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Bedetti L, Corso L, Miselli F, Guidotti I, Toffoli C, Miglio R, Roversi MF, Muttini EDC, Pugliese M, Bertoncelli N, Zini T, Mazzotti S, Lugli L, Lucaccioni L, Berardi A. Neurodevelopmental Outcome after Culture-Proven or So-Called Culture-Negative Sepsis in Preterm Infants. J Clin Med 2024; 13:1140. [PMID: 38398453 PMCID: PMC10889041 DOI: 10.3390/jcm13041140] [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: 01/18/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Prematurity is a serious condition associated with long-term neurological disability. This study aimed to compare the neurodevelopmental outcomes of preterm neonates with or without sepsis. (2) Methods: This single-center retrospective case-control study included infants with birth weight < 1500 g and/or gestational age ≤ 30 weeks. Short-term outcomes, brain MRI findings, and severe functional disability (SFD) at age 24 months were compared between infants with culture-proven or culture-negative sepsis or without sepsis. A chi-squared test or Mann-Whitney U test was used to compare the clinical and instrumental characteristics and the outcomes between cases and controls. (3) Results: Infants with sepsis (all sepsis n = 76; of which culture-proven n = 33 and culture-negative n = 43) were matched with infants without sepsis (n = 76). Compared with infants without sepsis, both all sepsis and culture-proven sepsis were associated with SFD. In multivariate logistic regression analysis, SFD was associated with intraventricular hemorrhage (OR 4.7, CI 1.7-13.1, p = 0.002) and all sepsis (OR 3.68, CI 1.2-11.2, p = 0.021). (4) Conclusions: All sepsis and culture-proven sepsis were associated with SFD. Compared with infants without sepsis, culture-negative sepsis was not associated with an increased risk of SFD. Given the association between poor outcomes and culture-proven sepsis, its prevention in the neonatal intensive care unit is a priority.
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Affiliation(s)
- Luca Bedetti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy; (F.M.); (I.G.); (M.F.R.); (E.d.C.M.); (M.P.); (N.B.); (T.Z.); (L.L.)
| | - Lucia Corso
- Pediatric Postgraduate School, University of Modena and Reggio Emilia, 41121 Modena, Italy; (L.C.); (C.T.); (S.M.)
| | - Francesca Miselli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy; (F.M.); (I.G.); (M.F.R.); (E.d.C.M.); (M.P.); (N.B.); (T.Z.); (L.L.)
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Isotta Guidotti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy; (F.M.); (I.G.); (M.F.R.); (E.d.C.M.); (M.P.); (N.B.); (T.Z.); (L.L.)
| | - Carlotta Toffoli
- Pediatric Postgraduate School, University of Modena and Reggio Emilia, 41121 Modena, Italy; (L.C.); (C.T.); (S.M.)
| | - Rossella Miglio
- Department of Statistical Sciences, University of Bologna, 41121 Bologna, Italy;
| | - Maria Federica Roversi
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy; (F.M.); (I.G.); (M.F.R.); (E.d.C.M.); (M.P.); (N.B.); (T.Z.); (L.L.)
| | - Elisa della Casa Muttini
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy; (F.M.); (I.G.); (M.F.R.); (E.d.C.M.); (M.P.); (N.B.); (T.Z.); (L.L.)
| | - Marisa Pugliese
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy; (F.M.); (I.G.); (M.F.R.); (E.d.C.M.); (M.P.); (N.B.); (T.Z.); (L.L.)
| | - Natascia Bertoncelli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy; (F.M.); (I.G.); (M.F.R.); (E.d.C.M.); (M.P.); (N.B.); (T.Z.); (L.L.)
| | - Tommaso Zini
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy; (F.M.); (I.G.); (M.F.R.); (E.d.C.M.); (M.P.); (N.B.); (T.Z.); (L.L.)
| | - Sofia Mazzotti
- Pediatric Postgraduate School, University of Modena and Reggio Emilia, 41121 Modena, Italy; (L.C.); (C.T.); (S.M.)
| | - Licia Lugli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy; (F.M.); (I.G.); (M.F.R.); (E.d.C.M.); (M.P.); (N.B.); (T.Z.); (L.L.)
| | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy; (F.M.); (I.G.); (M.F.R.); (E.d.C.M.); (M.P.); (N.B.); (T.Z.); (L.L.)
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Lugli L, Pugliese M, Bertoncelli N, Bedetti L, Agnini C, Guidotti I, Roversi MF, Della Casa EM, Cavalleri F, Todeschini A, Di Caprio A, Zini T, Corso L, Miselli F, Ferrari F, Berardi A. Neurodevelopmental Outcome and Neuroimaging of Very Low Birth Weight Infants from an Italian NICU Adopting the Family-Centered Care Model. CHILDREN (BASEL, SWITZERLAND) 2023; 11:12. [PMID: 38275433 PMCID: PMC10813860 DOI: 10.3390/children11010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Improvements in perinatal care have substantially decreased mortality rates among preterm infants, yet their neurodevelopmental outcomes and quality of life persist as a pertinent public health concern. Family-centered care has emerged as a holistic philosophy that promotes effective alliances among patients, families, and healthcare providers to improve the quality of care. AIMS This longitudinal prospective study aims to evaluate the neurodevelopmental outcomes and brain MRI findings in a cohort of preterm newborns admitted to a neonatal intensive care unit (NICU) adopting a family-centered care model. METHODS Very low birth weight (VLBW) infants admitted to the NICU of Modena between 2015 and 2020 were enrolled. Infants who underwent conventional brain magnetic resonance imaging (MRI) at term-equivalent age were included. Neurodevelopmental follow-up was performed until the age of 24 months by a multidisciplinary team using the Amiel-Tison neurological assessment and the Griffiths Mental Developmental Scales (GMDS-R). Neurodevelopmental outcomes were classified as major sequelae (cerebral palsy, DQ ≤ 70, severe sensory impairment), minor sequelae (minor neurological signs such as clumsiness or DQ between 71 and 85), and normal outcomes (no neurological signs and DQ > 85). Risk factors for severe outcomes were assessed. RESULTS In total, 49 of the 356 infants (13.8%) died before hospital discharge, and 2 were excluded because of congenital disorders. Of the remaining 305 infants, 222 (72.8%) completed the 24 month follow-up and were included in the study. Neurodevelopmental outcomes were classified as normal (n = 173, 77.9%), minor (n = 34, 15.3%), and major sequelae (n = 15, 6.8%). Among 221 infants undergoing brain MRI, 76 (34.4%) had major lesions (intraventricular hemorrhage, hemorrhagic parenchymal infarction, periventricular leukomalacia, and large cerebellar hemorrhage). In the multivariate regression model, the retinopathy of prematurity (OR 1.8; p value 0.016) and periventricular-intraventricular hemorrhage (OR 5.6; p value < 0.004) were associated with major sequelae. CONCLUSIONS We reported low rates of severe neurodevelopmental outcomes in VLBW infants born in an Italian NICU with FCC. Identifying the risk factors for severe outcomes can assist in tailoring and optimizing early interventions on an individual basis, both within the NICU and after discharge.
