Cost-analysis of neonatal intensive and special care

Abstract In the present economic climate and with increasing expenditure on neonatal intensive care, there has been a demand for economic evaluation and justification of neonatal intensive care programmes. This study assesses the inhospital costs of neonatal intensive care. Fixed and variable costs were calculated for services and uses of an Intensive/Special Care Nursery for the year 1985 and corrected to 1987 Australian dollar equivalents. Establishing a new neonatal intensive care unit of 43 cots in an existing hospital with available floor space including operating costs for a year were estimated in Australian dollars for 1987 at $6 408 000. Daily costs per baby for each level of care were $1282 ventilator, $481 intensive, $293 transitional and $287 recovery, respectively. The cost per survivor managed in the Intensive/Special Care Nursery in 1985 showed the expected inverse relationship to birthweight being $2400 for > 2500 g, $4050 for 2000–2500 g, $9200 for 1500–1999 g, $23 900 for 1000–1499 g and $63 450 for < 1000 g. Further analysis for extremely low birthweight infants managed in 1986 and 1987 demonstrated costs per survivor of $128 400 for infants < 800 g birthweight and $43 950 for those 800–999 g. This methodology might serve as a basis for further accounting and cost-evaluation exercises.     

Growth and catch-up growth of Australian infants of low birthweight

Abstract The growth of 90 infants of low birthweight (1500–2499 g) has been studied longitudinally from birth to 2 years of age. Seventy-five per cent of those infants were of birthweight that was appropriate-for-gestational age (AGA) and of mean gestational age 33.6 weeks (boys) and 34.5 weeks (girls). Twenty-four per cent were small-for-gestational age (SGA) and of mean gestational age 39.4 weeks (boys) and 38.5 weeks (girls). The data showed that, when gestational age was considered, the growth of AGA infants was similar to that of full-term infants of normal birthweight; SGA infants displayed accelerated growth ('catch-up'), particularly in the first months of life with upward percentile crossing from below the 5th toward the 50th. These results provide further evidence of the need to consider gestational age and whether AGA or SGA when assessing the growth of low birthweight infants.     

Comparing Cause-Specific Infant Mortality in a West German State and the United States of America

ABSTRACT. The infant mortality rate in North Rhine Westphalia (NRW), the most populous West German state, has continuously been around 10 % higher than the German national average in the post-war period. Using white singleton data from the US 1980 National Infant Mortality Surveillance project (NIMS) and similar 1980/1981 data from NRW we compared infant mortality by birthweight and cause to describe the distribution of excess mortality in NRW. The US infant mortality rate was 8.7 deaths per 1000 live births, compared with 13.1/1000 for NRW (rate difference: 4.3/1000). Of the 4.3/1000 overall rate difference, 1.9/1000 was attributable to neonatal deaths, 2.4/1000 to postneonatal deaths. A major proportion, 2.0/1000, of the overall rate difference of 4.3/1000 was attributable to normal birthweight deaths postneonatally. 0.85/1000 of this 2.0/1000 rate difference was attributable to SIDS, 0.44/1000 to external causes and 0.42/1000 to infections.     

A 12-year experience of retinopathy of prematurity in infants ≤28 weeks gestation or ≤1000g birthweight

This study reported the prevalence and severity of retinopathy of prematurity (ROP) in less than or equal to 28 weeks gestation or less than or equal to 1000 g birthweight infants over a 12-year period. Among 328 survivors of less than or equal to 28 weeks gestation, 30% had ROP, 12% had severe ROP of Stage 3 or worse, 5% had at least one blind eye and 3% were bilaterally blind. Among 201 survivors of less than or equal to 1000 g birthweight, the above abnormalities were found in 40, 16, 6 and 4% respectively. In both cohorts there was a significant increase in the prevalence of ROP and severe ROP between the period 1977-80 and 1981-84, but the lesser increase observed between the periods 1981-84 and 1985-88 was not statistically significant. The rates of ROP-induced blindness were not significantly different between the three 4-year periods. An inverse relationship was noted between the prevalence of ROP and gestational age. The results suggest a resurgence of ROP in less than or equal to 28 weeks or less than or equal to 1000 g infants, the cause of which is uncertain. In view of this trend, continued surveillance of ROP is warranted.     

