1
|
Zepeda Romero LC, Ibarra DPR, Leon JCBD, Cruz VAS, Bouzo DB, Padilla JAG, Gilbert C. Oxygen delivery and monitoring in neonatal intensive care units in Mexico in 2011 and in 2023: an observational longitudinal study. BMC Nurs 2024; 23:590. [PMID: 39183262 PMCID: PMC11346044 DOI: 10.1186/s12912-024-02227-x] [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: 02/20/2024] [Accepted: 08/05/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a leading cause of avoidable blindness in children, particularly in Latin America, where hyperoxia is a significant risk factor. This study evaluated resource availability and use for administering and monitoring supplemental oxygen in Mexico. METHODS In 2011, an observational study in which 32 government neonatal intensive care units (NICUs) across Mexico were visited. Data collected included occupancy, staffing levels, and equipment to deliver and monitor supplemental oxygen. Preterm infants receiving oxygen were observed. In 2023, 13 NICUs were revisited, and similar data collected. Staffing levels were benchmarked against Argentinian and US recommendations. RESULTS In 2011, only 38% of NICUs had adequate medical and staffing levels to meet recommended cot-to-staff ratios for all shifts. Staffing ratios were worse during weekends and at night than during weekdays. Only 25.5% of cots had blenders, and 80.1% had saturation monitors. 153 infants were observed 87% of whom were being monitored. Upper and lower oxygen saturations were ≥ 96% in 53%, and ≤ 89% in 8%, respectively. Alarm settings were inadequate, as 38% and 32% of upper and lower alarms were switched off and 16% and 53% were incorrectly set, respectively. In the 13 NICUs with data from 2011 and 2023, cot-to-staff ratios deteriorated over time, and in 2023 no unit had recommended ratios for all shifts. Equipment provision did not change, with similar proportions of babies in oxygen being monitored (79% 2011; 75% 2023). Rates of hyperoxia decreased slightly from 54% in 2011 to 49% in 2023. More upper alarms were set (46% 2011; 75% 2023), but a higher proportion were incorrectly set (52% 2011; 68% 2023). CONCLUSIONS Between 2011 and 2023, cot-to-staff ratios worsened, and equipment for safe oxygen delivery and monitoring remained insufficient. Despite available monitoring equipment, oxygen saturations often exceeded recommended levels, and alarms were frequently not set or incorrectly configured. Urgent improvements are needed in healthcare workforce numbers and practices, along with ensuring adequate equipment for safe oxygen delivery.
Collapse
Affiliation(s)
- Luz Consuelo Zepeda Romero
- Neonatal Ophtalmology, Pediatric Surgery, Hospital Civil de Guadalajara, University Center of Health Sciences, University of Guadalajara, Zapopan, Jalisco, Mexico.
| | - Daniel Perez Rulfo Ibarra
- Departamento de Reproduccion Humana, Crecimiento y Desarrollo, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico
| | - Juan Carlos Barrera De Leon
- Departamento de Pediatría, Hospital Materno Infantil Esperanza Lopez Mateos, Secretaria de Salud Jaisco, Zapopan, Jalisco, Mexico
- Departamento de Salud, Centro Universitario Los Valles, Universidad de Guadalajara, Ameca, Jalisco, Mexico
| | - Valeria Alejandra Salas Cruz
- Neonatal Ophtalmology, Pediatric Surgery, Hospital Civil de Guadalajara, University Center of Health Sciences, University of Guadalajara, Zapopan, Jalisco, Mexico
| | - David Blanco Bouzo
- Neonatal Ophtalmology, Pediatric Surgery, Hospital Civil de Guadalajara, University Center of Health Sciences, University of Guadalajara, Zapopan, Jalisco, Mexico
| | - Jose Alfonso Gutierrez Padilla
- División de Discipinas Clínicas, Centro Universitario de Ciencias de la Salud, Universidad De Guadalajara, Zapopan, Jalisco, Mexico
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
2
|
Alsamae AA, Elzilal HA, Alzahrani E, Abo-Dief HM, Sultan MA. A Comparative Cross-sectional Study on Prevalence of Low Birth Weight and its Anticipated Risk Factors. Glob Pediatr Health 2023; 10:2333794X231203857. [PMID: 37846399 PMCID: PMC10576915 DOI: 10.1177/2333794x231203857] [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] [Received: 06/26/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023] Open
Abstract
Objective. This study aims to highlight the low birth weight (LBW) in Taiz City (Yemen), as LBW is one of the public health challenges experiencing a profound effect on newborns. Methods. This was a cross-sectional study since the interview and medical records were the sources of data to be analyzed by SPSS. Results. The findings of this study include; a high prevalence of LBW (39.11%), the maternal age was not associated with LBW (P = .68), and education level, economic status, residence place, and health status were not associated with LBW (P < .05). Although the pre-pregnancy BMI, during-pregnancy BMI, MUAC, and gestational age were significantly associated with LBW (P < .05), the only risk factor was gestational age (OR = 9.606, CI = 3.988-23.135, P = .00). Conclusion. LBW is highly prevalent in Taiz (Yemen), so providing good healthcare services is essential to manage LBW incidence.