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Affiliation(s)
- Licia Lugli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Marisa Pugliese
- Psychology Unit, University Hospital of Modena, 41100 Modena, Italy;
| | - Natascia Bertoncelli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Luca Bedetti
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Cristina Agnini
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Isotta Guidotti
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Maria Federica Roversi
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Elisa Muttini Della Casa
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Francesca Cavalleri
- Neuroradiology Unit, University Hospital of Modena, 41100 Modena, Italy; (F.C.); (A.T.)
| | - Alessandra Todeschini
- Neuroradiology Unit, University Hospital of Modena, 41100 Modena, Italy; (F.C.); (A.T.)
| | - Antonella Di Caprio
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Postgraduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy; (A.D.C.); (L.C.)
| | - Tommaso Zini
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Lucia Corso
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Postgraduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy; (A.D.C.); (L.C.)
| | - Francesca Miselli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Fabrizio Ferrari
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Alberto Berardi
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
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Jana A, Dey D, Ghosh R. Contribution of low birth weight to childhood undernutrition in India: evidence from the national family health survey 2019-2021. BMC Public Health 2023; 23:1336. [PMID: 37438769 DOI: 10.1186/s12889-023-16160-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Infants born with low birth weight (LBW), i.e. less than 2500g, is considered an important factor of malnutrition in Asia. In India, research related to this issue is still neglected and limited. Evidence exists that a large number of child deaths occur in India due to maternal and child malnutrition-related complications. Moreover, it has been found that the cost of malnutrition in India results in a significant reduction of the country's Gross Domestic Product (GDP). Thus, in this current context, this study aims to explore the contribution of low birth weight to childhood undernutrition in India. METHODS The study used data from the 5th round of the National Family Health Survey (NFHS-5), a large-scale survey conducted in India. The survey collected information from 176,843 mothers and 232,920 children. The study used the last birth information (last children born 5 years preceding the survey) due to the detailed availability of maternal care information. Univariate and bivariate analyses were conducted to determine the percentage distribution of outcome variables. Multivariate logistic regression was employed to examine the association between LBW and undernutrition (stunting, wasting, and underweight). The study also used the Fairlie decomposition analysis to estimate the contribution of LBW to undernutrition among Indian children. RESULTS The results show that childhood undernutrition was higher in states like Uttar Pradesh, Bihar, Jharkhand, Gujarat, and Maharashtra. The results of the logistic regression analysis show that infants born with low birth weight were more likely to be stunted (OR = 1.46; 95% CI: 1.41-1.50), wasted (OR = 1.33; 95% CI: 1.27-1.37), and underweight (OR = 1.76; 95% CI: 1.70-1.82) in their childhood compared to infants born without low birth weight. The findings from the decomposition analysis explained that approximately 14.8% of the difference in stunting, 10.4% in wasting, and 9.6% in underweight among children born with low birth weight after controlling for the individuals' selected characteristics. CONCLUSION The findings suggest that LBW has a significant contribution to malnutrition. The study suggests that policymakers should prioritize strengthening maternal and child healthcare schemes, particularly focusing on antenatal and postnatal care, as well as kangaroo mother care at the grassroots level to reduce the burden of LBW and undernourished children.
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Affiliation(s)
- Arup Jana
- Research Scholar, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Deepshikha Dey
- MPhil., International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Ranjita Ghosh
- PhD Scholar, Institute for Social and Economic Change, Karnataka, 560072, India.
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Kovács G, Abonyi-Tóth Z, Fadgyas-Freyler P, Kaló Z. Incremental cost of premature birth - a public health care payer perspective from Hungary. BMC Health Serv Res 2023; 23:686. [PMID: 37353814 DOI: 10.1186/s12913-023-09697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/13/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Preterm birth remains a significant burden to families, health systems and societies. The aim was to quantify the incremental prematurity-related public health expenditure in Hungary and to estimate the potential impact of a decrease in the prevalence of prematurity on the public payer's spending. METHODS Over a 6-year time horizon, public financing data of inpatient, outpatient and pharmaceutical care for children born at ≥ 25 weeks of gestation in 2009/2010 were retrieved from the Hungarian National Health Insurance Fund database. In descriptive analysis, the public payer's spending was given as cost/capita. The impact of a decrease in prematurity prevalence was specified as the total budget impact. An exchange rate of 294 Hungarian forint/Euro was applied. RESULTS A total of 93,124 children (including 8.6% who were premature babies) were included in the analysis. A strong negative relationship was shown between gestational age and per capita cost. The 6-year cost of care for the cohort born at 26 weeks of gestation (28,470 Euro per capita) was 24 times higher than that for the cohort born at 40 weeks. First-year inpatient spending accounted for the largest proportion of total health care spending across all gestational ages. All investigated prematurity complications (retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular cerebral bleeding and leukomalacia) resulted in additional significant incremental spending. If 70% of pregnancies ending with preterm birth could be prolonged by 1 week, the savings would be almost 7.0 million Euros in the first 6 years of life. CONCLUSION This comprehensive analysis of prematurity-related health care spending confirmed that premature infants have much higher costs for care than those born at term in Hungary. These quantitative outcomes can provide essential inputs for the cost-effectiveness analysis of medical technologies and public health interventions that can decrease the prevalence of premature birth. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Gábor Kovács
- Doctoral School of Sociology, Eötvös Loránd University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - Zsolt Abonyi-Tóth
- University of Veterinary Medicine, Budapest, Hungary
- RxTarget Ltd, Budapest, Hungary
| | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary.
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Mowitz ME, Gao W, Sipsma H, Zuckerman P, Wong H, Ayyagari R, Sarda SP. Burden of Comorbidities and Healthcare Resource Utilization Among Medicaid-Enrolled Extremely Premature Infants. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:147-155. [PMID: 36619291 PMCID: PMC9790150 DOI: 10.36469/001c.38847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 06/17/2023]
Abstract
Background: The effect of gestational age (GA) on comorbidity prevalence, healthcare resource utilization (HCRU), and all-cause costs is significant for extremely premature (EP) infants in the United States. Objectives: To characterize real-world patient characteristics, prevalence of comorbidities, rates of HCRU, and direct healthcare charges and societal costs among premature infants in US Medicaid programs, with respect to GA and the presence of respiratory comorbidities. Methods: Using International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification codes, diagnosis and medical claims data from 6 state Medicaid databases (1997-2018) of infants born at less than 37 weeks of GA (wGA) were collected retrospectively. Data from the index date (birth) up to 2 years corrected age or death, stratified by GA (EP, ≤28 wGA; very premature [VP], >28 to <32 wGA; and moderate to late premature [M-LP], ≥32 to <37 wGA), were compared using unadjusted and adjusted generalized linear models. Results: Among 25 573 premature infants (46.1% female; 4462 [17.4%] EP; 2904 [11.4%] VP; 18 207 [71.2%] M-LP), comorbidity prevalence, HCRU, and all-cause costs increased with decreasing GA and were highest for EP. Total healthcare charges, excluding index hospitalization and all-cause societal costs (US dollars), were 2 to 3 times higher for EP than for M-LP (EP $74 436 vs M-LP $27 541 and EP $28 504 vs M-LP $15 892, respectively). Conclusions: Complications of preterm birth, including prevalence of comorbidities, HCRU, and costs, increased with decreasing GA and were highest among EP infants during the first 2 years in this US analysis.
