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Sharma P, King B. EBNEO Commentary: The impact of timing of inguinal hernia repair on outcomes in preterm infants. Acta Paediatr 2024. [PMID: 39073191 DOI: 10.1111/apa.17361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/28/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Puneet Sharma
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian King
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Damodaran K, Brumberg HL, Jawale N, Giblin C, Shah S. Comparison of birth outcomes of mothers covered by Medicaid versus those privately insured when accounting for social determinants of health. J Perinatol 2024; 44:488-492. [PMID: 38082070 DOI: 10.1038/s41372-023-01842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To determine the association between maternal health insurance type and birth outcomes [prematurity, small for gestational age (SGA), Term/Appropriate for gestational age NICU admission (Term/AGA-NICU) & composite birth outcomes (CBO)] accounting for social determinants of health. DESIGN/METHODS A cross-sectional study of maternal surveys and birth certificate data of singleton live births in NY born to mothers with Medicaid (M) or Private Insurance (PI). RESULTS 1015 mothers [M = 631, PI = 384) included. Individual birth outcomes did not differ between groups. Adjusting for social, demographic and clinical covariates, M mothers had similar odds of preterm birth, SGA, Term/AGA-NICU admission and CBO compared to PI. CONCLUSIONS M mothers were as likely as PI mothers to deliver a preterm, SGA or a Term/AGA-NICU infant after controlling for social determinants of health. Despite more social adversity among enrollees, our study suggests NY Medicaid recipients have similar birth outcomes to privately insured, socially advantaged women.
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Affiliation(s)
- Kriti Damodaran
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Heather L Brumberg
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Nilima Jawale
- Division of Neonatology, UHS, Binghamton General Hospital, Binghamton, NY, USA
| | - Clare Giblin
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Shetal Shah
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA.
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3
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Siva N, Phagdol T, S Nayak B, Glane Mathias E, Edward S Lewis L, Velayudhan B, Shankar N R, D'Souza P. Stress and stressors experienced by the parents of high-risk neonates admitted in neonatal intensive care unit: Systematic review and meta-analysis evidence available from India. Stress Health 2024; 40:e3301. [PMID: 37596955 DOI: 10.1002/smi.3301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/21/2023]
Abstract
The aim of the systematic review and meta-analysis is to determine the stress and stressors experienced by the parents of high-risk neonates admitted to the neonatal intensive care unit (NICU) in India. We included both quantitative and qualitative studies. The Joanna Briggs Institute Critical Appraisal Checklist and Critical Appraisal Skill Programme checklist were used to assess the quality of included studies. A systematic search was conducted in PubMed, EMBASE, SCOPUS, EBSCOhost, Web of Science, ProQuest, Microsoft Academic, DOAJ, Indian Citation Index, and J-Gate to identify relevant studies. Additionally, online hand searching was performed on Indian websites of relevant institutions, women and child health departments, repositories, registries, and paediatric journals. Twelve of the 21 quantitative studies found that maternal stress was higher than fathers due to the separation from their babies and the medical condition of the neonate. One qualitative study reported that financial burden, alterations in the parenting role, and concern over domestic issues are significant causes of fathers' stress. A meta-analysis of the included studies assessed the prevalence of maternal, paternal, and parental stress and reported that mothers experienced higher stress levels than fathers across all subscales. The most typical stressors for parents were changes in neonatal looks, behaviour, and altered parental roles. Beyond the immediate NICU care and interactions, other triggering factors of stress among parents must be considered to design multicomponent interventions in a local (Indian) context. Moreover, parental psychological support and regular counselling can be incorporated into the standard neonatal intensive care policy.
