More Babies, More Complex Care, Higher Bills: What a New Six-Year Study Found Inside America's Children's Hospitals

Understanding a 2026 Analysis of NICU Admissions and Costs and What It Means for Families

Why This Matters

A large new analysis of more than 234,000 newborns treated in America's children's hospital NICUs between 2017 and 2022 found that babies admitted to these units are, on average, sicker and more medically complex than before, and that the cost of their care has climbed accordingly. For families who may one day walk into a neonatal intensive care unit (NICU) for the first time, understanding why can make an overwhelming experience feel a little less disorienting.

The Problem This Study Was Trying to Solve

For decades, when people pictured a "NICU baby," they pictured a very premature infant — tiny, fragile, born many weeks too soon. That picture is not wrong, but it is incomplete, and a large new study of 234,571 newborns treated at 39 US children's hospitals set out to test just how incomplete it had become ([1]). The question mattered because how hospitals plan and budget for neonatal care has long followed that same, narrower picture. Public health researchers had already begun to notice, in national birth-certificate records, that the number of babies admitted to NICUs was climbing — and that the fastest growth was not among the smallest, most premature infants, but among babies born only a little early, or even at full term ([2]). Earlier tracking of national admission patterns, going back to 2008, had shown this growth was also uneven across different communities ([3]). At the same time, hospitals equipped to handle the most complicated newborns — the ones with the most advanced equipment and the most specialists on staff — were becoming more concentrated in fewer, larger centers ([4], [5]). Separately, research looking at children of all ages, not just newborns, had already shown that kids with several ongoing health conditions at once account for a disproportionate share of both hospital cost and hospital readmissions ([6], [7]) — a pattern researchers suspected, but had not yet confirmed, was also true specifically inside the NICU. What nobody had done yet was connect all these dots: how many babies are actually coming in, how sick they are, how long they stay, and what it costs, all in the same picture, focused specifically on the children's hospitals that care for the most complicated newborns in the country.

How the Study Was Done

Researchers used a database called the Pediatric Health Information System, which collects detailed hospital records from 39 children's hospitals across the United States — the kind of large academic medical centers that typically care for the sickest newborns, including those transferred in from smaller community hospitals. They looked at every baby admitted to a NICU bed at one of these hospitals between January 2017 and December 2022: 234,571 infants in total. For each baby, they recorded how premature the baby was, whether the baby had any serious ongoing medical conditions (grouped into categories like heart, lung, digestive, and neurological problems, using a standard classification system doctors and researchers rely on for this kind of tracking ([8])), how long the baby stayed in the hospital, and how much the hospitalization cost, adjusted so that dollar amounts could be fairly compared across different years and different hospitals. They also used a statistical technique to separate out the unusual disruption of the COVID-19 pandemic year, 2020, so they could see whether cost increases were a temporary pandemic blip or something that kept climbing afterward.

What the Researchers Found

The results told a story with several layers. Babies born very early — extremely premature, before 27 weeks of pregnancy — and moderately early babies were admitted in noticeably higher numbers by the end of the study: 10% more extremely premature babies, 16% more very premature babies, and 18% more moderately premature babies compared to the start of the study period. But full-term babies — born at 37 weeks or later — remained, every single year, the single largest group of babies in the NICU, making up about 45% of all admissions. The babies being admitted were also, on the whole, more medically complicated than before: the share with at least one serious chronic health condition rose from about 47% to 51% of all NICU babies over the six years, and hospital stays grew a bit longer on average, with fewer quick, uncomplicated stays and more that stretched past a month. On cost, the typical NICU hospitalization rose from about $24,000 in 2017 to about $29,000 in 2022, adjusted for inflation. But the way that cost was distributed is perhaps the most striking finding: extremely premature babies made up only 7% of all NICU admissions, yet their care accounted for nearly 29% of total NICU spending, with a typical hospitalization costing around $275,000 and lasting about 84 days — reflecting how much specialized, round-the-clock care the smallest babies need over many weeks. Full-term babies, by contrast, typically cost around $15,000 per hospitalization — far less per baby — but because there are so many of them, their care added up to about 24% of total NICU spending, almost as much as the extremely premature group. The study also found that while costs jumped noticeably during 2020, the increase did not stop when the pandemic eased; costs kept climbing afterward, suggesting something more lasting is driving the trend. It is worth noting what the study did not find changing dramatically: the share of babies discharged home stayed steady at around 89% every single year, and in-hospital mortality held roughly stable, between 3.5% and 3.7%. In other words, more babies with more complex needs are coming through NICU doors and staying longer, but the fundamental outcome for the overwhelming majority of families — bringing their baby home — has not shifted.