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Affiliation(s)
| | - Wei Gao
- Analysis Group, Inc., Boston, Massachusetts
| | | | | | | | | | - Sujata P Sarda
- Global Evidence and Outcomes, Takeda Pharmaceutical Company Limited, Lexington, Massachusetts
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The effect of maternal anaemia on low birth weight among newborns in Northwest Ethiopia. Sci Rep 2022; 12:15280. [PMID: 36088384 PMCID: PMC9464186 DOI: 10.1038/s41598-022-19726-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/02/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractLow birth weight is an indicator of maternal-related multifactorial problems such as malnutrition, illness, and work overload. As a result, low birth weight is associated with maternal anaemia, and both of them were significant public health issues in developing nations. Low birth weight and anaemia are caused by insufficient nutrient intake, which is especially severe during pregnancy. So, this study aimed to assess the effect of maternal anaemia during the late trimester on low birth weight among newborns in Northwest Ethiopia. A systematic random sampling technique was used to select 211 participants for the primary data collection. Face-to-face interviews were used to collect data, while blood samples were collected using standard operating procedures. For further analysis, the data file was imported into Stata version 16 (MP) software. The binary logistic regression model was used to investigate significant factors related to low birth weight. Finally, the statistical significance of the variables was determined using a p value of ≤ 0.05. The prevalence of anaemia among pregnant women in the late trimester and newborns was 34 (16.11%, 95% CI: 11.42, 21.78) and 64 (30.33%, 95% CI: 24.20, 37.01), respectively. The mean ± standard deviation of the newborn babies' weight was 3.19 ± 0.49 kg. The proportion of low birth weight among newborns was 26 (12.32%, 95% CI: 8.20, 17.53%). The independent effect of anaemia on low birth weight was 4.19 times while all other factors were constant (COR = 4.19, 95% CI: 1.70, 10.30). Maternal educational status [unable to read and write (AOR = 10.94, 95% CI: 1.74, 68.58) and attained secondary education (AOR = 8.06, 95% CI: 1.53, 42.36)], and maternal anaemia (AOR = 3.51, 95% CI: 1.29, 9.55) were associated with low birth weight after adjusting with all other variables. In this study, the proportion of low birth weight was high. Here, maternal anaemia alone had a significant independent role in the development of low birth weight. Maternal education status and anaemic conditions were associated with low birth weight among newborns. Early detection and treatment of maternal anaemia during pregnancy is crucial with the usual nutritional-related care.
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Lee E, Schofield D, Owens CEL, Oei JL. An economic analysis of the cost of survival of micro preemies: A systematic review. Semin Fetal Neonatal Med 2022; 27:101336. [PMID: 35729046 DOI: 10.1016/j.siny.2022.101336] [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: 11/25/2022]
Abstract
OBJECTIVE This study aimed to systematically review the current literature on the economic costs of micro preemie as well as evidence on the cost-effectiveness of interventions to improve outcomes for micro preemie babies with a birth weight of ≤500 g. METHOD We searched MEDLINE, CINAHL, Scopus, ECONLIT, Business Source Premier and Cochrane Library for studies reporting costs of micro preemie from January 2000. Costs were inflated to 2019 United States dollars (US$). All full-text articles were assessed for eligibility and a quality assessment of included articles was conducted using the Drummond and the Larg and Moss checklists. RESULTS The search identified three studies that met the inclusion criteria; two cost-of-illness studies and one cost-effectiveness study. Across studies, the mean healthcare spending per micro preemie survivor (in 2019 US$) ranged from US$61,310 (birth admission) to US$263,958 (inpatient and outpatient for the first six months of life). One modelling study reported exclusive human milk diet for micro preemies at birth was more cost-effective compared to the standard approach with cow milk diet from the third-party payer and societal perspectives. CONCLUSION Despite significant advances in perinatal care and expanded access to life-saving equipment to improve survival outcomes of micro preemie, there remains a paucity of research on economic costs associated with these babies. No study has utilised quality-adjusted life-years as an outcome measure. Given the chronic conditions and long-term neurologic disability associated with micro preemie survivors, an estimate of the lifetime cost to the individual, healthcare providers and society would provide a benchmark of the potential cost-savings that could accrue from cost-effective interventions to improve the survival rate of micro preemies.
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Affiliation(s)
- Evelyn Lee
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, New South Wales, Australia.
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, New South Wales, Australia
| | - Christopher E L Owens
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, New South Wales, Australia
| | - Ju-Lee Oei
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
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Nsugbe E. A cybernetic framework for predicting preterm and enhancing care strategies: A review. BIOMEDICAL ENGINEERING ADVANCES 2021. [DOI: 10.1016/j.bea.2021.100024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Neurodevelopmental outcome of preterm very low birth weight infants admitted to an Italian tertiary center over an 11-year period. Sci Rep 2021; 11:16316. [PMID: 34381139 PMCID: PMC8357917 DOI: 10.1038/s41598-021-95864-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
Preterm very low birth weight infants (VLBWi) are known to be at greater risk of adverse neurodevelopmental outcome. Identifying early factors associated with outcome is essential in order to refer patients for early intervention. Few studies have investigated neurodevelopmental outcome in Italian VLBWi. The aim of our longitudinal study is to describe neurodevelopmental outcome at 24 months of corrected age in an eleven-year cohort of 502 Italian preterm VLBWi and to identify associations with outcome. At 24 months, Griffiths’ Mental Developmental Scales were administered. Neurodevelopmental outcome was classified as: normal, minor sequelae (minor neurological signs, General Quotient between 76 and 87), major sequelae (cerebral palsy; General Quotient ≤ 75; severe sensory impairment). 75.3% showed a normal outcome, 13.9% minor sequelae and 10.8% major sequelae (3.8% cerebral palsy). Male gender, bronchopulmonary dysplasia, abnormal neonatal neurological assessment and severe brain ultrasound abnormalities were independently associated with poor outcome on multivariate ordered logistic regression. Rates of major sequelae are in line with international studies, as is the prevalence of developmental delay over cerebral palsy. Analysis of perinatal complications and the combination of close cUS monitoring and neurological assessment are still essential for early identification of infants with adverse outcome.