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Affiliation(s)
- N Siva
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Tenzin Phagdol
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Edlin Glane Mathias
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Leslie Edward S Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Binil Velayudhan
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Ravi Shankar N
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Preethy D'Souza
- Social Research Institute, UCL Institute of Education, University College London, London, UK
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Gregory EJ, Abbasi AH, Markham KB. Patient Survey Regarding Non-Medical Burdens of Care at a Parental Fetal Care Center. J Patient Exp 2024; 11:23743735241231693. [PMID: 38348413 PMCID: PMC10860454 DOI: 10.1177/23743735241231693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Recognizing the paucity of literature describing the non-medical effects of care at a tertiary parental fetal care center upon families, the purpose of the study was to better examine the potential barriers that our patients face related to care in a parental fetal care center. An anonymous survey was sent via email to patients who received care from 2015 to 2021. The survey included questions regarding demographics, fetal diagnoses, non-medical expenses related to care, and the impact of care on patient relationships, employment, and other children. 453 patients (15.9%) responded out of the 2684 emails sent. 58.3% of patients traveled >100 miles to reach our referral center, with 20% traveling >300 miles. 42.6% of patients reported non-medical expenditures exceeding $1000, with nearly 1 in 10 reporting expenditures of >$5000 (8.6%). Overall, 38.2% of women reported moderate to severe financial burdens related to receiving care at the parental fetal care center. This study illuminates the financial and social burdens that care at a tertiary parental fetal care center imposes upon families. By acknowledging these barriers, we can strive to minimize them to best provide equitable access to high-quality fetal care services.
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Affiliation(s)
- Emily J Gregory
- Department of Obstetrics and Gynecology and Division of Maternal Fetal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Aleeza H Abbasi
- Department of Obstetrics and Gynecology and Division of Maternal Fetal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kara B Markham
- Department of Obstetrics and Gynecology and Division of Maternal Fetal Medicine, University of Cincinnati, Cincinnati, OH, USA
- Department of Maternal Fetal Medicine in the Cincinnati Children's Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Guillén Ú, Zupancic JAF, Litt JS, Kaempf J, Fanaroff A, Polin RA, Martin R, Eichenwald E, Wilson-Costello D, Edwards AD, Hallman M, Bührer C, Fanaroff J, Albersheim S, Embleton ND, Shah PS, Dennery PA, Discenza D, Jobe AH, Kirpalani H. Community Considerations for Aggressive Intensive Care Therapy for Infants <24+0 Weeks of Gestation. J Pediatr 2024; 268:113948. [PMID: 38336203 DOI: 10.1016/j.jpeds.2024.113948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/20/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Affiliation(s)
| | - John A F Zupancic
- Division of Newborn Medicine, Harvard Medical School, Boston, MA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan S Litt
- Division of Newborn Medicine, Harvard Medical School, Boston, MA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA
| | - Joseph Kaempf
- Women and Children's Services, Providence St. Vincent Medical Center, Portland, OR
| | - Avroy Fanaroff
- Emeritus, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | | | - Richard Martin
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Eric Eichenwald
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - A David Edwards
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mikko Hallman
- Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland
| | - Christoph Bührer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jonathan Fanaroff
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia, Vancouver, BC, Canada
| | | | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Phyllis A Dennery
- Warren Alpert School of Medicine of Brown University, Providence, RI
| | | | - Alan H Jobe
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, and University of Cincinnati, Cincinnati, OH
| | - Haresh Kirpalani
- Emeritus, Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, and Emeritus Department Pediatrics, McMaster University, Hamilton, ON, Canada
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Gamber RA, Blonsky H, McDowell M, Lakshminrusimha S. Declining birth rates, increasing maternal age and neonatal intensive care unit admissions. J Perinatol 2024; 44:203-208. [PMID: 38012436 DOI: 10.1038/s41372-023-01834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To describe the number of US births, maternal age at birth and NICU admissions by maternal age cohorts. Our study aims to measure NICU utilization by maternal age over time. STUDY DESIGN We queried the CDC WONDER Natality database for births, NICU admissions, and maternal age at delivery from 2016 to 2021. Births and NICU admissions were analyzed by maternal age. RESULTS Between 2016 and 2021, US births decreased by 7% (3,945,875 to 3,664,292/year). NICU admissions increased from 344,454 to 351,775 (+2%) and admit rate from 8.7% to 9.6%. The proportion of births by maternal age declined each year for ≤29 y but increased for ≥30 y. NICU admission rates were lowest at maternal age 20-29 y and increased with age ≥30 y. CONCLUSIONS US NICUs have demonstrated a 2% increase in admissions despite a 7% decrease in births. Higher rates of NICU admissions among infants born at maternal age ≥30 y warrants investigation.
