The Cost of Prematurity: Hospital Charges at Birth and Frequency of Rehospitalizations and Acute Care Visits over the First Year of Life

VITAS Innovative Hospice Care, Miami, FL, USA.
The American Journal of Nursing (Impact Factor: 1.3). 08/2005; 105(7):56-64; quiz 65. DOI: 10.1097/00000446-200507000-00031
Source: PubMed


The proportion of preterm and low-birth-weight infants has been growing steadily for two decades. Most of the more than US 10 billion dollars spent on neonatal care in the United States in 2003 was spent on the 12.3% of infants who were born preterm. Research has shown higher initial hospital costs and a higher rate of acute care visits and rehospitalization for preterm and low-birth-weight infants, but only a limited number of studies of the cost of prematurity that follow infants through the first year of life have been conducted. This study is a secondary analysis of data on a subset of infants drawn from a randomized clinical trial that examined health outcomes and health care costs in women with high-risk pregnancies and their infants. For the current study, a sample of 84 singleton infants was chosen. Forty-three infants (51%) were full term (37 weeks' gestation or more) and 41 (49%) were born preterm (less than 37 weeks' gestation). Fifty-five infants (65.5%) were born at normal birth weights (2,500 g or greater), 24 (28.5%) were born at low birth weights (1,501 to 2,499 g), and five (6%) were born at very low birth weights (less than 1,500 g). Data on the initial hospital charges and the rates of rehospitalization and acute care visits in the first year of life in relation to gestational age and birth weight were collected. The results clearly demonstrated that the charges for initial hospitalizations increased as birth weights and gestational ages decreased. Low-birth-weight infants were less likely to have unscheduled acute care visits than normal-birth-weight infants. Interventions to improve prenatal care targeted to women at high risk for delivering preterm or low-birth-weight infants would reduce health care costs and improve health outcomes of infants as well.