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Basile M, Calabrò GE, Ghelardi A, Ricciardi R, De Vincenzo R, Cicchetti A. HPV Vaccination in Women Treated for Cervical Intraepithelial Neoplasia: A Budget Impact Analysis. Vaccines (Basel) 2021; 9:816. [PMID: 34451941 PMCID: PMC8402448 DOI: 10.3390/vaccines9080816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/03/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Human Papillomavirus (HPV) is the most common sexually transmitted infection. Its progression is related to the development of malignant lesions, particularly cervical intraepithelial neoplasias (CINs). CINs correlate with a higher risk of premature births, and their excisional and ablative treatment further increases this risk in pregnant women. These complications are also correlated with higher healthcare costs for their management. In Italy, more than 26,000 new cases of CINs are estimated to occur yearly and their economic burden is significant. Therefore, the management of these conditions is a public health priority. Since HPV vaccination is associated with a reduced risk of relapse in women surgically treated for HPV-related injuries, we estimated the economic impact of extending HPV vaccination to this target population. This strategy would result in a significant reduction in the general costs of managing these women, resulting in an overall saving for the Italian Health Service of €155,596.38 in 5 years. This lower cost is due not only to the reduced incidence of CINs following vaccination, but also to the lower occurrence of preterm births. Extending HPV vaccination to this target population as part of a care path to be offered to women treated for HPV injuries is therefore desirable.
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Affiliation(s)
- Michele Basile
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.B.); (A.C.)
| | - Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Alessandro Ghelardi
- Azienda USL Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Via Enrico Mattei, 21, 54100 Massa, Italy;
| | - Roberto Ricciardi
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Rosa De Vincenzo
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, 00168 Rome, Italy;
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Americo Cicchetti
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.B.); (A.C.)
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Stjernholm AD, Thysen SM, Borges IDS, Fisker AB. Factors associated with birthweight and adverse pregnancy outcomes among children in rural Guinea-Bissau - a prospective observational study. BMC Public Health 2021; 21:1164. [PMID: 34140010 PMCID: PMC8212457 DOI: 10.1186/s12889-021-11215-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/27/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Low birthweight (LBW) is associated with higher mortality and morbidity, but there is limited data on the prevalence of LBW in rural Africa, where many births occur at home. The Bacillus Calmette-Guérin (BCG) vaccine has non-specific effects. Studies suggest that maternal BCG-vaccination may affect the health of the child. METHODS The present study is nested within a randomised trial in rural Guinea-Bissau: Pregnancies were registered at two-monthly village visits, where information on BCG scar status and other background factors were obtained. Children were enrolled in the trial and weighed at home within 72 h after birth. In this prospective observational study, we assessed factors associated with adverse pregnancy outcomes and birthweight in binomial and linear regression models. RESULTS Among 1320 women who had their BCG scar status assessed, 848 (64%) had a scar, 472 (36%) had no scar. The risk of adverse pregnancy outcomes (miscarriages, stillbirths, early neonatal deaths) tended to be higher among BCG scar-negative women (13%) than among women with a BCG scar (10%), adjusted prevalence ratio = 1.29 (0.99-1.68). Birthweight was assessed for 628 (50%) of the 1232 live born children. The mean birthweight was 2.89 kg (SD 0.43) and the proportion of LBW children was 17% (104/628). Sex, twinning, region of birth, maternal age, maternal mid-upper arm circumference (MUAC), antenatal consultations, parity and possession of a mobile phone were associated with birthweight, while maternal BCG scar status was not. CONCLUSIONS This study provides the first birthweight data for home-born children in rural Guinea-Bissau, with a mean birthweight of 2.89 kg (SD 0.43) and a LBW prevalence of 17%. We found a tendency for higher risk of adverse pregnancy outcomes among BCG scar-negative women. Birthweight was similar in children of mothers with and without BCG scar.
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Affiliation(s)
- Alexander Dahl Stjernholm
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Sanne Marie Thysen
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Bandim Health Project, Bissau, Guinea-Bissau.
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.
- Center for Global Health (GloHAU), Aarhus University, Aarhus, Denmark.
| | | | - Ane Bærent Fisker
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
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12
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Garofoli F, Longo S, Pisoni C, Accorsi P, Angelini M, Aversa S, Caporali C, Cociglio S, De Silvestri A, Fazzi E, Rizzo V, Tzialla C, Zecca M, Orcesi S. Oral melatonin as a new tool for neuroprotection in preterm newborns: study protocol for a randomized controlled trial. Trials 2021; 22:82. [PMID: 33482894 PMCID: PMC7820522 DOI: 10.1186/s13063-021-05034-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Prevention of neurodevelopmental impairment due to preterm birth is a major health challenge. Despite advanced obstetric and neonatal care, to date there are few neuroprotective molecules available. Melatonin has been shown to have anti-oxidant/anti-inflammatory effects and to reduce brain damage, mainly after hypoxic ischemic encephalopathy. The planned study will be the first aiming to evaluate the capacity of melatonin to mitigate brain impairment due to premature birth. Method In our planned prospective, multicenter, double-blind, randomized vs placebo study, we will recruit, within 96 h of birth, 60 preterm newborns with a gestational age ≤ 29 weeks + 6 days; these infants will be randomly allocated to oral melatonin, 3 mg/kg/day, or placebo for 15 days. After the administration period, we will measure plasma levels of malondialdehyde, a lipid peroxidation product considered an early biological marker of melatonin treatment efficacy (primary outcome). At term-equivalent age, we will evaluate neurological status (through cerebral ultrasound, cerebral magnetic resonance imaging, vision and hearing evaluations, clinical neurological assessment, and screening for retinopathy of prematurity) as well as the incidence of bronchodysplasia and sepsis. We will also monitor neurodevelopmental outcome during the first 24 months of corrected age (using the modified Fagan Test of Infant Intelligence at 4–6 months and standardized neurological and developmental assessments at 24 months). Discussion Preterm birth survivors often present long-term neurodevelopmental sequelae, such as motor, learning, social-behavioral, and communication problems. We aim to assess the role of melatonin as a neuroprotectant during the first weeks of extrauterine life, when preterm infants are unable to produce it spontaneously. This approach is based on the supposition that its anti-oxidant mechanism could be useful in preventing neurodevelopmental impairment. Considering the short- and long-term morbidities related to preterm birth, and the financial and social costs of the care of preterm infants, both at birth and over time, we suggest that melatonin administration could lead to considerable saving of resources. This would be the first study addressing the role of melatonin in very low birth weight preterm newborns, and it could provide a basis for further studies on melatonin as a neuroprotection strategy in this vulnerable population. Trial registration ClinicalTrials.gov NCT04235673. Prospectively registered on 22 January 2020.