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Kortz TB, Nielsen KR, Mediratta RP, Reeves H, O'Brien NF, Lee JH, Attebery JE, Bhutta EG, Biewen C, Coronado Munoz A, deAlmeida ML, Fonseca Y, Hooli S, Johnson H, Kissoon N, Leimanis-Laurens ML, McCarthy AM, Pineda C, Remy KE, Sanders SC, Takwoingi Y, Wiens MO, Bhutta AT. The Burden of Critical Illness in Hospitalized Children in Low- and Middle-Income Countries: Protocol for a Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:756643. [PMID: 35372149 PMCID: PMC8970052 DOI: 10.3389/fped.2022.756643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/31/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The majority of childhood deaths occur in low- and middle-income countries (LMICs). Many of these deaths are avoidable with basic critical care interventions. Quantifying the burden of pediatric critical illness in LMICs is essential for targeting interventions to reduce childhood mortality. OBJECTIVE To determine the burden of hospitalization and mortality associated with acute pediatric critical illness in LMICs through a systematic review and meta-analysis of the literature. DATA SOURCES AND SEARCH STRATEGY We will identify eligible studies by searching MEDLINE, EMBASE, CINAHL, and LILACS using MeSH terms and keywords. Results will be limited to infants or children (ages >28 days to 12 years) hospitalized in LMICs and publications in English, Spanish, or French. Publications with non-original data (e.g., comments, editorials, letters, notes, conference materials) will be excluded. STUDY SELECTION We will include observational studies published since January 1, 2005, that meet all eligibility criteria and for which a full text can be located. DATA EXTRACTION Data extraction will include information related to study characteristics, hospital characteristics, underlying population characteristics, patient population characteristics, and outcomes. DATA SYNTHESIS We will extract and report data on study, hospital, and patient characteristics; outcomes; and risk of bias. We will report the causes of admission and mortality by region, country income level, and age. We will report or calculate the case fatality rate (CFR) for each diagnosis when data allow. CONCLUSIONS By understanding the burden of pediatric critical illness in LMICs, we can advocate for resources and inform resource allocation and investment decisions to improve the management and outcomes of children with acute pediatric critical illness in LMICs.
Collapse
Affiliation(s)
- Teresa B Kortz
- Division of Critical Care, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States.,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Katie R Nielsen
- Division of Critical Care, Department of Pediatrics, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Rishi P Mediratta
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Hailey Reeves
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Nicole F O'Brien
- Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University/Nationwide Children's Hospital, Columbus, OH, United States
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.,SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
| | - Jonah E Attebery
- Division of Critical Care, Department of Pediatrics, University of Colorado, Aurora, CO, United States
| | - Emaan G Bhutta
- Eberly College of Science, Pennsylvania State University, State College, PA, United States
| | - Carter Biewen
- Division of Critical Care, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Alvaro Coronado Munoz
- Division of Critical Care, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mary L deAlmeida
- Division of Critical Care, Department of Pediatrics, Emory University, Atlanta, GA, United States
| | - Yudy Fonseca
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Shubhada Hooli
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Hunter Johnson
- Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University/Nationwide Children's Hospital, Columbus, OH, United States
| | - Niranjan Kissoon
- Children's and Women's Global Health, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mara L Leimanis-Laurens
- Pediatric Critical Care Unit, Helen DeVos Children's Hospital, Grand Rapids, MI, United States.,Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Amanda M McCarthy
- Division of Critical Care, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Carol Pineda
- Division of Critical Care, Department of Pediatrics, Baystate Medical Center, University of Massachusetts Chan Medical School, Springfield, MA, United States
| | - Kenneth E Remy
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.,Division of Pediatric Critical Care Medicine, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, United States
| | - Sara C Sanders
- Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University/Nationwide Children's Hospital, Columbus, OH, United States
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham National Health Service Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Matthew O Wiens
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adnan T Bhutta