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Lambiase CV, Mansi G, Salomè S, Conelli ML, Vendemmia M, Zurlo MC, Raimondi F, Capasso L. The financial burden experienced by families during NICU hospitalization and after discharge: A single center, survey-based study. Eur J Pediatr 2024; 183:903-913. [PMID: 38038769 PMCID: PMC10912114 DOI: 10.1007/s00431-023-05352-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
To investigate a broad array of costs and perceived financial burden (FB) faced by families of NICU graduates both during hospitalization and after discharge. Cross-sectional survey-based study design. A survey measuring socio-demographics, direct non-medical costs, indirect costs, social support and perceived FB was developed. One-hundred-twenty-two pairs of parents of NICU graduates participated in the study. Most of the families (87.7%) experienced FB due to NICU hospitalization. The median cost of visiting infant during NICU admission was 615 euros (range: 42,7320). FB correlated with cost for drugs (ρ = .271, p < .05, 95%CI:[.020, .490]), dietary supplement (ρ = .385, p < .05, CI:[.010, .665]), behavioral disorders (ρ = -.186, p < .05, 95%CI:[-.356, -.003]), language delay (ρ = .243, p < .01, CI:[-.408, -.063]) and comorbidities (ρ = -.206, p < .05, 95% CI:[-.374, -.024]). Transportation costs due to medical visits (ρ = .415, p < .01, 95% CI:[.239, .564]) and therapy sessions (ρ = .517, p < .05, CI:[.121, .771]) correlated with higher FB. Grandparents of the infant were the most frequent source of help (86.1%). Families having infants with adverse outcome experienced more hospitalizations after NICU discharge (p < .05) and higher FB (p < .01) than families with typically developing infant. Lack of government financial help was associated with higher perceived FB (CI:[1.117,29.127], p < .05). Conclusions: Our findings demonstrated that parents of NICU graduates experience high rates of FB, highlighting their sources (e.g., grandparents support) and difficulties (e.g., private therapy costs) through the lens of patient perspective. Our study promotes reflection on policies which should be adopted from the European health services that are similar to the Italian one to support NICU graduate families and reduce inequalities. What is Known: • Families of NICU graduates face several kinds of costs during hospitalization and after discharge. What is New: • NICU hospitalization is a multifaceted event that impact financial burden experienced by families. • NICU graduate families whose infant had adverse outcome and felt lack of financial help from local policy makers experience higher rates of financial burden.
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Affiliation(s)
- Carmine Vincenzo Lambiase
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Department of Humanities, University of Naples Federico II, Via Porta di Massa 1, 80133, Naples, Italy.
| | - Giuseppina Mansi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Laura Conelli
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Vendemmia
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Clelia Zurlo
- Department of Humanities, University of Naples Federico II, Via Porta di Massa 1, 80133, Naples, Italy
- Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
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Tedesco A, Bloom JA, Lee J, Nicholson B, Moon T, Karamchandani M, Chwals W, Chatterjee A, Salehi P. The Benefit of Cost-Transparency Calculators Does Not Extend to Vascular Surgery Patients. Ann Vasc Surg 2024; 98:350-354. [PMID: 37451401 DOI: 10.1016/j.avsg.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND In 2021, the Centers for Medicare & Medicaid Services (CMS) mandated that every hospital create a publicly available webtool for pricing various medical services in an effort to give patients transparency in regard to their health care expenses and allow patients to "shop around" to receive the care most fitting their budget. Our objective is to investigate the utility this mandate provides for vascular surgery patients. METHODS Standardized searches were performed to find patient cost calculators for Newsweek's Top 50 Hospitals in the United States. If the webtool was found, a list of standardized searches were performed to investigate whether the tool listed prices for the following vascular procedures: Arteriovenous fistula (AVF), varicose vein procedures, and Endovascular Aneurysm Repair (EVAR). RESULTS Of the 50 hospitals included, all had an easily accessible web-based cost estimator tool. The average time to find the cost estimator was 33.27 sec. Of these 50 hospitals, 10% provided cost information on AVF surgery, 12% provided cost information on varicose vein procedures, and 0% provided information on EVAR. There was no difference in the hospital's likelihood to report a price based on region of the United States. Average preinsurance price for AVF surgery was $11,933.61 and $22,191 for vein procedures. CONCLUSIONS In conclusion, despite good adherence to the CMS mandate requiring a publicly available pricing tool, these tools provide little to no information for vascular surgery patients. Overall, this discrepancy places vascular surgery patients at a significant disadvantage. As such, vascular patients do not have access to the knowledge necessary to financially prepare for surgery, and furthermore, they are not afforded the luxury to choose where to have procedures performed based on price variability. Hopefully this research will encourage hospitals to broaden the scope of their cost calculators to allow it to benefit all patients.