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Affiliation(s)
- Francesca Garofoli
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy
| | - Stefania Longo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy
| | - Camilla Pisoni
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy.
| | - Patrizia Accorsi
- Child and Adolescence Neuropsychiatry Unit, Children's Hospital, ASST Spedali Civili of Brescia, 25123, Brescia, Italy
| | - Micol Angelini
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy
| | - Salvatore Aversa
- Neonatal Unit and Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili of Brescia, 25123, Brescia, Italy
| | - Camilla Caporali
- Child Neurology and Psychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100, Pavia, Italy
| | - Sara Cociglio
- Child Neurology and Psychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Elisa Fazzi
- Child and Adolescence Neuropsychiatry Unit, Children's Hospital, ASST Spedali Civili of Brescia, 25123, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - Vittoria Rizzo
- Clinical Chemistry Laboratory and Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Chryssoula Tzialla
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy
| | - Marco Zecca
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100, Pavia, Italy
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13
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Banchani E, Tenkorang EY. Determinants of Low Birth Weight in Ghana: Does Quality of Antenatal Care Matter? Matern Child Health J 2020; 24:668-677. [PMID: 32026325 DOI: 10.1007/s10995-020-02895-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Low birth weight is a public health issue that contributes to perinatal and infant mortality, especially in limited-resource settings, but there is limited understanding of the determinants of low birth weight and the contributions of quality antenatal care to maintaining healthy birth weights for newborns in such settings. This study aims at establishing links between birthweight and quality antenatal care in Ghana. METHODS We used data collected from the recent 2017 Ghana Maternal Health Survey and applied complementary log-log models to investigate relationships between the quality of antenatal care (screening/diagnostic procedures, clinical interventions, type of health provider) and low birth weight in Ghana. RESULTS The results reveal that compared to women who received low quality clinical interventions, those who received high quality interventions were significantly less likely to have a low birth weight baby. Similarly, women who made the recommended number of antenatal visits (at least eight) were significantly less likely to have a baby with low birth weight than women making fewer visits. CONCLUSION Our findings suggest that while the number of antenatal visits is important, the quality of care received during such visits is equally relevant to reducing low birth weight in Ghana.
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Affiliation(s)
- Emmanuel Banchani
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
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14
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Shibre G, Tamire M. Prevalence of and socioeconomic gradient in low birth weight in Ethiopia: further analysis of the 2016 demographic and health survey data. BMC Pregnancy Childbirth 2020; 20:608. [PMID: 33032553 PMCID: PMC7545879 DOI: 10.1186/s12884-020-03313-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Evidence suggests appearance of socioeconomic gradient in the probability of low birth weight (LBW). Such evidence, however, is scanty in Ethiopia. The study aimed to examine the prevalence of and socioeconomic gradient in LBW in Ethiopia. Method Data for the study were drawn from the Ethiopia Demographic and Health Survey conducted in 2016. The 2016 EDHS is the fourth wave in the series of nationally representative household surveys carried out in the country to deliver up-to-date health and demographic indicators for the Ethiopian population. Women aged 15 to 49 years were the main focus of the survey, with data also gathered from men aged 15 to 59 years and under five children. The study pursued complex sampling strategy to draw samples representative at national as well as at urban and rural levels. The data are available to the public domain and were accessed from the MEASURE DHS following registration. Multivariable logistic regression model and marginal standardization were used to estimate socioeconomic gradient in the probability of LBW. We performed sensitivity analysis to evaluate variation of LBW according to different categories of socioeconomic position. Maternal education and household wealth were used as measures of the socioeconomic position in the study. Results 13.2% (95% confidence interval = 10.73, 15.65) of births were complicated by LBW. The findings showed that socioeconomic gradient was evident between maternal education and LBW; as education increases from no education to secondary education, the probability of occurrence of LBW consistently declined. However, no gradient in LBW was detected for household wealth. Conclusions We have identified education gradient in LBW, with the highest burden of LBW occurring among the non-educated women. To redress the observed education disparity in LBW, targeted interventions need to be implemented with greater emphasis placed on illiterate women.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mulugeta Tamire
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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15
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Meregaglia M, Croci I, Brusco C, Herich LC, Di Lallo D, Gargano G, Carnielli V, Zeitlin J, Fattore G, Cuttini M. Low socio-economic conditions and prematurity-related morbidities explain healthcare use and costs for 2-year-old very preterm children. Acta Paediatr 2020; 109:1791-1800. [PMID: 31977107 DOI: 10.1111/apa.15183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 12/29/2022]
Abstract
AIM To estimate healthcare use and related costs for 2-year-old very preterm (VP) children after discharge from the neonatal unit. METHODS As part of a European project, we recruited an area-based cohort including all VP infants born in three Italian regions (Lazio, Emilia-Romagna and Marche) in 2011-2012. At 2 years corrected age, parents completed a questionnaire on their child health and healthcare use (N = 732, response rate 75.6%). Cost values were assigned based on national reimbursement tariffs. We used multivariable analyses to identify factors associated with any rehospitalisation and overall healthcare costs. RESULTS The most frequently consulted physicians were the paediatrician (85% of children), the ophthalmologist (36%) and the neurologist/neuropsychiatrist (26%); 38% of children were hospitalised at least once after the initial discharge, for a total of 513 admissions and over one million euros cost, corresponding to 75% of total healthcare costs. Low maternal education and parental occupation index, congenital anomalies and postnatal prematurity-related morbidities significantly increased the risk of rehospitalisation and total healthcare costs. CONCLUSION Rehospitalisation and outpatient care are frequent in VP children, confirming a substantial health and economic burden. These findings should inform the allocation of resources to preventive and rehabilitation services for these children.
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Affiliation(s)
- Michela Meregaglia
- Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi Milan Italy
| | - Ileana Croci
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Carla Brusco
- Medical Direction Department, Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Lena C. Herich
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | | | - Giancarlo Gargano
- Neonatal Intensive Care Unit Department of Obstetrics and Pediatrics Arcispedale Santa Maria Nuova IRCCS Reggio Emilia Italy
| | - Virgilio Carnielli
- Maternal and Child Health Institute Marche University and Salesi Hospital Ancona Italy
| | - Jennifer Zeitlin
- Obstetrics, Perinatal and Pediatric Epidemiology Research Team Centre for Epidemiology and Biostatistics (U1153), INSERM and DHU Risks in Pregnancy, Paris‐Descartes UniversityParis France
| | - Giovanni Fattore
- Department of Social and Political Sciences Bocconi University & Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi Milan Italy
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
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16
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Garofoli F, Mazzucchelli I, Decembrino L, Bartoli A, Angelini M, Broglia M, Tinelli C, Banderali G, Stronati M. Levels and effectiveness of oral retinol supplementation in VLBW preterm infants. Int J Immunopathol Pharmacol 2019; 32:2058738418820484. [PMID: 30897987 PMCID: PMC6311539 DOI: 10.1177/2058738418820484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Retinol palmitate oral administration is convenient, but it is difficult to
assess/monitor its nutritional status in preterm infants and literature is
controversial about the administration route and the effectiveness of vitamin A
supplementation. We primarily evaluated retinol plasma levels to assess the
vitamin A nutritional status in preterm infants (<1500 g; 32 weeks) after
28 days of oral supplementation (3000 IU/kg/day, retinol palmitate drops), in
addition to vitamin A standard amount as suggested by European Society of
Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines. We
then observed the rate of typical preterm pathologies in the supplemented group
(31 newborns) and in 10 matching preterm infants, hospitalized in neonatal
intensive care unit (NICU) in the same period, who received neither vitamin A
supplementation nor parents allowed plasma sampling. Oral integration resulted
in constant retinol plasma concentration around the desired level of 200 ng/mL,
but without statistical increase during the study period. Due to the complexity
of vitamin A metabolism and the immaturity of preterm infant’s organs, retinol
supplementation may had first saturated other needy tissues; therefore,
plasmatic measures may not be consistent with improved global vitamin A body
distribution. Therefore, achieving a constant retinol concentration is a
valuable result and supportive for oral administration: decreasing levels, even
after parenteral/enteral supplementation, were reported in the literature. In
spite of favourable trend and no adverse events, we did not report statistical
difference in co-morbidities. This investigation confirms the necessity to
perform further trials in preterm newborns, to find an index reflecting the
complex nutritional retinol status after oral administration of vitamin A,
highlighting its effectiveness/tolerability in correlated preterm infant’s
pathologies.
