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

Presented at the Annual Meeting of the Society of Pediatric Research, Washington, D.C., May 10, 1996.
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Abstract

Objective: This study was undertaken to determine the cost of initial hospital care for newborn infants according to gestational age at birth and survival status. Study Design: This was a retrospective review of prospectively collected data on hospital and physician costs for all infants born in the study institutions at ≤32 weeks’ gestation for 1989 through 1992. A cohort of term and near-term infants was selected at random. Variables were examined by multiple logistic regression for their independent effects on cost. Results: Length of stay and gestational age were related to cost among survivors born at ≤32 weeks’ gestation but not among nonsurvivors. Total cost of initial care for the US population of neonates is estimated at $10.2 billion annually, with 11.9% spent on infants born between 24 and 26 weeks’ gestation and 42.7% spent on those born at ≥37 weeks’ gestation. Conclusions: Although costs for an individual surviving extremely premature baby may be high, the costs for extremely low gestational age infants is a small component of total neonatal care costs because so few infants are born at these gestational ages. The mathematic model developed from these data allows cost savings to be predicted for management strategies designed to alter gestational age at birth or survival. (Am J Obstet Gynecol 2000;182:170-5.)

Section snippets

Population

The database of the regional neonatal intensive care unit at the University of Alabama at Birmingham’s University Hospital was used to define the population of premature infants born in the study institutions. Data were collected for all infants born between 24 and 32 weeks’ gestation during the years 1989 through 1992, excluding infants that may have been admitted to the well-baby nursery. All nonsurviving infants born at ≥33 weeks’ gestation were identified from the mortality records of

Results

There were 974 infants born between 24 and 32 weeks’ gestation at University Hospital from October 1989 through December 1992. Among these, 281 were excluded because they received a portion of their care at a hospital other than the University Hospital or the Children’s Hospital of Alabama. An additional 72 were excluded because the obstetric estimate of gestational age was ≥3 weeks different from the postnatal estimate of gestational age according to Ballard examination. Among the 300 infants

Comment

This study is the first to examine the cost of initial hospital care according to survival for infants across a broad range of gestational ages. It represents a vast undertaking with remarkable cooperation from 2 hospitals and numerous physician billing departments that resulted in a comprehensive data set of actual charges for 958 infants. The study gives perspective to the high costs of very low gestational age infants by placing them in the larger context of the population of neonates of all

Acknowledgements

We are grateful for the assistance of Melanie Salsgiver, RN, head nurse of the regional neonatal intensive care unit, in identifying infant charges in the nearly 300 combined mother-infant accounts for term infants and to the billing and administrative personnel of University Hospital and the Children’s Hospital of Alabama for their assistance and cooperation. We acknowledge the physicians in the departments of pediatrics, radiology, and surgery for generously sharing billing data on their

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Supported by contract 282-92-0055 from the Agency for Health Care Policy and Research.

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Reprint requests: Elaine B. St. John, MD, Associate Professor of Pediatrics, Division of Neonatology, 525 NHB, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233-7335.

0002-9378/2000 $12.00 + 06/1/101830

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