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| |
Collapse
|
5
|
Li Z, Karlsson O, Kim R, Subramanian SV. Distribution of under-5 deaths in the neonatal, postneonatal, and childhood periods: a multicountry analysis in 64 low- and middle-income countries. Int J Equity Health 2021; 20:109. [PMID: 33902593 PMCID: PMC8077916 DOI: 10.1186/s12939-021-01449-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background As under-5 mortality rates declined all over the world, the relative distribution of under-5 deaths during different periods of life changed. To provide information for policymakers to plan for multi-layer health strategies targeting child health, it is essential to quantify the distribution of under-5 deaths by age groups. Methods Using 245 Demographic and Health Surveys from 64 low- and middle-income countries conducted between 1986 and 2018, we compiled a database of 2,437,718 children under-5 years old with 173,493 deaths. We examined the share of deaths that occurred in the neonatal (< 1 month), postneonatal (1 month to 1 year old), and childhood (1 to 5 years old) periods to the total number of under-5 deaths at both aggregate- and country-level. We estimated the annual change in share of deaths to track the changes over time. We also assessed the association between share of deaths and Gross Domestic Product (GDP) per capita. Results Neonatal deaths accounted for 53.1% (95% confidence interval [CI]: 52.7, 53.4) of the total under-5 deaths. The neonatal share of deaths was lower in low-income countries at 44.0% (43.5, 44.5), and higher in lower-middle-income and upper-middle income countries at 57.2% (56.8, 57.6) and 54.7% (53.8, 55.5) respectively. There was substantial heterogeneity in share of deaths across countries; for example, the share of neonatal to total under-5 deaths ranged from 20.9% (14.1, 27.6) in Eswatini to 82.8% (73.0, 92.6) in Dominican Republic. The shares of deaths in all three periods were significantly associated with GDP per capita, but in different directions—as GDP per capita increased by 10%, the neonatal share of deaths would significantly increase by 0.78 percentage points [PPs] (0.43, 1.13), and the postneonatal and childhood shares of deaths would significantly decrease by 0.29 PPs (0.04, 0.54) and 0.49 PPs (0.24, 0.74) respectively. Conclusions Along with the countries’ economic development, an increasing proportion of under-5 deaths occurs in the neonatal period, suggesting a need for multi-layer health strategies with potentially heavier investment in newborn health. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01449-8.
Collapse
Affiliation(s)
- Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Omar Karlsson
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Department of Economic History, School of Economics and Management, Lund University, P.O. Box 7083, 220 07, Lund, Sweden
| | - Rockli Kim
- Division of Health Policy & Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, South Korea.,Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, South Korea.,Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. .,Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA.
| |
Collapse
|
6
|
Agudelo SI, Molina CF, Gamboa ÓA, Suárez JD. Direct costs of neonatal infection acquired in the community in full-term newborns and low risk at birth, Cundinamarca, Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2021; 41:87-98. [PMID: 33761192 PMCID: PMC8055585 DOI: 10.7705/biomedica.5196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/21/2020] [Indexed: 11/21/2022]
Abstract
Introduction: Half of the episodes of neonatal sepsis are acquired in the community with a high percentage of mortality and complications. Objective: To estimate the direct costs of hospitalizations due to systemic neonatal infection acquired in the community in low-risk newborns. Materials and methods: For the estimation of costs, we used the perspective of the health systems and the microcosting technique and we established the duration of hospitalization as the time horizon. We identified cost-generating events through expert consensus and the quantification was based on the detailed bill of 337 hospitalized newborns diagnosed with neonatal infection. The costs of the medications were calculated based on the drug price information system (SISMED) and the ISS 2001 rate manuals adjusting percentage, and the mandatory insurance rates for traffic accidents (SOAT). We used the bootstrapping method for cost distribution to incorporate data variability in the estimate. Results: We included the medical care invoices for 337 newborns. The average direct cost of care per patient was USD$ 2,773,965 (Standard Deviation, SD=USD$ 198,813.5; 95% CI: $ 2,384,298 - $ 3,163,632). The main cost-generating categories were hospitalization in intensive care units and health technologies. The costs followed a log-normal distribution. Conclusions: The categories generating the greatest impact on the care costs of newborns with infection were hospitalization in neonatal units and health technologies. The costs followed a log-normal distribution.
