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To determine the additional financial cost to families of babies admitted to the nurseries of The Royal Women's Hospital, Melbourne, Australia.
Prospective case series of consecutive babies admitted to the Special and Intensive Care Nurseries at The Royal Women's Hospital, Melbourne, Australia. Data were collected from diaries completed by parents who recorded expenses related to having their baby in hospital. Fifty nine families of babies born <34 weeks' gestation who were hospitalised for at least 2 weeks.
The median expenditure per family per week was Australian (A) $243 and the median length of stay in the nurseries was 7 weeks. The major costs were related to food and transport. Expenses related to the expression/storage of breast milk and accommodation were also considerable consuming 11% and 14%, respectively of the weekly amount spent. Of the 23 families who reported lost or reduced income, the median amount lost per week per family was A$324.
The financial burden on families with babies admitted to a tertiary neonatal unit is substantial. The median cost per week was approximately one quarter of the average gross weekly income and included lost income as well as additional expenses. It is important that institutions and health-care systems recognise the magnitude of this additional burden on vulnerable families.
To read the full-text of this research, you can request a copy directly from the authors.
... For many of these newborns, interfacility transfers to hospitals providing level III and level IV neonatal care with neonatologists and neonatal intensive care units (NICUs) are critical  ; however, some of these transfers may be avoidable when reassurance and decision support from a neonatologist are available. Because transfers may incur health risks for newborns and economic burdens for mothers and family members,  reducing potentially avoidable transfers is important. ...
To perform an economic evaluation to estimate the return on investment (ROI) of making available telemedicine consultations from a healthcare payer perspective, and to estimate the economic impacts of telemedicine under a hypothetical scenario where all rural hospitals providing level I neonatal care in California had access to telemedicine consultations from neonatologists at level III and level IV Neonatal Intensive Care Units (NICUs).
We developed standard decision models with assumptions derived from primary data and the literature. Telemedicine costs included equipment installation and operation costs. Probabilistic analysis with Monte Carlo simulation was performed to address model uncertainties and to estimate 95% probabilistic confidence intervals (PCIs). All costs were adjusted to 2017 US dollars using the consumer price index.
Our probabilistic analysis estimated the ROI to have a mean value of 2.23 (95% PCI: -0.7, 6.0). That is, a one-dollar investment in this telemedicine model would yield a net medical expenditure saving of $1.23. “Cost-saving” was observed among 75% of the hypothetical 1,000 Monte Carlo simulations. For the state of California, the mean annual net-savings is estimated to be $661,000.
Providing telemedicine and making available consultations to rural hospitals providing level I neonatal care are likely to save medical expenditures by reducing potentially avoidable transfers of newborns to level III and IV NICUs, offsetting all telemedicine-related costs.
... Other evidence showed that the financial burden on parents with babies admitted to a neonatal unit was high. The average cost per week is one-fourth of the total weekly income and includes lost income and additional expenses . This agreement might be linked with the cost of long-time hospitalisation and other expenses outside of the NICU. ...
Neonatal intensive care unit is important to save the lives of a sick neonate; however, parents are challenged by several stressful conditions during their stay. Therefore, this study aimed to explore the lived experiences of parents in neonatal intensive care units in Ethiopia.
We used a phenomenological study design. The data were collected using an in-depth interview method from purposively selected parents. In addition, we followed a thematic analysis approach and used Open Code Software Version 4.02 to process the data.
In this study, 18 parents were interviewed. The researchers have identified six themes. Parents complained of psychological problems like anxiety, stress, worries, hopelessness, and a state of confusion. In addition, anger, crying, sadness, frustration, dissatisfaction, regret, disappointment, feeling bad, self-blaming, nervousness, disturbance, and lack of self-control were major emotional problems raised by the parents. Parents expressed that health care providers showed indiscipline, lack of commitment, and uncooperative behaviour. Likewise, shortage of medicines, money, and limited time to visit their neonates were the other concerns of many parents. At the same time, parents were provided minimal information and limited cooperation from health care providers.
Parents whose infants admitted to the NICU were suffered from various psychological and emotional problems. Researchers recommend that health care providers should be supported parents with psycho-emotional problems, strengthen parents–healthcare workers' interaction, and scale up neonatal intensive care unit services to the primary health care centres.
• Parents whose infants admitted to the NICU were suffered from psychological and emotional problems.
• Poor NICU environment, shortage of equipment, long hospital stay, the presence of pandemic COVID-19, and lack of parental involvement in the care were identified barriers that affected parents' stay.
... Owing to potentially large distances between regional or rural nontertiary special care nurseries and metropolitan NICUs, a transfer may result in family disruptions, with associated psychosocial and financial costs. 1,2 The use of nasal continuous positive airway pressure (CPAP) in large Australian special care nurseries is beneficial and cost-effective, and it is associated with a lower incidence of treatment failure or transfer to a NICU than supplemental oxygen alone. 3 Infants with respiratory distress now routinely receive CPAP in large special care nurseries in Australia. ...
