Abstract
We aimed to evaluate whether neonatal intensive care unit (NICU) intensivist staffing is associated with improved survival outcomes among neonates admitted to NICUs in South Korea. This nationwide retrospective cohort study included all neonates hospitalized in NICUs between January 1, 2019, and December 31, 2021. Patients were categorized into two groups based on intensivist staffing: the intensivist group, comprising neonates admitted to hospitals with full-time NICU intensivists, and the non-intensivist group, comprising those treated in hospitals without dedicated NICU intensivist coverage. A total of 79,306 neonates were included in the final analysis; among them, 44,330 (56.1%) were admitted to NICUs with registered NICU intensivists. In multivariable logistic regression analysis, the intensivist group had a significantly lower odds of 30-day mortality (odds ratio [OR]: 0.73; 95% confidence interval [CI] 0.58-0.92; P = 0.007) compared to the non-intensivist group. Similarly, in Cox regression analysis, the intensivist group showed a lower risk of 1-year all-cause mortality (hazard ratio: 0.79; 95% CI 0.69-0.91; P = 0.001). These findings suggest that the presence of dedicated NICU intensivists is associated with improved short- and long-term survival outcomes among neonates, supporting policies to enhance specialized staffing in neonatal intensive care settings.