妊娠期妇女血清叶酸水平的变化及其与婴儿出生体重的关系

本文对185名正常初产孕妇的血清叶酸水平、缺乏情况以及与婴儿出生体重的关系进行了研究。结果表明,血清叶酸水平随妊娠周数的增加呈下降趋势,孕中期、末期与早期相比,血清叶酸浓度明显降低,有显著差别。血清叶酸低于3ng/ml人数所占百分比由早期8.5％、中期9.7％至末期升至31.3％,三期共计31例,占总观察人数的16.8％。 对127名孕妇妊娠末期叶酸水平与婴儿出生体重的关系进行了分析,按婴儿出生体重分三组,母亲叶酸水平各组无显著差异。另对30名婴儿出生体重超过4000g的母亲,于产后24小时内取血测血清叶酸,结果与上述三种不同出生体重组母亲血清叶酸浓度亦无明显差别。本次研究未观察到孕期血清叶酸水平与婴儿出生体重之间有相关。     

Phosphorus Deficiency Syndrome in Two Very Low Birthweight Infants

Biochemical and radiographic abnormalities linked with phosphorus deficiency syndrome (PDS) developed in two very low birthweight (VLBW) infants fed exclusively with human milk. By increasing phosphorus (P) and calcium (Ca) intakes with the introduction of a specialized premature formula, osteopenia or rickets, as well as hypophosphatemia, hypo-phosphaturia and increased serum alkaline phosphatase levels improved in both patients. We speculated that all VLBW infants who are being fed exclusively with human milk should be monitored for PDS and that if PDS develops, supplementation of human milk with both P and Ca appears to be necessary for its treatment.     

Maternal determinants of birthweight in normal pregnancy

Partial and multiple regression analysis was performed to find out the correlation between birthweight and maternal anthropometric variables. Pearson regression analysis revealed significant dependence of birthweight on gestation of pregnancy, maternal weight, symphysis-sternal distance and height, but not on armspan and skin thickness. However, the only maternal variable bearing significant influence on birthweight in partial regression analysis was bodyweight. The effects of maternal determinants on birthweight, though some of them were statistically significant, were clinically unimportant.     

Longitudinal study of very low birthweight infants: Impairments, health and distance growth to 14 years of age

Of 456 consecutive infants born in a tertiary maternity centre in 1966–70 and of birthweight under 1501 g, 171 (37.5%) survived their primary hospitalization. Subsequently three children died and the outcome of 142 (90.5%) of the remaining children presumably still alive were reviewed at a mean age of 14.5 years. Four children had cerebral palsy although only one child was legally blind, 31.6% (48/152) had an existing or corrected visual impairment; visual impairments occurred significantly more frequently in those of birthweight under 1251 g or those born before 29 weeks gestation. Six children required hearing aids and three others were still epileptic. Four children were chronic asthmatics and one had rheumatoid arthritis. None had disabling malformations and there was no delay in pubertal changes. The distributions of weight, height and head circumference percentiles were not significantly different from a standard Australian population. For children in the cohort, weights and heights were under the 10th percentile in 13.4% and 14.1%, respectively. Of the 30 children with birthweights under the 10th percentile and who were reviewed as teenagers, only eight (26.7%) were still in this weight category.     

Outcome of infants 23-26 weeks' gestation pre and post surfactant

To describe mortality and neurodevelopmental outcome before and after the introduction of rescue therapy with natural surfactant in two neonatal units in Toronto, Canada, a retrospective cohort study of 891 liveborn 23-26 wk gestational age infants, 421 presurfactant (1982-1987) and 470 postsurfactant (1990-1994) was performed. Overall mortality was stable over time (41% vs 35%, p = 0.077), but declined for inborn 24 (71% vs 43%, p = 0.03) and 26 wk (26% vs 13%, p = 0.01) gestational age infants and was higher in surfactant-treated infants (p < 0.0001). Chronic lung disease (61% vs 34%, p < 0.0001) and bilateral blindness (8% vs 4%, p = 0.004) declined over time, with stable rates of cerebral palsy (12% vs 15%), cognitive deficit (27% vs 26%) and aided sensorineural hearing loss (5% vs 4%). Sixty-five percent of surviving infants in both eras were free from neurodevelopmental impairment, and severe impairment declined over time (p = 0.035). This study shows no secular change in overall mortality in a large cohort of 23-26 wk gestational age infants since the introduction of rescue therapy with natural surfactant. However, it does suggest that maternal transfer to and delivery of all extremely preterm infants in high risk perinatal centres is justified.     

Balloon dilatation of critical left heart stenoses in low birthweight infants

We describe the results of balloon angioplasty in 5 infants with body weights of 850-2400 g. Three patients with severe aortic valve stenosis and two patients with isthmic coarctation of the aorta experienced relief of stenosis. Two patients with aortic valve stenosis developed thrombosis of the femoral artery; however, complete resolution of the compromised pulse occurred following thrombolytic therapy. In both patients with isthmic coarctation, pulses on the right leg remained diminished. All patients are doing well 0.28 to 3.32 y after the procedure; none has required additional therapy. Our results in a limited number of consecutive low birthweight infants show that balloon dilatation is feasible and can be performed successfully even in neonates with body weights < 1500 g. According to our experience, balloon dilatation in infants with body weights > 2000 g does not differ significantly from standard procedures. In very small infants, however, balloon angioplasty requires special precautions to avoid temperature loss. Arterial access is the major problem in small children, and requires further improvement. CONCLUSION: Balloon dilatation is feasible even in neonates < 1500 g. However, special precautions to avoid temperature loss are required and arterial access is the major problem.