Nasal high-flow therapy is an alternative to nasal continuous positive airway pressure (CPAP) as a means of respiratory support for newborn infants. The efficacy of high-flow therapy in nontertiary special care nurseries is unknown.
We performed a multicenter, randomized, noninferiority trial involving newborn infants (<24 hours of age; gestational age, ≥31 weeks) in special care nurseries in Australia. Newborn infants with respiratory distress and a birth weight of at least 1200 g were assigned to treatment with either high-flow therapy or CPAP. The primary outcome was treatment failure within 72 hours after randomization. Infants in whom high-flow therapy failed could receive CPAP. Noninferiority was determined by calculating the absolute difference in the risk of the primary outcome, with a noninferiority margin of 10 percentage points.
A total of 754 infants (mean gestational age, 36.9 weeks, and mean birth weight, 2909 g) were included in the primary intention-to-treat analysis. Treatment failure occurred in 78 of 381 infants (20.5%) in the high-flow group and in 38 of 373 infants (10.2%) in the CPAP group (risk difference, 10.3 percentage points; 95% confidence interval [CI], 5.2 to 15.4). In a secondary per-protocol analysis, treatment failure occurred in 49 of 339 infants (14.5%) in the high-flow group and in 27 of 338 infants (8.0%) in the CPAP group (risk difference, 6.5 percentage points; 95% CI, 1.7 to 11.2). The incidences of mechanical ventilation, transfer to a tertiary neonatal intensive care unit, and adverse events did not differ significantly between the groups.
Nasal high-flow therapy was not shown to be noninferior to CPAP and resulted in a significantly higher incidence of treatment failure than CPAP when used in nontertiary special care nurseries as early respiratory support for newborn infants with respiratory distress. (Funded by the Australian National Health and Medical Research Council and Monash University; HUNTER Australian and New Zealand Clinical Trials Registry number, ACTRN12614001203640.).
... A shortened hospital stay would have reduced hospital costs and preserved hospital resources  . An earlier discharge would have also decreased the financial and emotional costs to the family associated with having an infant in the NICU and would have facilitated earlier family bonding 48,49 . ...
The purpose of this article was to present the case of a premature infant who displayed immature feeding progression because of nasal occlusion. Two male preterm infants of 33 weeks' gestational age at birth from a larger randomized trial were observed in a comparative case study. Using a prospective design, feeding assessments were conducted weekly from initiation of oral feeding until hospital discharge. Sucking organization was measured using the Medoff-Cooper Nutritive Sucking Apparatus (M-CNSA), which measured negative sucking pressure generated during oral feedings. Oral and nasogastric (NG) intake and vital signs were recorded. At 35 weeks, infant A demonstrated an immature feeding pattern with the M-CNSA NG feedings prevailing over oral feedings. When attempting to feed orally, infant A exhibited labored breathing and an erratic sucking pattern. During the third weekly feeding evaluation, nasal occlusion was discovered, the NG tube was discontinued, and phenylephrine (Neo-Synephrine) and humidified air were administered. Following treatment, infant A's sucking pattern normalized and the infant maintained complete oral feeding. Infant B demonstrated normal feeding progression. Nasal occlusion prevented infant A from achieving successful oral feeding. The M-CNSA has the ability to help clinicians detect inconsistencies in the sucking patterns of infants and objectively measures patterns of nutritive sucking. The M-CNSA has the potential to influence clinical decision making and identify the need for intervention.
The Boarder Program is a unique, family-centered program designed to keep a mother and her infant together when the mother has been discharged, but her infant requires additional medical attention and hospitalization. The hospital-sponsored program includes a room in the obstetric department, meals, and services. This provides the mother and second caregiver the opportunity to participate in their infant’s physical care and engage in the decision-making process. The program is designed to support families with infants in an intermediate care nursery and has been expanded to include infants experiencing neonatal abstinence syndrome (NAS). The purpose of this article is to describe the Boarder Program at a community medical center, share its history, and provide evidence-based support for the effectiveness of this model.
While the high costs of neonatal intensive care have been a topic of increasing study, the financial impact on families have been less frequently reported or summarized. We conducted a systematic review of the literature using Pubmed/Medline and EMBASE (1990-2020) for studies reporting estimates of out-of-pocket costs or qualitative estimates of financial burden on families during a neonatal intensive care unit stay or after discharge. 44 studies met inclusion criteria, with 25 studies providing cost estimates. Cost estimates primarily focused on direct non-medical out-of-pocket costs or loss of productivity, and there was a paucity of cost estimates for insurance cost-sharing. Available estimates suggest these costs are significant to families, cause significant stress, and may impact care received by patients. More high-quality studies estimating the entirety of out-of-pocket costs are needed, and particular attention should be paid to how these costs directly impact the care of our high-risk population.