Collapse
Affiliation(s)
- Sergio Iván Agudelo
- Escuela de Graduados, Universidad CES, Medellín, Colombia; Departamento de Pediatría, Clínica Universidad de La Sabana, Universidad de La Sabana, Chía, Colombia.
| | | | | | | |
Collapse
|
7
|
Rolnitsky A, Urbach D, Unger S, Bell CM. Regional variation in cost of neonatal intensive care for extremely preterm infants. BMC Pediatr 2021; 21:134. [PMID: 33731048 PMCID: PMC7968295 DOI: 10.1186/s12887-021-02600-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background Regional variation in cost of neonatal intensive care for extremely preterm infant is not documented. We sought to evaluate regional variation that may lead to benchmarking and cost saving. Methods An analysis of a Canadian national costing data from the payor perspective. We included all liveborn 23–28-week preterm infants in 2011–2015. We calculated variation in costs between provinces using non-parametric tests and a generalized linear model to evaluate cost variation after adjustment for gestational age, survival, and length of stay. Results We analysed 6932 infant records. The median total cost for all infants was $66,668 (Inter-Quartile Range (IQR): $4920–$125,551). Medians for the regions varied more than two-fold and ranged from $48,144 in Ontario to $122,526 in Saskatchewan. Median cost for infants who survived the first 3 days of life was $91,000 (IQR: $56,500–$188,757). Median daily cost for all infants was $1940 (IQR: $1518–$2619). Regional variation was significant after adjusting for survival more than 3 days, length of stay, gestational age, and year (pseudo-R2 = 0.9, p < 0.01). Applying the model on the second lowest-cost region to the rest of the regions resulted in a total savings of $71,768,361(95%CI: $65,527,634–$81,129,451) over the 5-year period ($14,353,672 annually), or over 11% savings for the total program cost of $643,837,303 over the study period. Conclusion Costs of neonatal intensive care are high. There is large regional variation that persists after adjustment for length of stay and survival. Our results can be used for benchmarking and as a target for focused cost optimization, savings, and investment in healthcare.
Collapse
Affiliation(s)
- Asaph Rolnitsky
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M4 wing NICU, Toronto, Ontario, M4N3M5, Canada.
| | - David Urbach
- Surgery and Health Policy Management and Evaluation, University of Toronto, Women's College Hospital, Toronto, Ontario, Canada
| | - Sharon Unger
- Paediatrics, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Chaim M Bell
- Medicine and Health Policy Management and Evaluation, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Abbas Q, Holloway A, Caporal P, López-Barón E, Agulnik A, Remy KE, Appiah JA, Attebery J, Fink EL, Lee JH, Hooli S, Kissoon N, Miller E, Murthy S, Muttalib F, Nielsen K, Puerto-Torres M, Rodrigues K, Sakaan F, Rodrigues AT, Tabor EA, von Saint Andre-von Arnim A, Wiens MO, Blackwelder W, He D, Kortz TB, Bhutta AT. Global PARITY: Study Design for a Multi-Centered, International Point Prevalence Study to Estimate the Burden of Pediatric Acute Critical Illness in Resource-Limited Settings. Front Pediatr 2021; 9:793326. [PMID: 35155314 PMCID: PMC8835113 DOI: 10.3389/fped.2021.793326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/10/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The burden of pediatric critical illness and resource utilization by children with critical illness in resource limited settings (RLS) are largely unknown. Without specific data that captures key aspects of critical illness, disease presentation, and resource utilization for pediatric populations in RLS, development of a contextual framework for appropriate, evidence-based interventions to guide allocation of limited but available resources is challenging. We present this methods paper which describes our efforts to determine the prevalence, etiology, hospital outcomes, and resource utilization associated with pediatric acute, critical illness in RLS globally. METHODS We will conduct a prospective, observational, multicenter, multinational point prevalence study in sixty-one participating RLS hospitals from North, Central and South America, Africa, Middle East and South Asia with four sampling time points over a 12-month period. Children aged 29 days to 14 years evaluated for acute illness or injury in an emergency department) or directly admitted to an inpatient unit will be enrolled and followed for hospital outcomes and resource utilization for the first seven days of hospitalization. The primary outcome will be prevalence of acute critical illness, which Global PARITY has defined as death within 48 hours of presentation to the hospital, including ED mortality; or admission/transfer to an HDU or ICU; or transfer to another institution for a higher level-of-care; or receiving critical care-level interventions (vasopressor infusion, invasive mechanical ventilation, non-invasive mechanical ventilation) regardless of location in the hospital, among children presenting to the hospital. Secondary outcomes include etiology of critical illness, in-hospital mortality, cause of death, resource utilization, length of hospital stay, and change in neurocognitive status. Data will be managed via REDCap, aggregated, and analyzed across sites. DISCUSSION This study is expected to address the current gap in understanding of the burden, etiology, resource utilization and outcomes associated with pediatric acute and critical illness in RLS. These data are crucial to inform future research and clinical management decisions and to improve global pediatric hospital outcomes.