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Affiliation(s)
| | | | | | | | - Tina Moon
- Department of Surgery, Tufts Medical Center, Boston, MA
| | | | - Walter Chwals
- Division of Pediatric Surgery, Department of Surgery, Tufts Medical Center, Boston, MA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, MA
| | - Payam Salehi
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center, Boston, MA
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King B, Patel RM. Using Quality Improvement to Improve Value and Reduce Waste. Clin Perinatol 2023; 50:489-506. [PMID: 37201993 DOI: 10.1016/j.clp.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Value is defined as health outcomes achieved per dollar spent. Addressing value in quality improvement (QI) efforts can help optimize patient outcomes while reducing unnecessary spending. In this article, we discuss how QI focused on reducing morbidities frequently reduces costs, and how proper cost accounting can help demonstrate improvements in value. We provide examples of high-yield opportunities for value improvement in neonatology and review the literature associated with these topics. Opportunities include reducing neonatal intensive care admissions for low-acuity infants, sepsis evaluations in low-risk infants, unnecessary total parental nutrition use, and utilization of laboratory and imaging.
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Affiliation(s)
- Brian King
- Department of Pediatrics, University of Pittsburg School of Medicine.
| | - Ravi M Patel
- Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive, NE, Atlanta, GA 30322, USA
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Creswell L, Lindow SW, Monteith C, McNamee E, O'Gorman N, O'Connell MP. The duration of labor in spontaneous preterm deliveries: A retrospective observational study in a tertiary Irish maternity hospital. Eur J Obstet Gynecol Reprod Biol 2023; 285:110-114. [PMID: 37099860 DOI: 10.1016/j.ejogrb.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Preterm deliveries account for 10% of all births, and are the most important cause of neonatal mortality globally. Despite their frequency, there is a paucity of information known about usual patterns of preterm labor, as previous studies which critically defined the normal progression of labor excluded preterm gestations. OBJECTIVE To compare the durations of the first, second and third stages of spontaneous preterm labor in nulliparous and multiparous women at varying preterm gestations. METHODS A retrospective observational study was undertaken of women admitted in spontaneous preterm labor from January 2017 to December 2020 with viable singleton gestations between 24 and 36 + 6 weeks' gestation who then proceeded to have a vaginal delivery. There were 512 cases following exclusion of preterm inductions of labor, instrumental vaginal deliveries, provider-initiated pre-labor Caesarean sections and emergency intrapartum Caesarean sections. The data was then examined to determine our outcomes of interest including the durations of the first, second and third stages of preterm labor, analyzing results by parity and gestation. For comparison, we reviewed data of term spontaneous labors and spontaneous vaginal deliveries during the same study period, identifying 8339 cases. FINDINGS 97.6% of participants achieved a spontaneous cephalic vaginal delivery with the remainder undergoing an assisted breech birth. 5.7% of gestations delivered spontaneously between 24 + 0 and 27 + 6 weeks, with most births at gestations greater than 34 weeks (74%). The second stage duration (mean 15 vs 32 vs 32 mins respectively) was significantly different across the three gestation periods (p < 0.05), but was notably much quicker in extremely preterm labors. The first and third stage durations were similar between all gestational age groups with no statistically significant differences in results. There was a significant influence of parity on the first and second stages of labor, with multiparous women progressing more quickly than nulliparae (p < 0.001). CONCLUSION The duration of spontaneous preterm labor is described. Multiparous women progress more quickly in the first and second stages of preterm labor than nulliparous women.