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Available from: JoAnne M Youngblut, Sep 30, 2015
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    • "Preterm birth (before 37 gestational weeks) and low birth weight (LBW) are leading causes of neonatal morbidity and mortality as well as possible increased morbidity in adulthood,[12] and its rate is increasing worldwide,[3] affecting 13-15% of births.[4] Families of preterm neonates also bear a substantial economic burden, including inpatient hospital costs[56] and long-term health care costs during the first year[67] and through early childhood.[789] The etiology of the majority of preterm births remains unknown. "
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    ABSTRACT: Although several studies have investigated the association between maternal exposure to air pollution and preterm birth, the results are inconsistent. The aim of this study was to further investigate the relation between maternal exposure to ambient air pollution during pregnancy and the risk of preterm birth and low birth weight (LBW) in an Iranian pregnant population. In this study, we identified 4758 consecutive singleton birth records from one large referral hospital (2010-2012) in Isfahan, Iran. We identified cases of preterm birth and LBW, which were combined with meteorological and air pollution monitoring data. We estimated the effect of air pollution exposure during the entire pregnancy, each trimester, and last month, and preterm birth (gestational age <37 weeks) and LBW (<2500 g) by Pollutant Standard Index (PSI) using logistic regression adjusted for gestational age, neonate gender, birth order, and mother's age. The PSI for entire pregnancy was significantly associated with preterm birth [Odds Ratio (95% CI) = 1.26 (1.20, 1.33)]. There was no association between maternal exposure to ambient air pollution and each trimester and the last month of pregnancy, and preterm birth or LBW. Maternal exposure to ambient air pollution during the entire pregnancy was associated with preterm birth in Isfahani women.
    Journal of research in medical sciences 10/2013; 18(10):875-81. · 0.65 Impact Factor
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    • "This includes increased risks of necrotizing enterocolitis , cerebral palsy, neuromotor and cognitive dysfunctions and behavioral difficulties (Saigal et al., 1991; Lems et al., 1993; Holman et al., 1997; O'Shea et al., 1998; Buck et al., 2000; Saigal, 2000; Hille et al., 2001). Additionally, PTD is one of the predominant contributors to ART health care costs (Luke et al., 1996): charges for hospitalization increase as gestational age and birthweight decrease (Cuevas et al., 2005). In 2001, fees for PTD and LBW totaled $5.8 billion and represented 47% of all costs for infant hospitalizations in the USA (Russell et al., 2007). "
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    ABSTRACT: Since the birth of the first IVF-conceived child in 1978, the use of assisted reproductive technologies (ART) has grown dramatically, contributing to the successful birth of five million individuals worldwide. However, there are several reported associations of ART with pregnancy complications, such as low birth weight, preterm birth, birth defects, epigenetic disorders, cancer, and poor metabolic health. Whether this is attributed to ART procedures or to the subset of the population seeking ART remains controversial, but the most relevant question today concerns the potential long-term implications of assisted conception. Recent evidence has emerged suggesting that ART-conceived children have distinct metabolic profiles that may predispose to cardiovascular pathologies in adulthood. Because the eldest IVF individuals are still too young to exhibit components of chronic middle-aged syndromes, the use of animal models has become particularly useful in describing the effects of unusual or stressful preimplantation experiences on adult fitness.Elucidating the molecular mechanisms by which embryos integrate environmental signals into development and metabolic gene expression programs will be essential for optimizing ART procedures such as in vitro culture conditions, embryo selection, and transfer. In the future, additional animal studies to identify mechanisms underlying unfavorable ART outcomes, as well as more epidemiological reviews to monitor the long-term health of ART children are required, given that ART procedures have become routine medical practice.
    Molecular Human Reproduction 12/2012; 19(4). DOI:10.1093/molehr/gas066 · 3.75 Impact Factor
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    • "Spontaneous human preterm birth remains an enigma and the major unsolved problem in modern obstetrics and perinatal medicine [6]. The preterm parturition syndrome in which human labor and delivery are premature (i.e. between 20 to 37 weeks of gestation) affects one of every eight human pregnancies in the United States at an annual cost of $26 billion per year [7], [8], [9], [10]. Prematurity remains the leading cause of perinatal [11] and infant [12] morbidity and mortality. "
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    ABSTRACT: Preterm birth is a leading cause of perinatal mortality, yet the evolutionary history of this obstetrical syndrome is largely unknown in nonhuman primate species. We examined the length of gestation during pregnancies that occurred in a captive chimpanzee colony by inspecting veterinary and behavioral records spanning a total of thirty years. Upon examination of these records we were able to confidently estimate gestation length for 93 of the 97 (96%) pregnancies recorded at the colony. In total, 78 singleton gestations resulted in live birth, and from these pregnancies we estimated the mean gestation length of normal chimpanzee pregnancies to be 228 days, a finding consistent with other published reports. We also calculated that the range of gestation in normal chimpanzee pregnancies is approximately forty days. Of the remaining fifteen pregnancies, only one of the offspring survived, suggesting viability for chimpanzees requires a gestation of approximately 200 days. These fifteen pregnancies constitute spontaneous abortions and preterm deliveries, for which the upper gestational age limit was defined as 2 SD from the mean length of gestation (208 days). The present study documents that preterm birth occurred within our study population of captive chimpanzees. As in humans, pregnancy loss is not uncommon in chimpanzees, In addition, our findings indicate that both humans and chimpanzees show a similar range of normal variation in gestation length, suggesting this was the case at the time of their last common ancestor (LCA). Nevertheless, our data suggest that whereas chimpanzees' normal gestation length is ∼20-30 days after reaching viability, humans' normal gestation length is approximately 50 days beyond the estimated date of viability without medical intervention. Future research using a comparative evolutionary framework should help to clarify the extent to which mechanisms at work in normal and preterm parturition are shared in these species.
    PLoS ONE 09/2011; 6(9):e24509. DOI:10.1371/journal.pone.0024509 · 3.23 Impact Factor
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