409 Neuronal Damage After Moderate Hypoxia and Erythropoietin

Abstract

Background: Necrotizing enterocolitis (NEC) is a serious complication among pre-term infants. Surfactant replacement therapy can help to prevent respiratory distress syndrome (RDS) among very low birth weight (VLBW) pre-term infants. Currently, there are no pharmacoeconomic analyses that estimate the cost savings in preventing RDS among pre-term infants diagnosed with NEC who receive surfactant therapy.Objectives: To estimate the economic impact of the synthetic protein-containing surfactant lucinactant (Surfaxin) and pooled animal-derived surfactants (beractant [Survanta] and poractant alfa [Curosurf]) in the prevention of RDS among surviving pre-term infants weighing 600 to 1,250 grams who have been diagnosed with NEC.Methods: A decision-analytic model was developed using a hospital perspective to estimate the economic impact of initial length of stay in the neonatal intensive care unit (NICU) for pre-term infants with NEC. Clinical outcomes consist of the average initial NICU length of stay from the combined Phase III randomized, controlled clinical trials of surfactant therapy (SELECT and STAR). The cost input was the average cost of treating surviving pre-term infants with medical NEC, U.S. $2,039, the combined level II and level III NICU cost per day (2002).Results: Pre-term infants with NEC who survived and received lucinactant had 2.27 fewer initial NICU days compared to the pooled animal-derived cohort (73.73 versus 76.00 days, respectively). The estimated average cost of an initial NICU stay per infant was U.S. $150,320 for infants receiving lucinactant compared to U.S. $154,948 for infants receiving animal-derived surfactants. Due to fewer NICU days, lucinactant therapy results in a medical cost savings of U.S. $4,628 per infant.Conclusion: Among surviving pre-term infants diagnosed with NEC who received surfactant therapy, the synthetic protein-containing surfactant lucinactant reduced total initial NICU hospital costs when compared to pooled animal-derived surfactants. Anecdotal evidence, however, suggests that cyanotic episodes are more common in neonates sleeping supine. We wanted to determine whether term neonates do indeed have more episodes of intermittent hypoxia in the supine than in the side position. INTERMITTENT HYPOXIA IN SUPINE VERSUS SIDE POSITION IN 1-5 D OLD TERM NEONATESMethods: We enrolled 1-5 day old term neonates in a controlled 2-phase cross-over study design. They were randomised to sleep, for 6 h each, either in supine followed by side position (right or left) or vice versa. Pulse oximeter saturation (SpO2) values and a signal quality indicator were recorded throughout (VitaGuard VG 300 with Masimo SET, Irvine, CA; 2-4 s averaging). Only recordings lasting at least 3 h in either position were included. Desaturation events to Ͻ85% and Ͻ80% SpO2 were analysed, excluding events with poor signal quality.Results: 477 neonates had recordings of sufficient duration. Mean duration of analyzable signal was 4.93 h for supine and 4.89 h for side position. 38% and 75%, respectively, of in...