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Desai RK, Bhola M, Ronis S, Ryan RM. How much does a minimum weight at discharge delay discharge from the neonatal intensive care unit? J Neonatal Perinatal Med 2023; 16:453-459. [PMID: 37718866 DOI: 10.3233/npm-230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Current American Academy of Pediatrics guidelines recommend discharge at physiologic maturity regardless of weight; however, our institution's neonatal ICU policy requires a minimum weight of 1800 g for discharge even when infant is physiologically mature. So, we wanted to determine if discharge at physiologic maturity (PM), based on national guidelines, would decrease hospital days (HD). METHODS We reviewed 129 infants with birthweight 1300g- 1800 g. Data were analyzed by paired t-test/ Wilcoxon-rank-sum test. RESULTS Age at discharge vs. age at PM was 0.55d per infant higher (P-value 0.033) resulting in 71 total HD. For SGA babies, this difference was 1.47d vs 0.19d in non-SGA babies (P- value 0.0243) and this difference was an average of 2.63d (P-value < 0.001) for those who reached PM < 1800 g, contributing to 50 of 71 HD potentially saved. CONCLUSION There was a 0.55-2.6-day difference between age at discharge and age at PM, greater in SGA infants and infants who reached PM prior to 1800 g. There might be an opportunity to send infants home earlier to their families if there is no minimum weight required.
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Affiliation(s)
- R K Desai
- Division of Neonatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Bhola
- Division of Neonatology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - S Ronis
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of General Academic Pediatrics and Adolescent Medicine, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - R M Ryan
- Division of Neonatology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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12
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Yieh L, King BC, Hay S, Dukhovny D, Zupancic JAF. Economic considerations at the threshold of viability. Semin Perinatol 2022; 46:151547. [PMID: 34887108 DOI: 10.1016/j.semperi.2021.151547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neonatal intensive care for infants born at 22-24 weeks has become more prevalent in the past three decades, but outcomes remain highly variable between centers, in part due to different approaches in management. With this increased frequency of intervention, there has been concern for a concurrent increase in costs of care for survivors. This article reviews the direct medical, direct non-medical, and indirect costs of care for periviable infants and their families, as well as the current limitations of published data. In addition, we highlight the cost-effectiveness of neonatal intensive care and various therapies offered to extremely preterm infants, while also considering the ethical dilemmas inherently tied to periviable decision-making. Strategies to improve the gaps in knowledge on the economic impact of the smallest infants are discussed.
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Affiliation(s)
- Leah Yieh
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA 90027, USA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | - Brian C King
- Department of Pediatrics, University of Pittsburgh, Pittsburgh PA, USA
| | - Susanne Hay
- Division of Newborn Medicine, Harvard Medical School, Boston, MA, USA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dmitry Dukhovny
- Division of Neonatology, Department of Pediatrics, Oregon Health & Sciences University, Portland, OR, USA
| | - John A F Zupancic
- Division of Newborn Medicine, Harvard Medical School, Boston, MA, USA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Ferrari RM, McClain EK, Tucker C, Charles N, Verbiest S, Lewis V, Bryant K, Stuebe AM. Postpartum Health Experiences of Women with Newborns in Intensive Care: The Desire to Be by the Infant Bedside as a Driver of Postpartum Health. J Midwifery Womens Health 2022; 67:114-125. [PMID: 35037387 DOI: 10.1111/jmwh.13330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/09/2021] [Accepted: 10/06/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Women with infants in a neonatal intensive care unit (NICU) encounter multiple challenges following childbirth, including greater burden of chronic disease and increased risk for depression, compared with women with well infants. At the same time, they are confronted with the trauma of a hospitalized infant while also managing their postpartum recovery. Limited research exists describing the health needs of these women, despite the many numbers living this experience daily. This study aimed to better understand postpartum health needs of women with infants in the NICU in the 90 days following birth and to propose actionable system improvements to address identified needs. METHODS The authors conducted in-depth individual interviews with 50 postpartum women of infants admitted to the NICU at a quaternary care hospital. Eligible women were aged at least 18 years, spoke English or Spanish, and had infants in the NICU longer than 3 days. Interview topics included NICU experience, recommended and desired health care, and suggestions for improvement. Interviews were audiotaped and transcribed verbatim. The authors used qualitative description techniques including memo-writing, coding, matrices, diagramming, and team discussion to analyze the data. RESULTS Women reported significant intrapartum health conditions and concerns (eg, preeclampsia, emergency cesarean birth, anxiety) and described unmet social, emotional, mental, and physical health needs. Unmet practical needs while in the NICU (eg, a place to rest, affordable parking, access to food, childcare) caused considerable burden. Despite disease burden and emergent health needs, few women reported regular monitoring of their postpartum health by maternal health care providers. Women frequently minimized and delayed care for their health needs so as to remain by the infant bedside. DISCUSSION Women with infants in the NICU would benefit from patient-centered care that provides greater attention to their postpartum health and recovery while also supporting their drive to remain close to their hospitalized infant.