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Affiliation(s)
- Francesca Garofoli
- 1 Neonatal Immunology Laboratory, UOC Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Iolanda Mazzucchelli
- 1 Neonatal Immunology Laboratory, UOC Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,2 Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Lidia Decembrino
- 3 Department of the Mother and Child Health, UOC Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonella Bartoli
- 4 Clinical and Experimental Pharmacokinetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Micol Angelini
- 1 Neonatal Immunology Laboratory, UOC Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Monica Broglia
- 4 Clinical and Experimental Pharmacokinetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carmine Tinelli
- 5 Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Mauro Stronati
- 1 Neonatal Immunology Laboratory, UOC Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,2 Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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Petrou S, Yiu HH, Kwon J. Economic consequences of preterm birth: a systematic review of the recent literature (2009-2017). Arch Dis Child 2019; 104:456-465. [PMID: 30413489 DOI: 10.1136/archdischild-2018-315778] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite extensive knowledge on the functional, neurodevelopmental, behavioural and educational sequelae of preterm birth, relatively little is known about its economic consequences. OBJECTIVE To systematically review evidence around the economic consequences of preterm birth for the health services, for other sectors of the economy, for families and carers, and more broadly for society. METHODS Updating previous reviews, systematic searches of Medline, EconLit, Web of Science, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase and Scopus were performed using broad search terms, covering the literature from 1 January 2009 to 28 June 2017. Studies reporting economic consequences, published in the English language and conducted in a developed country were included. Economic consequences are presented in a descriptive manner according to study time horizon, cost category and differential denominators (live births or survivors). RESULTS Of 4384 unique articles retrieved, 43 articles met the inclusion criteria. Of these, 27 reported resource use or cost estimates associated with the initial period of hospitalisation, while 26 reported resource use or costs incurred following the initial hospital discharge, 10 of which also reported resource use or costs associated with the initial period of hospitalisation. Only two studies reported resource use or costs incurred throughout the childhood years. Initial hospitalisation costs varied between $576 972 (range $111 152-$576 972) per infant born at 24 weeks' gestation and $930 (range $930-$7114) per infant born at term (US$, 2015 prices). The review also revealed a consistent inverse association between gestational age at birth and economic costs regardless of date of publication, country of publication, underpinning study design, follow-up period, age of assessment or costing approach, and a paucity of evidence on non-healthcare costs. Several categories of economic costs, such as additional costs borne by families as a result of modifications to their everyday activities, are largely overlooked by this body of literature. Moreover, the number and coverage of economic assessments have not increased in comparison with previous review periods. CONCLUSION Evidence identified by this review can be used to inform clinical and budgetary service planning and act as data inputs into future economic evaluations of preventive or treatment interventions. Future research should focus particularly on valuing the economic consequences of preterm birth in adulthood.
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Affiliation(s)
- Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hei Hang Yiu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Joseph Kwon
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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18
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Ali RA, Obeisat SM, Tarawneh LH. Improving nursing knowledge and care for neonates with respiratory distress in Jordan. Int Nurs Rev 2019; 66:338-345. [PMID: 30937901 DOI: 10.1111/inr.12510] [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: 11/29/2022]
Abstract
AIM This study evaluates the effectiveness of an educational intervention in the area of nursing knowledge and practice relating to neonatal respiratory distress syndrome. BACKGROUND In Jordan, respiratory distress is the leading cause of death among neonates. Recent studies have revealed a knowledge deficit relating to respiratory distress among nurses in neonatal intensive care units, hence the need for advanced training and specialization in this area. METHODS A quasi-experimental, repeated-measures, one-group pre-test-post-test design was used to assess the effectiveness of the educational intervention. A convenience sample of 48 nurses was recruited from three hospitals in northern Jordan. A self-reporting questionnaire was used to assess the respondents' knowledge of respiratory distress and an observational checklist to assess their practice. The study intervention consisted of 12 two-hour lecture-based interactive teaching sessions lasting 4 weeks. A follow-up assessment was conducted 1 month after the post-test. RESULTS The baseline assessment revealed that more than half of the nurses scored low on knowledge and the majority scored low on practice. One-way repeated ANOVA showed that post-test and follow-up test scores on nursing knowledge and practice were significantly higher than the baseline scores. CONCLUSION The study findings show the efficacy of educational interventions in enhancing nursing knowledge and practice relating to the care of neonates with respiratory distress. IMPLICATIONS FOR NURSING AND HEALTH POLICY For neonatal nurses, periodic teaching and training interventions are essential to ensuring the quality nursing care required to reduce morbidity and mortality rates among neonates. Health policymakers should support nurses in pursuing educational opportunities aimed at enhancing their knowledge of advanced neonate care.
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Affiliation(s)
- R A Ali
- Department of Maternal and Child Health Nursing, Faculty of Nursing - Jordan University of Science and Technology, Irbid, Jordan
| | - S M Obeisat
- Department of Maternal and Child Health Nursing, Faculty of Nursing - Jordan University of Science and Technology, Irbid, Jordan
| | - L H Tarawneh
- Department of Maternal and Child Health Nursing, Faculty of Nursing - Jordan University of Science and Technology, Irbid, Jordan
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19
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Merinopoulou E, Pokras S, Pimenta JM, Blini V, Veronesi C, Buda S, Degli Esposti L, Lambrelli D. The cost of preterm labor and preterm birth for mothers with uncomplicated pregnancies and their infants in Italy: a retrospective cohort study. Expert Rev Pharmacoecon Outcomes Res 2018; 19:231-241. [PMID: 29764243 DOI: 10.1080/14737167.2018.1476340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preterm labor (PTL)/preterm birth (PTB) impose significant burden on health-care systems. Women with uncomplicated pregnancies at risk of PTL/PTB have not been widely investigated, and published evidence on the costs of these women and their infants in Italy is absent. We aimed to describe women with uncomplicated pregnancies and associated costs for these women and their infants. METHODS Data on women aged 12-44 years with uncomplicated pregnancies who delivered between 1 September 2009 and 31 December 2014 with PTL diagnosis alone or PTL and PTB were included from four Italian databases. Costs were examined during pregnancy, delivery, and 3 years after delivery for mothers and infants, overall and by gestational age (GA). RESULTS A total of 3058 mothers linked to 3333 infants were included. Costs during pregnancy were €1777. Costs during delivery for PTL/PTB mothers and their infants ranged from €3174 (GA ≥37) to €21007 (GA <28). Combined maternal and infant costs appeared higher for births with lower GAs (<37) in the three-year follow-up. CONCLUSIONS In Italy, PTL/PTB mothers with uncomplicated pregnancies with infants at lower GAs appeared to incur higher medical costs compared to mothers with infants at higher GAs in all three time periods, with particularly marked differences found when considering mother and infant combined costs.
