Cost of neonatal care according to gestational age at birth and survival status

John, Elizabeth; Nelson, Kathleen G.; Cliver, Suzanne P.; Bishnoi, Rita R; Goldenberg, Robert L.

doi:10.1016/s0002-9378(00)70509-6

Cited by 125 publications

(68 citation statements)

References 6 publications

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“…1,2 Despite modern advances in neonatal care, mortality remains frequent, with rates reported between 18% and 63%. [2][3][4][5][6][7][8] Clinical management of critically ill neonates, 9 and with NEC in particular, carries considerable financial costs. 10,11 If medical management fails, operative management is pursued, including either laparotomy or placement of a percutaneous peritoneal drain.…”

Section: What This Study Addsmentioning

confidence: 99%

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

et al. 2015

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BACKGROUND AND OBJECTIVES: Despite previous studies demonstrating no difference in mortality or morbidity, the various surgical approaches for necrotizing enterocolitis (NEC) in infants have not been evaluated economically. Our goal was to compare total in-hospital cost and mortality by using propensity score-matched infants treated with peritoneal drainage alone, peritoneal drainage followed by laparotomy, or laparotomy alone for surgical NEC. RESULTS: Successful propensity score matching was performed with 699 infants (peritoneal drainage, n = 101; peritoneal drainage followed by laparotomy, n = 172; and laparotomy, n = 426). Average adjusted cost for peritoneal drainage followed by laparotomy was $ CONCLUSIONS: Propensity score-matched analysis of surgical NEC treatment found that peritoneal drainage followed by laparotomy was associated with decreased mortality compared with peritoneal drainage alone but at significantly increased costs. WHAT'S KNOWN ON THIS SUBJECT:Mortality rates and health care expenditures are high among infants requiring surgery for necrotizing enterocolitis. The impact of different surgical managements on mortality remains equivocal. Adjusted economic differences for various surgical treatments may exist but have not been elucidated. WHAT THIS STUDY ADDS:After performing a relatively large-scale, adjusted analysis of cost and mortality for surgical managements currently used for treating necrotizing enterocolitis, a costbenefit for a particular surgical approach was demonstrated while accounting for comorbidities and group assignment bias.

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Section: What This Study Addsmentioning

confidence: 99%

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

et al. 2015

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“…There are profound public health implications to prematurity, as US data from 2000 showed that of USD 10.2 billion spent per year on initial newborn care, 57% of the money was spent on the 9% of babies born at <37 weeks of gestation [14]. In 2003, more than USD 10 billion was spent on the 12.3% born preterm [15].…”

Section: The Problemmentioning

confidence: 99%

Fetal Reduction: 25 Years' Experience

2014

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Fetal reduction (FR) began in the 1980s to salvage the pregnancies of couples needing fertility therapy who were finally successful but with too many fetuses. Since then, it has gone from a rarity performed in only the highest risk situations to an integral fail-safe of infertility practice. Our understanding of the problems of multiple and premature births has increased - even twins carry 4-5 times more risk than singletons. Evaluation of fetuses before FR has permitted more intelligent choices and improved resultant outcomes. We now perform chorionic villus sampling in approximately 85% of cases, obtain fluorescent in situ hybridization (FISH) results overnight, and then perform FR the next day. Decisions about which to reduce prioritize anomalies, but now can include fetal gender in the decision process, as couples are now just as likely to want girls as boys. In Mendelian cases, sophisticated molecular analyses permit diagnoses before FR, and new uses such as paternity analysis can be performed. Ethical arguments have also evolved; as with many technologies in which the start was for only ‘life or death cases', FR has also moved into ‘quality of life' issues. FR of twins to a singleton now compromise about 30% of our cases.

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“…Among the infant survivors, 23% suffer a major neurological disability (WilsonCostello et al, 2007), and it is estimated that just the initial in-hospital care after birth costs $10 billion annually (St. John et al, 2000). In the United States, there has been a 20% increase in the preterm birth rate from 1990 to 2005, to 12.7% of all births (Hamilton et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

In vivo ultrasonic attenuation slope estimates for detecting cervical ripening in rats: Preliminary results

Bigelow

McFarlin

O’Brien

et al. 2008

The Journal of the Acoustical Society of America

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To effectively postpone preterm birth, cervical ripening needs to be detected and delayed. As the cervix ripens, the spacing between the collagen fibers increases and fills with water, hyaluronan, decorin, and enzymes suggesting that the ultrasonic attenuation of the cervix should decrease. The decrease in ultrasonic attenuation may be detectable, leading to an effective means of detecting cervical ripening. Herein, the traditional attenuation slope-estimation algorithm based on measuring the downshift in center frequency of the ultrasonic backscattered signal with propagation depth was modified and applied to the cervix of rats. The modified algorithm was verified using computer simulations and an ex vivo tissue sample before being evaluated in in vivo animal studies. Sphericallyfocused f/3 transducers with 33-MHz center frequencies and with 9-mm focal lengths were used in both the simulations and experiments. The accuracy was better than 15% in the simulations, and the attenuation slope of the cervix in the ex vivo experiment was 2.6±0.6 dB/cm-MHz, which is comparable to 2.5±0.4 dB/cm-MHz measured using a through-transmission insertion loss technique. For the in vivo experiments, a statistically significant effect of ultrasonic attenuation with gestational age was not observed. The large variances in the in vivo results were most likely due to the natural variation in attenuation for biological tissue between animals.

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Cost of neonatal care according to gestational age at birth and survival status

Cited by 125 publications

References 6 publications

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

Fetal Reduction: 25 Years' Experience

In vivo ultrasonic attenuation slope estimates for detecting cervical ripening in rats: Preliminary results

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