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Affiliation(s)
- Renée M Ferrari
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin K McClain
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christine Tucker
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nkechi Charles
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sarah Verbiest
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Jordan Institute for Families, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Virginia Lewis
- Multilingual Research Advancement for Health (MURAL), North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine Bryant
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alison M Stuebe
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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14
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Lakshmanan A, Song AY, Belfort MB, Yieh L, Dukhovny D, Friedlich PS, Gong CL. The financial burden experienced by families of preterm infants after NICU discharge. J Perinatol 2022; 42:223-230. [PMID: 34561556 PMCID: PMC8460846 DOI: 10.1038/s41372-021-01213-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Describe the financial burden and worry that families of preterm infants experience after discharge from the neonatal intensive care unit (NICU). METHODS We surveyed 365 parents of preterm infants in a cross-sectional study regarding socio-demographics, supplemental security income (SSI), and financial worry. We completed a multivariable logistic regression model to examine the adjusted association of financial worry with modifiable factors. RESULTS We found that 53% of participants worried about healthcare costs after NICU discharge. After adjusting for socio-demographic and infant characteristics, we identified that, aOR (95% CI), out-of-pocket costs from the NICU index hospitalization, 3.51 (1.7, 7.26) and durable medical equipment use, 2.41 (1.11, 5.23) was associated with increased financial worry while enrollment in SSI, 0.38 (0.19, 0.76) was associated with decreased financial worry. CONCLUSIONS We identified factors that could contribute to financial burden after NICU discharge that may advise future work to target financial support systems.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Ashley Y. Song
- grid.21107.350000 0001 2171 9311Department of Preventive Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Mandy B. Belfort
- grid.62560.370000 0004 0378 8294Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Leah Yieh
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA USA
| | - Dmitry Dukhovny
- grid.5288.70000 0000 9758 5690Division of Neonatology, Department of Pediatrics, Oregon Health Sciences University, Portland, OR USA
| | - Philippe S. Friedlich
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Cynthia L. Gong
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA USA
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15
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Abdel-Aziz SM, Hamed EA, Shalaby AM. Study on Inborn and Outborn Neonatal Admissions in Relation to Gestational Maturity in Neonatal Intensive Care Unit at a Tertiary Care University Hospital in Upper Egypt. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1736478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractNeonatal morbidity and mortality rates indicate a country's socioeconomic status and the quality, and effectiveness of its health care system. This research aimed to identify the clinical pattern and causes of neonatal admission for inborn and outborn babies in a tertiary care university hospital and their outcomes. Over a year, this prospective hospital-based research was conducted in the neonatal intensive care unit (NICU) of Assiut Children's Hospital in Upper Egypt (January 1st to December 31st, 2020). Gender, birth weight, gestational age, postnatal age, delivery mode, delivery place, admission cause, hospital stay period, and neonatal outcomes were collected. A total of 1,638 newborns were admitted; 930 (56.8%) were preterm and 708 (43.2%) full-term. Inborn admissions were 1,056 (64.5%) and outborn 582 (35.5%). The majority of inborn admissions were preterm 726 (68.8%), and outborn were full-term 378 (64.9%). The commonest admission causes among inborn and outborn preterm infants were respiratory distress syndrome (84.3%) and congenital intestinal obstruction (22.5%), respectively, while multiple congenital anomalies were the commonest cause for admission among both inborn and outborn full-term babies. The mortality rate was 708 (43.2%), higher among inborn (50%) versus outborn (30.9%). The leading cause of death was respiratory distress syndrome among premature inborn with case fatality rate of (56.9%) and multiple congenital anomalies among premature outborn (60%), as well as inborn (67.4%), and outborn (42.6%) full-term neonates. In conclusion, the neonatal mortality rate was high among studied cases. Morbidity and mortality of respiratory distress syndrome and congenital anomalies were alarmingly high. Therefore, all health care providers must devote a considerable effort to improve health care delivered to these neonates.
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Affiliation(s)
- Safwat M. Abdel-Aziz
- Department of Paediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Enas A. Hamed
- Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amira M. Shalaby
- Department of Paediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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