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Affiliation(s)
| | - Shibani Pokras
- b Value Evidence & Outcomes , GlaxoSmithKline , Upper Providence , PA , USA
| | - Jeanne M Pimenta
- c Real-World Evidence (Epidemiology) , GlaxoSmithKline , Uxbridge , UK
| | - Valerio Blini
- d CliCon Srl , Health Economics and Outcomes Research , Ravenna , Italy
| | - Chiara Veronesi
- d CliCon Srl , Health Economics and Outcomes Research , Ravenna , Italy
| | - Stefano Buda
- d CliCon Srl , Health Economics and Outcomes Research , Ravenna , Italy
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20
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Lanssens D, Vandenberk T, Smeets CJ, De Cannière H, Vonck S, Claessens J, Heyrman Y, Vandijck D, Storms V, Thijs IM, Grieten L, Gyselaers W. Prenatal Remote Monitoring of Women With Gestational Hypertensive Diseases: Cost Analysis. J Med Internet Res 2018; 20:e102. [PMID: 29581094 PMCID: PMC5891672 DOI: 10.2196/jmir.9552] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background Remote monitoring in obstetrics is relatively new; some studies have shown its effectiveness for both mother and child. However, few studies have evaluated the economic impact compared to conventional care, and no cost analysis of a remote monitoring prenatal follow-up program for women diagnosed with gestational hypertensive diseases (GHD) has been published. Objective The aim of this study was to assess the costs of remote monitoring versus conventional care relative to reported benefits. Methods Patient data from the Pregnancy Remote Monitoring (PREMOM) study were used. Health care costs were calculated from patient-specific hospital bills of Ziekenhuis Oost-Limburg (Genk, Belgium) in 2015. Cost comparison was made from three perspectives: the Belgian national health care system (HCS), the National Institution for Insurance of Disease and Disability (RIZIV), and costs for individual patients. The calculations were made for four major domains: prenatal follow-up, prenatal admission to the hospital, maternal and neonatal care at and after delivery, and total amount of costs. A simulation exercise was made in which it was calculated how much could be demanded of RIZIV for funding the remote monitoring service. Results A total of 140 pregnancies were included, of which 43 received remote monitoring (30.7%) and 97 received conventional care (69.2%). From the three perspectives, there were no differences in costs for prenatal follow-up. Compared to conventional care, remote monitoring patients had 34.51% less HCS and 41.72% less RIZIV costs for laboratory test results (HCS: mean €0.00 [SD €55.34] vs mean €38.28 [SD € 44.08], P<.001; RIZIV: mean €21.09 [SD €27.94] vs mean €36.19 [SD €41.36], P<.001) and a reduction of 47.16% in HCS and 48.19% in RIZIV costs for neonatal care (HCS: mean €989.66 [SD €3020.22] vs mean €1872.92 [SD €5058.31], P<.001; RIZIV: mean €872.97 [SD €2761.64] vs mean €1684.86 [SD €4702.20], P<.001). HCS costs for medication were 1.92% lower in remote monitoring than conventional care (mean €209.22 [SD €213.32] vs mean €231.32 [SD 67.09], P=.02), but were 0.69% higher for RIZIV (mean €122.60 [SD €92.02] vs mean €121.78 [SD €20.77], P<.001). Overall HCS costs for remote monitoring were mean €4233.31 (SD €3463.31) per person and mean €4973.69 (SD €5219.00) per person for conventional care (P=.82), a reduction of €740.38 (14.89%) per person, with savings mainly for RIZIV of €848.97 per person (23.18%; mean €2797.42 [SD €2905.18] vs mean €3646.39 [SD €4878.47], P=.19). When an additional fee of €525.07 per month per pregnant woman for funding remote monitoring costs is demanded, remote monitoring is acceptable in their costs for HCS, RIZIV, and individual patients. Conclusions In the current organization of Belgian health care, a remote monitoring prenatal follow-up of women with GHD is cost saving for the global health care system, mainly via savings for the insurance institution RIZIV.
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Affiliation(s)
- Dorien Lanssens
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Thijs Vandenberk
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Christophe Jp Smeets
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Hélène De Cannière
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Sharona Vonck
- Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Health and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jade Claessens
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Yenthel Heyrman
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Dominique Vandijck
- Department of Health and Life Sciences, Hasselt University, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, Ghent University, Gent, Belgium
| | - Valerie Storms
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge M Thijs
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Lars Grieten
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Wilfried Gyselaers
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
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21
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Garcia-Casado J, Ye-Lin Y, Prats-Boluda G, Mas-Cabo J, Alberola-Rubio J, Perales A. Electrohysterography in the diagnosis of preterm birth: a review. Physiol Meas 2018; 39:02TR01. [PMID: 29406317 DOI: 10.1088/1361-6579/aaad56] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Preterm birth (PTB) is one of the most common and serious complications in pregnancy. About 15 million preterm neonates are born every year, with ratios of 10-15% of total births. In industrialized countries, preterm delivery is responsible for 70% of mortality and 75% of morbidity in the neonatal period. Diagnostic means for its timely risk assessment are lacking and the underlying physiological mechanisms are unclear. Surface recording of the uterine myoelectrical activity (electrohysterogram, EHG) has emerged as a better uterine dynamics monitoring technique than traditional surface pressure recordings and provides information on the condition of uterine muscle in different obstetrical scenarios with emphasis on predicting preterm deliveries. OBJECTIVE A comprehensive review of the literature was performed on studies related to the use of the electrohysterogram in the PTB context. APPROACH This review presents and discusses the results according to the different types of parameter (temporal and spectral, non-linear and bivariate) used for EHG characterization. MAIN RESULTS Electrohysterogram analysis reveals that the uterine electrophysiological changes that precede spontaneous preterm labor are associated with contractions of more intensity, higher frequency content, faster and more organized propagated activity and stronger coupling of different uterine areas. Temporal, spectral, non-linear and bivariate EHG analyses therefore provide useful and complementary information. Classificatory techniques of different types and varying complexity have been developed to diagnose PTB. The information derived from these different types of EHG parameters, either individually or in combination, is able to provide more accurate predictions of PTB than current clinical methods. However, in order to extend EHG to clinical applications, the recording set-up should be simplified, be less intrusive and more robust-and signal analysis should be automated without requiring much supervision and yield physiologically interpretable results. SIGNIFICANCE This review provides a general background to PTB and describes how EHG can be used to better understand its underlying physiological mechanisms and improve its prediction. The findings will help future research workers to decide the most appropriate EHG features to be used in their analyses and facilitate future clinical EHG applications in order to improve PTB prediction.