Background and objectives:
Telemedicine may have the ability to reduce avoidable transfers by allowing remote specialists the opportunity to more effectively assess patients during consultations. In this study, we examined whether telemedicine consultations were associated with reduced transfer rates compared to telephone consultations among a cohort of term and late preterm newborns. We hypothesized that neonatologist consultations conducted over telemedicine would result in fewer interfacility transfers than consultations conducted over telephone.
We collected data on all newborns who received a neonatal telemedicine or telephone consultation at six rural hospitals in northern and central California between August 2014 and June 2018. We used adjusted analyses to compare transfer rates between telemedicine and telephone cohorts.
A total of 317 patients were included in the analysis; 89 (28.1%) of these patients received a telemedicine consultation and 228 (71.9%) received a telephone consultation only. The overall transfer rate was 77.0%. Patient consultations conducted using telemedicine were significantly less likely to result in a transfer than patient consultations conducted using the telephone (64.0% vs 82.0%, p=0.001). After controlling for 5-minute Apgar score, birthweight, gestational age, site of consultation, and transport risk index of physiologic stability (TRIPS-II) score, the odds of transfer for telemedicine consultations was 0.48 (95% CI: 0.26,0.90, p=0.02).
Our findings suggest that telemedicine may have the potential to reduce potentially avoidable transfers of term and late preterm newborns. Future research on potentially avoidable transfers and patient outcomes is needed to better understand the ways in which telemedicine affects clinical decision making.
Studies suggest that postnatal cytomegalovirus (CMV) infection can lead to long-term morbidity in infants with very low birth weight (VLBW; <1500 g), including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and neurodevelopmental impairment. However, to date, the association of postnatal CMV with hearing, growth, and length of stay among VLBW infants is unknown.
To determine the risk for failed hearing screen, increased postnatal age at discharge, or decreased growth at discharge in VLBW infants with postnatal CMV infection compared with CMV-uninfected infants and to compare the risk for other major outcomes of prematurity, including BPD and NEC, in infants with and without postnatal CMV infection.
This multicenter retrospective cohort study included VLBW infants from 302 neonatal intensive care units managed by the Pediatrix Medical Group from January 1, 2002, through December 31, 2016. Infants hospitalized on postnatal day 21 with a diagnosis of postnatal CMV and hearing screen results after a postmenstrual age of 34 weeks were included in the study population. Data were analyzed from December 11, 2017, to June 14, 2019.
Main Outcomes and Measures
Infants with and without postnatal CMV infection were matched using propensity scores. Poisson and linear regression were used to examine the association between postnatal CMV and the risk of failed hearing screen, postnatal age at discharge, growth, BPD, and NEC.
A total of 304 infants with postnatal CMV were identified, and 273 of these infants (89.8%; 155 boys [56.8%]) were matched with 273 infants without postnatal CMV (148 boys [54.2%]). Hearing screen failure occurred in 45 of 273 infants (16.5%) with postnatal CMV compared with 25 of 273 infants (9.2%) without postnatal CMV (risk ratio [RR], 1.80; 95% CI, 1.14 to 2.85; P = .01). Postnatal CMV was also associated with an increased postnatal age at discharge of 11.89 days (95% CI, 6.72 to 17.06 days; P < .001) and lower weight-for-age z score (−0.23; 95% CI, −0.39 to −0.07; P = .005). Analysis confirmed an increased risk of BPD (RR, 1.30; 95% CI, 1.17 to 1.44; P < .001), previously reported on infants from this cohort from 1997 to 2012, but not an increased risk of NEC after postnatal day 21 (RR, 2.00; 95% CI, 0.18 to 22.06; P = .57).
Conclusions and Relevance
These data suggest that postnatal CMV infection is associated with lasting sequelae in the hearing and growth status of VLBW infants and with prolonged hospitalization. Prospective studies are needed to determine the full effects of postnatal CMV infection and whether antiviral treatment reduces the associated morbidity.
This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the benefits and harms of the expression and storage of breast milk during pregnancy by women with diabetes.
Frühgeborene und schwer kranke Neugeborene, die auf einer Intensivstation behandelt werden müssen, benötigen wegen ihrer anhaltenden erhöhten Vulnerabilität während der ganzen Kindheit vermehrten Schutz und besondere Zuwendung ihrer Eltern. Zu den therapeutischen Aufgaben gehört es, die oben dargestellten Reaktionen gar nicht erst entstehen zu lassen oder frühzeitig zu mildern.
