Cost of neonatal intensive care

ABSTRACT. An analysis was made of the costs of provision for the intensive care of inborn babies in an inner city hospital equipped to deal with high risk obstetrics. Costs showed the expected inverse proportion to birthweight. The larger number of more mature babies nevertheless contributed almost 2/3 of the total cost. The adjusted cost/survivor ("adjusted'to reflect the fact that only the survivors benefit) was $39,845 for babies less than 801 g; $26,100 for those between 801 g and 1,000 g; $14,137 between 1,001 g and 1,500 g and $4,782 over 1,500 g. The largest single expense was in nursing salaries which constituted 60–80% of the total outlay.
No data are available for precise comparison. The figures are presented as a basis on which to begin forming judgements of the cost effectiveness of newborn intensive care.     

Cost of neonatal intensive care

An analysis was made of the costs of provision for the intensive care of inborn babies in an inner city hospital equipped to deal with high risk obstetrics. Costs showed the expected inverse proportion to birthweight. The larger number of more mature babies nevertheless contributed almost 2/3 of the total cost. The adjusted cost/survivor ("adjusted" to reflect the fact that only the survivors benefit) was $39,845 for babies less than 801 g; $26,100 for those between 801 g and 1,000 g; $14,137 between 1,001 g and 1,500 g and $4,782 over 1,500 g. The largest single expense was in nursing salaries which constituted 60-80% of the total outlay. No data are available for precise comparison. The figures are presented as a basis on which to begin forming judgements of the cost effectiveness of newborn intensive care.     

Cost of neonatal intensive care

Neonates are among those patients generating the highest hospital costs in recent years. There are no published data on the costs of neonatal intensive care in our country. The aim of our study was to analyse the cost of neonatal intensive care in a tertiary care unit. The average hospital charges per day were higher among non-survivors, (Rs. 1857) compared to survivors (Rs. 727). Care of more than 1250 gms infant is cost beneficial in our set up.     

Cost of neonatal intensive care in a tertiary care center

BACKGROUND: The number of neonatal intensive care units (NICUs) in India has increased substantially over the last decade; yet many more are required. There is limited information on the actual costs of setting up and running an NICU in India. OBJECTIVE: Systematic and comprehensive calculation and analysis of the costs of neonatal intensive care in a tertiary care teaching hospital. METHODS: The costs were compiled by studying the detailed records of various hospital departments and prospectively documenting the costs of drugs, consumables and investigations for a representative group of 30 babies. RESULTS: The total cost of establishing a 16 bed level III tertiary care NICU was Rs 3.78 crore (Rs. 37.8 million, USdollar 860,000) (2003). Equipment cost formed two-thirds of the establishment cost. The running cost of NICU care per patient per day was Rs 5450 (USdollar 125). NICU and ancillary personnel salary comprised the largest proportion of the running costs. The average total cost of care for a baby less than 1000 grams was Rs. 168000 (USdollar 3800), Rs. 88300 (USdollar 2000) for babies 1000 g to 1250 g. and Rs. 41700 (USdollar 950) for those between 1250 to 1500 g. The family had to bear only 25 percent; rest was subsidized. CONCLUSIONS: Equipment and personnel salary form the biggest proportion of establishment and running costs. The costs of treatment for a baby in NICU should be seen in context with costs of other types of health care and the number of useful life years gained.     

Evolution of neonatal intensive care in a district general hospital.

Before 1975 in Blackburn in the Premature Baby Unit monitoring facilities were limited. Ambient oxygen monitoring, blood gas analysis, and ventilation were not being performed. Gradually, special care was introduced and from 1978-80 all babies requiring intensive care and long term ventilatory care were transferred to the Regional Neonatal Intensive Care Unit. Not all babies with incipient or established respiratory failure, however, could be accepted, and those declined had unfavourable outcomes. In 1981 local intensive and ventilatory care was begun, and since then the survival of all babies has improved considerably. Our early neonatal mortality and neonatal mortality have fallen below the regional levels. In a district general hospital it is possible to achieve survival figures comparable with those of a regional centre.     

Death in neonatal intensive care

The aim of this study was to review the frequency of decisions to withdraw treatment from neonates who had died in a large neonatal intensive care unit the reasons for these decisions, and the procedures followed. A 12 month retrospective review of medical and nursing records was undertaken. There were 67 deaths; treatment was withdrawn from 52 infants who were dead or dying, from 9 infants on the basis of a severe congenital abnormality, and from 6 infants with severe acquired brain damage. The decision-making process and the management of treatment withdrawal are reviewed. It is concluded that withdrawal of treatment resulting in death occurs frequently in the neonatal intensive care service of National Women's Hospital, Auckland, New Zealand, but is usually a recognition of the inevitable. Truly elective withdrawal of treatment is uncommon in the immature infant, but does occur in the context of multiple abnormalities or severe birth asphyxia, where it follows a formal procedure.     