Collapse
Affiliation(s)
- Qalab Abbas
- Department of Pediatrics and Child Health, Aga Khan University Karachi, Karachi, Pakistan
| | - Adrian Holloway
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland Baltimore, Baltimore, MD, United States
| | - Paula Caporal
- Hospital Interzonal Especializado en Pediatría "Sor María Ludovica", La Plata, Argentina.,Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Buenos Aires, Argentina
| | - Eliana López-Barón
- Hospital Pablo Tobón Uribe, Unidad de Cuidado Crítico Pediátrico, Medellín, Colombia
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kenneth E Remy
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University Hospitals of Cleveland and Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - John A Appiah
- Pediatric Intensive Care Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Jonah Attebery
- Department of Pediatrics, Section of Pediatric Critical Care, University of Colorado, Aurora, CO, United States
| | - Ericka L Fink
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.,SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
| | - Shubhada Hooli
- Division of Pediatric Critical Care, Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Niranjan Kissoon
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Erika Miller
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland Baltimore, Baltimore, MD, United States
| | - Srinivas Murthy
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Fiona Muttalib
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Katie Nielsen
- Division of Pediatric Critical Care, Department of Pediatrics, University of Washington, Seattle Children's, Seattle, WA, United States
| | - Maria Puerto-Torres
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Karla Rodrigues
- Department of Pediatrics, Hospital das Clínicas da UFMG/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Firas Sakaan
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Adriana Teixeira Rodrigues
- Department of Pediatrics, Hospital das Clínicas da UFMG/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Erica A Tabor
- Pennsylvania State University, State College, PA, United States
| | - Amelie von Saint Andre-von Arnim
- Division of Pediatric Critical Care, Department of Pediatrics, University of Washington, Seattle Children's, Seattle, WA, United States
| | - Matthew O Wiens
- Center for Child Health at BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - William Blackwelder
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, United States
| | - David He
- Analytical Solutions Group, Inc., North Potomac, MD, United States
| | - Teresa B Kortz
- Division of Critical Care, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States.,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Adnan T Bhutta
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland Baltimore, Baltimore, MD, United States.,Center for Vaccine Development and Global Health, University of Maryland, Baltimore, MD, United States
| |
Collapse
|
9
|
Bak GS, Shaffer BL, Madriago E, Allen A, Kelly B, Caughey AB, Pereira L. Detection of fetal cardiac anomalies: cost-effectiveness of increased number of cardiac views. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:758-767. [PMID: 31945242 DOI: 10.1002/uog.21977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/22/2019] [Accepted: 12/31/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the recommended three-view fetal heart screening method to detect major congenital heart disease (CHD) with more elaborate screening strategies to determine the cost-effective strategy in unselected (low-risk) pregnancies. METHODS A decision-analytic model was designed to compare four screening strategies to identify fetuses with major CHD in a theoretical cohort of 4 000 000 births in the USA. The four strategies were: (1) three views: four-chamber view (4CV) and views of the left (LVOT) and right (RVOT) ventricular outflow tracts; (2) five views: 4CV, LVOT, RVOT and longitudinal views of the ductal arch and aortic arch; (3) five axial views: 4CV, LVOT, RVOT, three-vessel (3V) view and three-vessels-and-trachea view; and (4) six views: 4CV, LVOT, RVOT and 3V views and longitudinal views of the ductal arch and aortic arch. Outcomes related to neonatal mortality and neurodevelopmental disability were evaluated. The analysis was performed from a healthcare-system perspective, with a cost-effectiveness willingness-to-pay threshold set at $100 000 per quality-adjusted life year (QALY). Baseline analysis, one-way sensitivity analysis and Monte-Carlo simulation were performed. RESULTS In our baseline model, screening with five axial views was the optimal strategy, detecting 