Neonatal transfer is necessary when a newborn baby needs care that cannot be provided in the referral center. Since it represents an additional risk factor for a critically ill neonate, it should be performed, when possible, by a well-organized neonatal transport service. In a network, aimed at the regionalization of perinatal care, high-risk pregnancies should be transferred “in utero” in order to minimize risks for both mother and neonate. However, there will always be a number of neonates who need to be transferred for unpredicted or unpredictable reasons. Every maternity unit should therefore be able to provide effective neonatal resuscitation in the delivery room, be able to maintain a sick baby in a stable condition in the short term, and have access to a neonatal emergency transport service (NETS) for the provision of neonatal intensive care when appropriate. Thus, NETS provides a bridge between birth centers and neonatal intensive care units (NICUs).
Organization of NETS, quality evaluation, transport process, family-centered care, and challenging situations that can be encountered during neonatal transport are some of the topics treated in this chapter.
Neonatal transfer is necessary when a newborn baby needs care that cannot be provided in the referral centre. Since it represents an additional risk factor for a critically ill neonate [1, 2], it should be performed, when possible, by a well-organized neonatal transport service.
Australia is a prosperous, culturally diverse country where respect for quality of life, freedom of speech and religion as well as equal opportunities for all, are values that rank highly amongst society. Its unique physical geography and population distribution continually challenge
the health-care system. There are high expectations by both health care providers as well as consumers when emotive issues surrounding the care of a vulnerable infant arise. The care of the periviable infant is one such issue. Moral dilemmas arise from providing intensive care to extremely
preterm infants. How far should we, as health care professionals go to preserve life? Should we continue to provide aggressive life-sustaining treatments with the knowledge that there will be some babies and families who will experience significant disability, emotional suffering and financial
hardship? In a society such as this, and while uncertainty surrounding survival and morbidity, varying methods of management, and the differing professional and personal views of health professionals, parents, and arbiters of law exist, the care of the peri-viable infant will continue to remain
a challenge. This paper aims to describe how Australia's laws and social and medical practices have allowed us to manage infants born in the “grey zone” of viability.
Some women with diabetes in pregnancy are encouraged to express and store colostrum prior to birthing. Following birth, the breastfed infant may be given the stored colostrum to minimise the use of artificial formula or intravenous dextrose administration if correction of hypoglycaemia is required. However, findings from observational studies suggest that antenatal breast milk expression may stimulate labour earlier than expected and increase admissions to special care nurseries for correction of neonatal hypoglycaemia.
To evaluate the benefits and harms of the expression and storage of breast milk during late pregnancy by women with diabetes.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2014).
All published and unpublished randomised controlled trials comparing antenatal breast milk expressing with not expressing, by pregnant women with diabetes (pre-existing or gestational) and a singleton pregnancy.
Data collection and analysis:
Two review authors independently evaluated reports identified by the search strategy.
There were no published or unpublished randomised controlled trials comparing antenatal expressing with not expressing. One randomised trial is currently underway.
There is no high level systematic evidence to inform the safety and efficacy of the practice of expressing and storing breast milk during pregnancy.
With increasing concerns regarding rapidly expanding healthcare costs, cost-effectiveness analysis allows assessment of whether marginal gains from new technology are worth the increased costs. Particular methodologic issues related to cost and cost-effectiveness analysis in the area of neonatal and periviable care include how costs are estimated, such as the use of charges and whether long-term costs are included; the challenges of measuring utilities; and whether to use a maternal, neonatal, or dual perspective in such analyses. A number of studies over the past three decades have examined the costs and the cost-effectiveness of neonatal and periviable care. Broadly, while neonatal care is costly, it is also cost effective as it produces both life-years and quality-adjusted life-years (QALYs). However, as the gestational age of the neonate decreases, the costs increase and the cost-effectiveness threshold is harder to achieve. In the periviable range of gestational age (22-24 weeks of gestation), whether the care is cost effective is questionable and is dependent on the perspective. Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies related to the care of periviable pregnancies and neonates.
Parents of babies who spend long periods in special care baby units are faced with the problem of developing a caring relationship with their baby. The journeys to and from the hospital pose additional financial and social stress on parents who are already under considerable emotional strain. A survey into the financial costs incurred by parents visiting their babies in six hospitals during a period of 2 months was conducted using questionnaires. Complete data were available for analysis from four hospitals on 126 babies (98 inborn and 28 outborn). For babies inborn in a maternity hospital, the mean cost of visiting for parents with a car was 41 pounds (range 1-336) and for those who travelled by public transport the mean cost was 30 pounds (range 2-151). For babies born outside the hospital and transferred to a special care baby unit, the mean cost of visiting for parents with a car was 123 pounds (range 11-518), and for those who travelled by public transport the mean cost was 46 pounds (range 16-80). There was almost no financial assistance available to help these families, one-third of whom had at least one serious social problem.