What This Means for Families

For a family whose baby ends up in a NICU, this study offers two reassuring and two sobering pieces of context. First, the reassuring: it confirms that the vast majority of NICU babies eventually go home, and this kind of intensive, specialized care exists precisely because it improves outcomes for babies who need it — most infants who spend time in a NICU, including many who spend a long time there, go on to grow and thrive. Second, understanding that a baby's NICU stay is expensive is not a reflection of anything a family did or didn't do; it reflects genuinely complex, resource-intensive medical care, whether that baby was born many weeks early or born at full term but with an unexpected medical condition. The more sobering context is twofold: NICU care, and the health conditions that bring babies there, are becoming more medically complex over time, which is part of why hospital stays and specialist involvement can feel more intensive than families might expect; and the dollar figures in this study describe what hospitals spend to provide care, not necessarily what a family will personally be billed, since insurance coverage, government programs, and hospital financial assistance policies vary enormously and were not part of what this study measured. Families navigating a NICU stay, especially one involving a baby with multiple medical needs, are often connected with care coordination support — nurses, social workers, or case managers who help organize follow-up appointments across different specialists after discharge — and research on these programs suggests they can meaningfully ease that transition home ([9]). It can also help simply to know what a NICU is built to do: it is a hospital unit staffed around the clock with specialists in newborn medicine, equipped to support breathing, feeding, temperature control, and monitoring for babies whose bodies need extra help adjusting to life outside the womb, whether that help is needed for a few days or several months.

What Researchers Are Working On Next

This study is a snapshot of what is happening, not a full explanation of why, and the researchers themselves are careful to say so. Several open questions are already shaping the next wave of research. One is cost to families themselves: this study measured what hospitals spend, using their own internal accounting, not what families actually pay out of pocket after insurance — closing that gap is a priority for researchers who study the financial strain families face after a NICU stay. Another is whether these same trends — more complexity, longer stays, rising costs — are happening at smaller, community-based NICUs too, or whether they are specific to the large academic children's hospitals this study examined; a broader look across all types of NICUs, not just the largest ones, would help answer that question, building on frameworks already proposed for comparing resource use fairly across NICUs of different sizes and complexity levels ([10]). A third is simply better support for the specific, and until recently under-recognized, group of full-term babies who need intensive care for unexpected reasons — research focused specifically on this group's needs, historically overshadowed by the focus on prematurity, is still catching up. For now, this study offers families and the clinicians who care for their babies a clearer, more honest picture of what is actually happening inside the country's NICUs — one that goes beyond "babies born too soon" to capture the fuller, more complicated reality of who needs this kind of care, and why.

References

  1. Vance AJ, Richardson T, King B, et al. Trends in admissions and costs for neonatal intensive care in US children's hospitals, 2017–2022. J Perinatol. 2026;46(6):1035-1043. doi:10.1038/s41372-026-02619-8 ↩
  2. Martin JA, Osterman MJK. Increases in Neonatal Intensive Care Admissions in the United States, 2016–2023. NCHS Data Brief. 2025;No. 525. doi:10.15620/cdc/174581 ↩
  3. Kim Y, Ganduglia-Cazaban C, Chan W, Lee M, Goodman DC. Trends in neonatal intensive care unit admissions by race/ethnicity in the United States, 2008–2018. Sci Rep. 2021;11:23795. doi:10.1038/s41598-021-03183-1 ↩
  4. Boghossian NS, Geraci M, Phibbs CS, Lorch SA, Edwards EM, Horbar JD. Trends in Resources for Neonatal Intensive Care at Delivery Hospitals for Infants Born Younger Than 30 Weeks' Gestation, 2009-2020. JAMA Netw Open. 2023;6(5):e2312107. doi:10.1001/jamanetworkopen.2023.12107 ↩
  5. Pineda R, Knudsen K, Breault CC, Rogers EE, Mack WJ, Fernandez-Fernandez A. NICUs in the US: levels of acuity, number of beds, and relationships to population factors. J Perinatol. 2023;43(6):796-805. doi:10.1038/s41372-023-01693-6 ↩
  6. Berry JG, Ash AS, Cohen E, Hasan F, Feudtner C, Hall M. Contributions of Children With Multiple Chronic Conditions to Pediatric Hospitalizations in the United States: A Retrospective Cohort Analysis. Hosp Pediatr. 2017;7(7):365-372. doi:10.1542/hpeds.2016-0179 ↩
  7. Cohen E, Berry JG, Camacho X, Anderson G, Wodchis W, Guttmann A. Patterns and Costs of Health Care Use of Children With Medical Complexity. Pediatrics. 2012;130(6):e1463-e1470. doi:10.1542/peds.2012-0175 ↩
  8. Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr. 2014;14:199. doi:10.1186/1471-2431-14-199 ↩
  9. Vance AJ, Benjamin A, Hsu J, Berry JG. Care Coordination Programs for Infants With Complex Conditions: A Systematic Review. Pediatrics. 2023;152(1):e2022061083. doi:10.1542/peds.2022-061083 ↩
  10. King BC, Richardson T, Patel RM, Lee HC, Bamat NA, Hall M, Slaughter JL. Prioritization framework for improving the value of care for very low birth weight and very preterm infants. J Perinatol. 2021;41(10):2463-2473. doi:10.1038/s41372-021-01114-6 ↩