3520 more CHDs, and resulting in 259 fewer children with neurodevelopmental disability, 40 fewer neonatal deaths and only slightly higher costs, compared with screening with the currently recommended three views. Screening with six views was more effective, but also cost considerably more, compared with screening with five axial views, and had an incremental cost of $490 023/QALY, which was over the willingness-to-pay threshold. The five-view strategy was dominated by the other three strategies, i.e. it was more costly and less effective in comparison. The data were robust when tested with Monte-Carlo and one-way sensitivity analysis. CONCLUSION Although current guidelines recommend a minimum of three views for detecting CHD during the mid-trimester anatomy scan, screening with five axial views is a cost-effective strategy that may lead to improved outcome compared with three-view screening. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- G S Bak
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - B L Shaffer
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - E Madriago
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - A Allen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - B Kelly
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - A B Caughey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - L Pereira
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
10
|
Abstract
Regionalization, which emphasizes matching patient needs with the capabilities of the hospital in which care is provided, has long been a recommended approach to reducing neonatal morbidity and mortality. Over the past decade, research methods surrounding the measurement and evaluation of such programs have improved, thus strengthening arguments for implementation of these strategies. However, regionalization policies vary widely across regions and between countries, with potential impacts on neonatal outcomes as well as costs of care. It is important to account for geographic and other regional differences when determining the feasibility of regionalization for a specific region, as certain areas and populations may need particular consideration in order for regionalization policies to be successful.
Collapse
|
11
|
Bartsch SM, Stokes-Cawley OJ, Buekens P, Asti L, Bottazzi ME, Strych U, Wedlock PT, Mitgang EA, Meymandi S, Falcon-Lezama JA, Hotez PJ, Lee BY. The potential economic value of a therapeutic Chagas disease vaccine for pregnant women to prevent congenital transmission. Vaccine 2020; 38:3261-3270. [PMID: 32171575 DOI: 10.1016/j.vaccine.2020.02.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Currently, there are no solutions to prevent congenital transmission of Chagas disease during pregnancy, which affects 1-40% of pregnant women in Latin America and is associated with a 5% transmission risk. With therapeutic vaccines under development, now is the right time to determine the economic value of such a vaccine to prevent congenital transmission. METHODS We developed a computational decision model that represented the clinical outcomes and diagnostic testing strategies for an infant born to a Chagas-positive woman in Mexico and evaluated the impact of vaccination. RESULTS Compared to no vaccination, a 25% efficacious vaccine averted 125 [95% uncertainty interval (UI): 122-128] congenital cases, 1.9 (95% UI: 1.6-2.2) infant deaths, and 78 (95% UI: 66-91) DALYs per 10,000 infected pregnant women; a 50% efficacious vaccine averted 251 (95% UI: 248-254) cases, 3.8 (95% UI: 3.6-4.2) deaths, and 160 (95% UI: 148-171) DALYs; and a 75% efficacious vaccine averted 376 (95% UI: 374-378) cases, 5.8 (95% UI: 5.5-6.1) deaths, and 238 (95% UI: 227-249) DALYs. A 25% efficacious vaccine was cost-effective (incremental cost-effectiveness ratio <3× Mexico's gross domestic product per capita, <$29,698/DALY averted) when the vaccine cost ≤$240 and ≤$310 and cost-saving when ≤$10 and ≤$80 from the third-party payer and societal perspectives, respectively. A 50% efficacious vaccine was cost-effective when costing ≤$490 and ≤$615 and cost-saving when ≤$25 and ≤$160, from the third-party payer and societal perspectives, respectively. A 75% efficacious vaccine was cost-effective when ≤$720 and ≤$930 and cost-saving when ≤$40 and ≤$250 from the third-party payer and societal perspectives, respectively. Additionally, 13-42 fewer infants progressed to chronic disease, saving $0.41-$1.21 million to society. CONCLUSION We delineated the thresholds at which therapeutic vaccination of Chagas-positive pregnant women would be cost-effective and cost-saving, providing economic guidance for decision-makers to consider when developing and bringing such a vaccine to market.
