The Impact of Preterm Birth on Hospital Inpatient Admissions and Costs During the First 5 Years of Life

Petrou, Stavros; Mehta, Ziyah; Hockley, Christine; Cook-Mozaffari, Paula; Henderson, Jane; Goldacre, Michael J

doi:10.1542/peds.112.6.1290

Cited by 218 publications

(177 citation statements)

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“…While differences in study design, cost accounting methods and health-care delivery systems make comparisons difficult, it appears that the cost of readmission in our study represents a smaller portion of the total in-patient cost of premature infants than those reported in the previously mentioned recent studies from Europe. 6,7 Similar to the study from the United Kingdom, 7 we found increased average cost per admission among infants <28 and <32 weeks compared to infants at 33 to 35 weeks.…”

Section: Discussionsupporting

confidence: 79%

“…The other study reviewed the cost and causes of hospitalization in the first 5 years of life for 240 000 infants of all gestational ages born in the United Kingdom between 1970 and 1993. 7 These authors found that average hospital readmissions within the first year of life for surviving preterm infants actually cost more than the average initial birth admission, and that hospital readmissions within the first year of life for the most premature infants (<28 weeks gestation) cost 30-fold more than those for term infants.…”

Section: Introductionmentioning

confidence: 99%

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Cost, causes and rates of rehospitalization of preterm infants

Danielsen²,

2007

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Objective: To examine hospital readmissions for premature infants during the first year of life.Study Design: The California maternal and newborn/infant hospital discharge records were examined for subsequent readmission during the first year of life for all newborns from 1992 to 2000. Discharge diagnoses, hospital days, demographic data and hospital charges for infants born preterm (<36 weeks gestation) were identified and evaluated.Result: About 15% of preterm infants required at least one rehospitalization within the first year of life (average cost per readmission $8468, average annual cost in excess of $41 million). Infants with gestational age <25 weeks had the highest rate of readmission (31%) and longest average length of stay (12 hospital days). The largest cohort, infants born at 35 weeks gestation, had the highest total cost of readmission ($92.9 million). The most common cause of rehospitalization was acute respiratory disease. There was no decrease in the number or cost of readmissions of premature infants for respiratory syncytial virus infections following the introduction of palivizumab in 1998. Conclusion:After initial discharge, premature infants continue to have significant in-patient health-care needs and costs.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Cost, causes and rates of rehospitalization of preterm infants

Danielsen²,

2007

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“…4,5 Hospitalization for preterm contractions with suspected imminent preterm delivery poses a major burden on health services, and costs and accounts for more than one-third of obstetric admissions before delivery. 6,7 Although used in prenatal genetic screening programs since the 1980s 8 and also for risk assessment of preterm labor, 9 the predictive power of pregnancy-associated plasma protein A (PAPP-A) in the second trimester for preterm delivery is still considered speculative. 10 In assessing the predictive value of first-trimester PAPP-A for preterm delivery and fetal growth restriction in a selected study group of pregnancies achieved via assisted technologies, only weak associations have been found.…”

Section: Introductionmentioning

confidence: 99%

PAPP-A levels as an early marker of idiopathic preterm birth: a pilot study

et al. 2007

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Objective: To evaluate late PAPP-A levels as predictive of preterm birth in symptomatic women.Study Design: Prospective cohort study of singleton gestations, 23 to 34 weeks, and symptoms of preterm labor. PAPP-A, IGF-I and IGF-III analysis were performed. Primary end point was delivery p7 days. Accuracy and optimally predictive PAPP-A values were based on receiver operator characteristic (ROC) curves.Result: In all, 26 women (51%) delivered p7 days post-admission (Group 1); 25 women (49%) >7 days (Group 2). Group 1 mean PAPP-A ¼ 38 000 vs 55 333 for Group 2 (P<0.04). Group 1 mean gestational age at delivery ¼ 29 weeks vs 37 weeks for Group 2 (P<0.00014). PAPP-A level p30 000 mU l À1 had highest specificity (88%), sensitivity (50%), and positive predictive (81%) and negative predictive (62%) values for delivery p7 days. ROC area under curve ¼ 0.703.Conclusion: PAPP-A levels p30 000 mU l À1 at admission was associated with increased risk for preterm birth p7 days, supporting active management and therapeutic approach in these women.

