The cost of preterm birth: the low cost versus high value of tocolysis

Abstract

The consequences of preterm birth (PTB), to the individual and society at large, remain a major financial and personal burden. Babies born at the limits of viability, who survive, often have major neurological impairments, such as cerebral palsy, developmental delay and blindness. The cost of initial hospitalisation is more than $200 000 for each birth but takes no account of future costs once they leave the hospital. The major morbidities associated with extreme prematurity are respiratory distress syndrome (RDS), intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC). With advancing gestational age at birth, the financial costs and morbidity associated with these conditions decrease. The major morbidities (RDS, IVH and NEC) are rare by 34 weeks of gestation, with the exception of RDS, which complicates 7% of deliveries at this gestational age. While the vast majority of infants survive the first year of life, the infant mortality rate is markedly increased by three‐ to five‐fold even for the mildly preterm infants, as compared with that of the term infants. Neonates born after 34 completed weeks of gestation rarely have mortality or major morbidity, but the financial costs remain significant ($7000 per case), and efforts to prevent delivery at this gestational age are probably indicated. Economic costs associated with PTB include the cost of initial hospitalisation, the cost of any chronic diseases resulting from the prematurity and social costs including loss of gainful employment by a family member taking care of the infant or child and loss of potential future earnings of the affected child. Antenatal steroids, if given to the mother at least 48 hours prior to a PTB, have shown significant reductions in RDS, IVH and NEC. Efforts to prevent, or avoid, PTB include the use of tocolytic agents which have been shown to prolong gestation for a minimum of 48 hours, or longer in some cases. The range of tocolytic agents used to delay or prevent PTB work through many different pathways, with varying degrees of success. Which tocolytic agent to use depends on many factors including underlying maternal status, gestational age of the fetus and documented efficacy of agent used.

Nutritional modulation of the gut microbiota and immune system in preterm neonates susceptible to necrotizing enterocolitis

“…The tendency for earlier delivery is most evident in industrialized countries [1][2][3], partly resulting from advanced medical facilities which improve the survival rate of these preterm infants [4]. One of the consequences of preterm delivery is an increase in the proportion of preterm infants suffering from gastrointestinal complications, including necrotizing enterocolitis (NEC) [5].…”

Saliva Estriol Levels in Women with and Without Prenatal Antidepressant Treatment

“…Preterm birth affects between 7 and 15% of all births in the United States, is a leading cause of perinatal morbidity and mortality, and poses significant financial burdens (1). Though morbidity is most concerning with early preterm births, studies have reported increased rates of neonatal medical problems and increased hospital costs both at delivery and for readmission in the first year of life for premature infants born between 35 and 37 weeks of age (late preterm birth) (2)(3)(4).…”

Comparison of effects of nifedipine and ritodrine on maternal and fetal blood flow patterns in preterm labor

“…Preterm birth accounts for approximately two-thirds of neonatal mortality. In particular, in underdeveloped and developing countries, it causes serious social and economic loses (4). Therefore, it is important to prevent or delay preterm births to improve the perinatal outcome.…”