Collapse
Affiliation(s)
- Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA
| | - Owen J Stokes-Cawley
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lindsey Asti
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA
| | - Maria Elena Bottazzi
- National School of Tropical Medicine and Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, BCM113 Houston, TX 77030, USA
| | - Ulrich Strych
- National School of Tropical Medicine and Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, BCM113 Houston, TX 77030, USA
| | - Patrick T Wedlock
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA
| | - Elizabeth A Mitgang
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA
| | - Sheba Meymandi
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, 14445 Olive View Drive, Sylmar, CA 91342, USA
| | - Jorge Abelardo Falcon-Lezama
- Carlos Slim Foundation, Lago Zurich 245, Piso 20. Ampliación Granada, Del. Miguel Hidalgo, C.P. 11529 Ciudad de México, Mexico
| | - Peter J Hotez
- National School of Tropical Medicine and Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, BCM113 Houston, TX 77030, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA.
| |
Collapse
|
12
|
Mendizabal‐Espinosa RM, Warren I. Non-evidence-based beliefs increase inequalities in the provision of infant- and family-centred neonatal care. Acta Paediatr 2020; 109:314-320. [PMID: 31421061 DOI: 10.1111/apa.14972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/06/2019] [Accepted: 08/15/2019] [Indexed: 12/01/2022]
Abstract
AIM To identify barriers that might explain why healthcare staff struggle to implement infant- and family-centred developmental care programmes in two neonatal intensive care units in Mexico. METHODS Ethnographic fieldwork over the course of 10 months examined interactions among healthcare professionals, parents and babies in two Mexican publicly funded hospitals. Data are drawn from interviews with 29 parents and 34 healthcare professionals and participant observations in the hospitals' neonatal units. RESULTS Healthcare professionals believed they acted in babies' best interests by excluding parents from the neonatal unit. Professional frustration with working conditions seemed to be increased by the belief that parents were ignorant and unhygienic. Parents were perceived as a source of infection; in contrast, healthcare professionals failed to see themselves as a possible source of cross-contamination. CONCLUSIONS Beliefs and biases increase health inequalities when evidenced-based measures to prevent cross-infection and potentially life-saving programmes, such as kangaroo mother care and breastfeeding, are not implemented. It is imperative to develop context-appropriate education and practice guidelines to implement basic programmes.
Collapse
Affiliation(s)
| | - Inga Warren
- University College London Hospital London UK
| |
Collapse
|
13
|
Cheah IGS. Economic assessment of neonatal intensive care. Transl Pediatr 2019; 8:246-256. [PMID: 31413958 PMCID: PMC6675687 DOI: 10.21037/tp.2019.07.03] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/08/2019] [Indexed: 01/16/2023] Open
Abstract
Most of the studies on the costing of neonatal intensive care has concentrated on the costs associated with preterm infants which takes up more than half of neonatal intensive care unit (NICU) costs. The focus has been on determining the cost-effectiveness of extreme preterm infants and those at threshold of viability. While the costs of care have an inverse relationship with gestational age (GA) and the lifetime medical costs of the extreme preterm can be as high as $450,000, the total NICU expenditure are skewed towards the care of moderate and late preterm infants who form the main bulk of patients. Neonatal intensive care, has been found to be very cost-effective at $1,000 per term infant per QALY and $9,100 for extreme preterm survivor per QALY. For low and LMIC, where NICU resources are limited, the costs of NICU care is lower largely due to a patient profile of more term and preterm of greater GAs and correspondingly less intensity of care. Public health measures, neonatal resuscitation training, empowerment of nurses to do resuscitation, increasing the accessibility to essential newborn care are recommended cheaper cost-effective measures to reduce neonatal mortality in countries with high neonatal mortality rate, whilst upgraded neonatal intensive care services are needed to further reduce neonatal mortality rate once below 15 per 1,000 livebirths. Economic evaluation of neonatal intensive care should also include post discharge costs which mainly fall on the health, social and educational sectors. Strategies to reduce neonatal intensive care costs could include more widespread implementation of cost-effective methods of improving neonatal outcome and reducing neonatal morbidities, including access to antenatal care, perinatal interventions to delay preterm delivery wherever feasible, improving maternal health status and practising cost saving and effective neonatal intensive care treatment.