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Affiliation(s)
- J Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería (CI2B), Universitat Politècnica de València (UPV), Camino de Vera SN, 46022, Valencia, Spain
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22
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Jacob J, Lehne M, Mischker A, Klinger N, Zickermann C, Walker J. Cost effects of preterm birth: a comparison of health care costs associated with early preterm, late preterm, and full-term birth in the first 3 years after birth. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:1041-1046. [PMID: 27909819 DOI: 10.1007/s10198-016-0850-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/18/2016] [Indexed: 06/06/2023]
Abstract
Preterm birth is one of the main causes for infant morbidity and mortality. Apart from negative health outcomes, preterm birth also produces significant health care expenditures. This study evaluates the costs associated with preterm birth in different health sectors during the first 3 years of infants' lives. In a retrospective observational study based on claims data from a German statutory health insurance company, average costs for medication, hospital treatment, ambulatory treatment, and non-medical remedies during the first 3 years after birth were analyzed for early preterm, late preterm, and full-term births. Costs associated with preterm births were generally higher than for full-term births, with the highest costs for the hospital treatment of early preterm births. Cost differences tended to decrease in the second and third year after birth except for ambulatory treatment costs, which decreased for late preterm and full-term births but not for early preterm births. The study shows that preterm birth is associated with increased health care costs, particularly during the first year after birth, indicating that the implementation of adequate programs and policies for preventing preterm birth is not only desirable from a medical but also from a health economic perspective.
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Affiliation(s)
- Josephine Jacob
- Institut für angewandte Gesundheitsforschung Berlin (InGef), Spittelmarkt 12, 10117, Berlin, Germany.
| | | | | | | | | | - Jochen Walker
- Institut für angewandte Gesundheitsforschung Berlin (InGef), Spittelmarkt 12, 10117, Berlin, Germany
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23
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Mueller N, Rojas-Rueda D, Basagaña X, Cirach M, Cole-Hunter T, Dadvand P, Donaire-Gonzalez D, Foraster M, Gascon M, Martinez D, Tonne C, Triguero-Mas M, Valentín A, Nieuwenhuijsen M. Health impacts related to urban and transport planning: A burden of disease assessment. ENVIRONMENT INTERNATIONAL 2017; 107:243-257. [PMID: 28778040 DOI: 10.1016/j.envint.2017.07.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Until now, estimates of the Global Burden of Disease (GBD) have mainly been produced on national or regional levels. These general estimates, however, are less useful for city governments who have to take decisions on local scales. To address this gap, we focused on the city-level burden of disease (BD) due to exposures affected by urban and transport planning. We conducted a BD assessment using the Urban and Transport Planning Health Impact Assessment (UTOPHIA) tool to estimate annual preventable morbidity and disability-adjusted life-years (DALYs) under compliance with international exposure recommendations for physical activity (PA), exposure to air pollution, noise, heat, and access to green spaces in Barcelona, Spain. METHODS Exposure estimates and morbidity data were available for 1,357,361 Barcelona residents ≥20years (2012). We compared recommended with current exposure levels to estimate the associated BD. We quantified associations between exposures and morbidities and calculated population attributable fractions to estimate the number of attributable cases. We calculated DALYs using GBD Study 2015 background DALY estimates for Spain, which were scaled to Barcelona considering differences in population size, age and sex structures. We also estimated annual health costs that could be avoided under compliance with exposure recommendations. RESULTS Not complying with recommended levels for PA, air pollution, noise, heat and access to green spaces was estimated to generate a large morbidity burden and resulted in 52,001 DALYs (95% CI: 42,866-61,136) in Barcelona each year (13% of all annual DALYs). From this BD 36% (i.e. 18,951 DALYs) was due to traffic noise with sleep disturbance and annoyance contributing largely (i.e. 10,548 DALYs). Non-compliance was estimated to result in direct health costs of 20.10 million € (95% CI: 15.36-24.83) annually. CONCLUSIONS Non-compliance of international exposure recommendations was estimated to result in a considerable BD and in substantial economic expenditure each year in Barcelona. Our findings suggest that (1) the reduction of motor traffic together with the promotion of active transport and (2) the provision of green infrastructure would result in a considerable BD avoided and substantial savings to the public health care system, as these measures can provide mitigation of noise, air pollution and heat as well as opportunities for PA promotion.
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Affiliation(s)
- Natalie Mueller
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - David Rojas-Rueda
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Xavier Basagaña
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marta Cirach
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Tom Cole-Hunter
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Payam Dadvand
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - David Donaire-Gonzalez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Physical Activity and Sports Sciences Department, Fundació Blanquerna, Barcelona, Spain
| | - Maria Foraster
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Mireia Gascon
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - David Martinez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cathryn Tonne
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Margarita Triguero-Mas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Antònia Valentín
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mark Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Qiao NN, Gong MH, Jin ZA. [Concerns about neonates discharged against medical advice from the neonatal intensive care unit]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:254-258. [PMID: 28202129 PMCID: PMC7389475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/27/2016] [Indexed: 11/12/2023]
Abstract
Discharge against medical advice (DAMA) conflicts with the purpose of disease treatment in children. Some research has shown that there are high proportions of extremely preterm infants and infants with asphyxia or congenital malformation in neonates with DAMA. This suggests that the sustainable development of neonatology needs cooperation and co-development with obstetrics, neonatal surgery, and radiology to reduce the rate of DAMA. With reference to the current status of research in both China and other countries, this article reviews the causes for DAMA and the strategies for reducing the rate of DAMA, in order to provide a theoretical basis for effectively reducing the rate of DAMA from the neonatal intensive care unit, improving treatment outcomes of the neonates, and increasing hospitals' comprehensive benefits.
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Affiliation(s)
- Ning-Ning Qiao
- Department of Pediatrics, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, China.
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25
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Qiao NN, Gong MH, Jin ZA. [Concerns about neonates discharged against medical advice from the neonatal intensive care unit]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:254-258. [PMID: 28202129 PMCID: PMC7389475 DOI: 10.7499/j.issn.1008-8830.2017.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/27/2016] [Indexed: 06/06/2023]
Abstract
Discharge against medical advice (DAMA) conflicts with the purpose of disease treatment in children. Some research has shown that there are high proportions of extremely preterm infants and infants with asphyxia or congenital malformation in neonates with DAMA. This suggests that the sustainable development of neonatology needs cooperation and co-development with obstetrics, neonatal surgery, and radiology to reduce the rate of DAMA. With reference to the current status of research in both China and other countries, this article reviews the causes for DAMA and the strategies for reducing the rate of DAMA, in order to provide a theoretical basis for effectively reducing the rate of DAMA from the neonatal intensive care unit, improving treatment outcomes of the neonates, and increasing hospitals' comprehensive benefits.
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Affiliation(s)
- Ning-Ning Qiao
- Department of Pediatrics, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, China.
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