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“…Preterm infants often require intensive care that is associated with emotional and economic costs to both the family and society [5].…”

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confidence: 99%

Nifedipine versus Terbutaline, Tocolytic Effectiveness and Maternal and Neonatal Adverse Effects: A Randomized, Controlled Pilot Trial

Padovani

Guyatt

Lopes

2014

Basic Clin Pharma Tox

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Although previous evidence suggests advantages of nifedipine over terbutaline as tocolytic agents, in some jurisdictions, terbutaline is approved for use and nifedipine is not. In women in preterm labour, we compared the impact of terbutaline versus nifedipine on inhibition of uterine contractions, preterm birth, neonatal sepsis, intracranial haemorrhage or necrotizing enterocolitis, death or admission to a neonatal intensive care unit and maternal adverse reactions. We randomized 32 women to nifedipine and 34 to terbutaline. We found no difference between groups in tocolysis or preterm birth. No serious maternal adverse effects or serious neonatal adverse outcome occurred in either group. Less serious maternal adverse effects less common with terbutaline included flushing (2.94% versus 43.7%) and headache (5.9% versus 31.2%). The administration of terbutaline increased tremor (76.4% versus 0%), nausea (58.8% versus 9.4%) and dizziness (29.4% versus 6.25%). The total number of side effects, and the proportion of women experiencing one or more side effects, proved greater with terbutaline. In this study, terbutaline and nifedipine performed similarly in their tocolytic effects. Each drug has specific side effects, although overall, nifedipine was associated with fewer adverse effects.Premature birth is common (over 5% and, in some countries, over 10%) [1,2] and is responsible for approximately 75% of all neonatal deaths and 50% of childhood neurological morbidities [3,4]. Preterm infants often require intensive care that is associated with emotional and economic costs to both the family and society [5].Approximately 75% of preterm birth is attributable to spontaneous preterm labour [1]. Delay in preterm labour therefore provides a potential opportunity for decreasing neonatal morbidity and mortality [6].The optimal medical management of threatened preterm labour is controversial [7]. Despite theoretical benefits of keeping the foetus in utero long enough to enable administration of a full course of corticosteroids to assist in foetal lung maturation, and to organize transfer to an appropriate neonatal care unit, no agent has been shown to improve neonatal outcome [2,7]. Thus, the choice of therapy has focused on delay in delivery and minimization of adverse effects.The drugs registered for tocolysis include the b adrenoceptor agonist ritodrine (United States and Europe), terbutaline (Brazil) and the oxytocin receptor antagonist atosiban (Europe) [8]. Calcium channel blockers (nifedipine) and cyclooxygenase inhibitors (indomethacin) are also used for inhibiting preterm labour although, in many countries, they are not currently registered for this indication [9].Betamimetics (isoxsuprine, ritodrine, terbutaline, fenoterol and salbutamol) delay labour [10][11][12], but their use has been limited by a high incidence of maternal adverse effects [10,13,14]. Many centres use nifedipine, which also has established effectiveness in delaying labour [15] and has advantages of oral administration and relatively low...

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The Impact of Preterm Birth on Hospital Inpatient Admissions and Costs During the First 5 Years of Life

Abstract: Preterm birth is a major predictor of how much an individual will cost hospital service providers during the first 5 years of life.

Cited by 218 publications

References 29 publications

Cost, causes and rates of rehospitalization of preterm infants

Cost, causes and rates of rehospitalization of preterm infants

PAPP-A levels as an early marker of idiopathic preterm birth: a pilot study

Nifedipine versus Terbutaline, Tocolytic Effectiveness and Maternal and Neonatal Adverse Effects: A Randomized, Controlled Pilot Trial

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