Breast-feeding in neonatal intensive care

Objective : To determine the incidence of breast-feeding in very preterm babies while in neonatal intensive care.
Methodology : A retrospective records analysis of all 151 babies with gestational age less than 35 weeks admitted to the neonatal intensive care unit (NICU) of a major teaching hospital in 1993.
Results : On discharge 64% of babies were having some breast milk (45% having breast milk alone, 19% both breast milk and formula), and 38% some breast-feeding (17% being solely breast-fed, the other 21% combining breast-feeding with either bottle-feeding or an intragastric tube [IGT]). Breast milk was the first milk for 41% of babies, with 83% having breast milk at some stage.
Increasing gestational age was associated with a decreased likelihood of first milk being breast milk (73% of those less than 29 weeks compared to 21% of those aged 33–34 weeks, P <0.001), but with increased rates of breast-feeding (23 compared to 59%, P = 0.01) and breast milk consumption (42 compared to 73%, P = 0.04).
Conclusions : Breast-feeding rates in NICU are well below those found on discharge for full term babies. Both maternal and staff-related factors contribute to this. More and better education of mothers, doctors and nurses as well as changes to some unit practices could increase these rates.     

Endocarditis in neonatal intensive care unit

Summary The clinical spectrum of infective endocarditis (IE) in infants is examined in four infants between 3 and 9 months of age. None of the patients had signs of IE; all four had an anatomically normal heart. Echocardiograms showed echodense vegetations in the left side of heart in three cases and in the right side in one. Three of the four patients recovered after the episode of endocarditis. Three of the four patients had necrotizing enterocolitis in the neonatal period. The important predisposing factor was the presence of indwelling central catheter for intravenous nutrition. Unlike previously reported cases, coagulase-negativeStaphylococci andEnterococci were important causative organisms in this high-risk nursery population.Presented in part at the APS/SPR Meeting in Anaheim, California, May 8, 1990.     

Palliative care in the neonatal intensive care unit

With increasing facilities for antenatal diagnosis, lowering gestation for intiation of intensive care, palliative care in the perinatal period is increasingly recognized as a specialist area. There have been standards and pathways developed in the UK that provides guidance to health professionals. Providing holistic perinatal palliative care depends on close multiprofessional working between the neonatal team and the palliative care professionals who are being integrated into the core neonatal services. Even though most neonates will continue to receive end of life care within the NICU, there are increasing number of families who choose to have end of life care either at home or a hospice. There is a need to develop services across the regions to provide equitable access to excellent clinical care as well as ongoing support to families following loss of a neonate. This short article explores the issues raised in the provision of palliative care in the perinatal period and offers practical guidance for paediatricians in this emerging area.     

Computed radiography in neonatal intensive care

The Authors report their experience in the employment of a computerized digital radiographic system in Neonatal Intensive Care. The analog screen-film system is replaced by photosensitive imaging plates, scanned after X-ray exposure by a laser that releases the digital image, which can then be manipulated on computer work-stations. In a period of twelve months about 200 chest-abdomen X-ray examinations in Neonatal Intensive Care have been performed using this method with good technical and diagnostic results. The use of digital radiography in the neonatal area is of high interest: this system produces good guality images, these is a reduction in radiation dose and retakes, the system allows selective enhancement of different structures and their magnification.     

Bacterial endocarditis in neonatal intensive care

OBJECTIVES: To ascertain the incidence of bacterial endocarditis in a level III neonatal nursery. To document the clinical features, assess survival, and evaluate the role of central venous catheters in neonates with bacterial endocarditis. METHODOLOGY: Index cases were identified by retrospective review of the echocardiographic records of infants admitted to the neonatal nursery from 1983 to 1995. Data obtained by review of the clinical records of these infants, and case-matched controls. RESULTS: From January 1983 to December 1995, 12,249 infants were admitted to the Special Care Nursery. Eight infants with endocarditis were identified, an incidence of 0.07%. Presenting symptoms and signs were often vague and nonspecific. Gestation less than 32 weeks, birthweight less than 1500 g, thrombocytopenia and neutropenia or neutrophilia were common features. Infants with endocarditis had a significantly higher Clinical Risk Index for Babies score than those without endocarditis. The tricuspid valve was involved in seven infants, six of whom had a percutaneous central venous catheter in situ before diagnosis. Mitral valve involvement occurred in two infants, neither of whom had central lines inserted. However, compared to infants without endocarditis, the placement of a central venous line was not of statistical significance. Seven of the eight infants survived following prolonged antibiotic therapy. CONCLUSIONS: Bacterial endocarditis is a rare but serious condition which is usually not fatal. In the premature newborn infant, presenting signs and symptoms are often nonspecific. Endocarditis should therefore be considered in the unwell very low birthweight infant.     

Impact of antibiotic policy on antibiotic consumption in a neonatal intensive care unit in India

Objective

To study the impact of initiating antibiotic policy on antibiotic consumption in a neonatal intensive care unit (NICU).

Methods

This retrospective study was conducted between January, 2013 and December, 2014 in a 30 bed NICU. The antibiotic policy for neonatal sepsis was initiated on January 1st, 2014. The overall antibiotic consumption (Daily Defined Dose [DDD] per 100 patient-days), one year before and one year after the initiation of antibiotic policy was evaluated using interrupted time-series analysis.

Results

There was no significant change (12.47 vs. 11.47 DDD/100 patient-days; P = 0.57) in overall antibiotic consumption. A significant increase in the proportion of patients on first-line agents (ampicillin and gentamicin) (66% (n=449) vs. 84% (n=491); P <0.001) and significant decrease in consumption of third generation cephalosporins (1.45 vs. 0.45 DDD/100 patient-days; P =0.002) was observed.

Conclusion

Antibiotic policy increased the use of first-line agents and decreased the consumption of third generation cephalosporins.