vizient blog series. This series highlights some of the latest findings in pediatric medicine from Sg2 and Vizient®, leveraging analysis from the Vizient Clinical Data Base (CDB) to support our pediatric research efforts. Access the series using the search term Pediatric Research at Vizient for previous posts on topics ranging from firearm injury trends to rising congenital syphilis cases and more.

This blog post focuses on neonatal intensive care unit (NICU) utilization, a critical and resource-intensive component of pediatric hospital care. NICU utilization reflects both clinical severity at birth and broader structural and social factors shaping maternal and newborn health. Understanding which infants require NICU care and what happens after discharge is essential for neonatal capacity planning, care coordination and health equity efforts.

To better characterize NICU use patterns, this analysis examined newborn clinical outcomes, postdischarge readmissions and social vulnerability using recent nationwide inpatient data from the Vizient CDB. These findings were presented at the 2026 Pediatric Academic Societies Meeting, 2025 American Public Health Association National Annual Meeting and Expo, and 2025 American Academy of Pediatrics National Conference and Exhibition. (Click the following links to access the presentations and poster on these topics: NICU substance use; NICU readmissions; NICU utilization poster.) 

The study analyzed over 4 million newborn birth encounters from 2022 to 2024 across 1,111 hospitals nationwide using the CDB. Among these births, we examined subsequent emergency department visits and inpatient readmissions for the 326,476 newborns (8.2%) who received NICU services during their birth hospitalization. Community-level vulnerability was also assessed using the patent pending Vizient Vulnerability Index™, a multidimensional measure that captures social, economic and health care access factors at the zip code level.

Our findings demonstrate that the need for NICU services is not only a marker of neonatal acuity but also a signal of layered clinical and social risk that extends well beyond birth hospitalization.

Key Finding #1: NICU Utilization Reflects Both Clinical Acuity and Underlying Disparities

While NICU utilization occurred in 8.2% of births from 2022 to 2024, it was disproportionately concentrated among newborns with prematurity, low birthweight, Medicaid coverage and residence in high-vulnerability communities. Infants who received NICU services were more likely to be Black males, and they experienced substantially higher rates of neonatal morbidity and in-hospital mortality.

These patterns highlight NICU utilization as both a marker of clinical severity at birth and a signal of upstream social and structural inequities shaping maternal and newborn health.

Key Finding #2: Infants Utilizing NICUs Face Sustained Risk of Postdischarge Readmissions

Postdischarge utilization was common among infants who received NICU services, and it persisted well beyond the initial hospitalization. Within 90 days of discharge, 8.3% had an ED visit and 4.4% experienced an inpatient readmission. By one year, these rates rose to 18.6% for ED visits and 7.2% for inpatient readmissions, meaning nearly one in four infants receiving NICU services returned for hospital-based care within one year of discharge.

These findings underscore a prolonged vulnerability period after NICU discharge and point to the importance of effective care transitions and outpatient follow-up.

Source: Vizient Clinical Data Base. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com.

Key Finding #3: Prenatal Substance Use Amplifies NICU Utilization and Neonatal Complexity

Newborns affected by prenatal substance use experienced significantly higher clinical acuity and resource utilization. Nearly 18.4% required NICU care, more than double the rate among newborns without substance exposure. These infants were also more likely to be premature and had longer hospital and NICU lengths of stay. The strong overlap among prenatal substance use, NICU utilization and social vulnerability highlights the need for integrated prenatal and perinatal care models that address maternal behavioral health alongside neonatal risk.

Note: Categorical variables presented as n (%); continuous presented as median (interquartile range [IQR]).
Source: Vizient Clinical Data Base. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com.

Sg2’s Perspective

NICU utilization reflects far more than isolated clinical events at birth; it signals layered medical and social risk that extends into infancy and drives ongoing need for health care services. These findings reinforce the importance of viewing NICU care within a broader system context, where upstream maternal health, community vulnerability and postdischarge access play critical roles in outcomes.

Hospital leaders should:

• Plan for sustained NICU and postdischarge demand. Use NICU utilization and readmission trends to inform bed capacity, workforce planning and escalation pathways, recognizing that pressures extend beyond the initial hospitalization.
• Strengthen care transitions for NICU graduates. Invest in standardized discharge processes, early outpatient follow-up, and coordination with primary care and specialty services to reduce avoidable ED visits and readmissions.
• Address upstream drivers of NICU utilization. Deepen collaboration across obstetrics, neonatology, behavioral health and community partners to address prenatal substance use, social vulnerability and access barriers that contribute to high-acuity neonatal care.

By integrating clinical insight with vulnerability-informed data, health systems can better anticipate NICU demand, improve outcomes for high-risk newborns and advance more equitable models of perinatal care.

Click here to access the presentations and a poster on these topics: NICU substance use; NICU readmissions; NICU utilization poster.

Sources: Vizient Clinical Data Base. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com; Vizient Vulnerability Index™ Patent Pending. Copyright Vizient Inc. 2026. All rights reserved.