Collapse
Affiliation(s)
- Irene Guat Sim Cheah
- Department of Paediatrics, Paediatric Institute, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| |
Collapse
|
14
|
Phibbs CS, Schmitt SK, Cooper M, Gould JB, Lee HC, Profit J, Lorch SA. Birth Hospitalization Costs and Days of Care for Mothers and Neonates in California, 2009-2011. J Pediatr 2019; 204:118-125.e14. [PMID: 30297293 PMCID: PMC6309642 DOI: 10.1016/j.jpeds.2018.08.041] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 07/03/2018] [Accepted: 08/17/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To provide population-based estimates of the hospital-related costs of maternal and newborn care, and how these vary by gestational age and birth weight. STUDY DESIGN We conducted a retrospective analysis of 2009-2011 California in-hospital deliveries at nonfederal hospitals with the infant and maternal discharge data successfully (96%) linked to birth certificates. Cost-to-charge ratios were used to estimate costs from charges. Physician hospital payments were estimated by mean diagnosis related group-specific reimbursement and costs were adjusted for inflation to December 2017 values. After exclusions for incomplete or missing data, the final sample was 1 265 212. RESULTS The mean maternal costs for all in-hospital deliveries was $8204, increasing to $13 154 for late preterm (32-36 weeks) and $22 702 for very preterm (<32 weeks) mothers. The mean cost for all newborns was $6389: $2433 for term infants, $22 102 for late preterm, $223 931 for very preterm infants, and $317 982 for extremely preterm infants (<28 weeks). Preterm infants were 8.1% of cases but incurred 60.9% of costs; for very preterm and extremely preterm infants, these shares were 1.0% and 36.5%, and 0.4% and 20.0%, respectively. Overall, mothers incurred 56% of the total costs during the delivery hospitalization. CONCLUSIONS Both maternal and neonatal costs are skewed, with this being much more pronounced for infants. Preterm birth is much more expensive than term delivery, with the additional costs predominately incurred by the infants. The small share of infants who require extensive stays in neonatal intensive care incur a large share of neonatal costs and these costs have increased over time.
Collapse
Affiliation(s)
- Ciaran S Phibbs
- Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA; Perinatal Epidemiology and Health Outcomes Research Unit, Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA.
| | - Susan K Schmitt
- Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA; Perinatal Epidemiology and Health Outcomes Research Unit, Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA
| | - Matthew Cooper
- Progenity, Inc., San Diego, CA; Preeclampsia Foundation, Melbourne, FL
| | - Jeffrey B Gould
- Perinatal Epidemiology and Health Outcomes Research Unit, Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Henry C Lee
- Perinatal Epidemiology and Health Outcomes Research Unit, Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Scott A Lorch
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA; Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
15
|
Ali E, Al-Shafouri N, Hussain A, Baier RJ. Assessment of WINROP algorithm as screening tool for preterm infants in Manitoba to detect retinopathy of prematurity. Paediatr Child Health 2017; 22:203-206. [PMID: 29479215 DOI: 10.1093/pch/pxx053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective Developing less invasive methods for early detection of retinopathy of prematurity (ROP) is vital to minimizing blindness in premature infants. Lofqvist and colleagues developed a computer-based ROP risk algorithm (WINROP) (https://winrop.com), which detects downtrends in postnatal weight gain that correlate with the development of sight-threatening ROP. The aim of this study is to investigate the sensitivity and specificity of the WINROP algorithm to detect vision-threatening ROP. Methods This is a retrospective chart review study between January 2008 and December 2013. This study was conducted in the neonatal intensive care unit in Children's Hospital at Health Sciences Centre, Winnipeg, Manitoba, Canada. The study included preterm infants, less than 32 weeks' gestation, who were admitted to the hospital during the study period. The included 215 infants were eligible for ROP screening and had sufficient data to be entered into the WINROP algorithm. Infants were screened by a paediatric ophthalmologist for retinopathy of prematurity. The body weight of infants was measured weekly and entered into the WINROP algorithm; the sensitivity and the specificity of the WINROP algorithm were assessed. Results The mean gestational age was 28.6 ± 1.8 weeks. The mean body weight was 1244 ± 294 g. The sensitivity of the WINROP algorithm to detect vision-threatening retinopathy of prematurity in our cohort was 90% (P=0.021) with a specificity of 60% (P=0.002). Conclusion The WINROP algorithm lacks sufficient sensitivity to be used clinically in our population. The algorithm needs to be reassessed in contemporary populations.
Collapse
Affiliation(s)
- Ebtihal Ali
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba.,Neonatology Section, Pediatric, and Child Health Department, Winnipeg Regional Health Authority, Winnipeg, Manitoba
| | - Nasser Al-Shafouri
- Neonatology Section, Pediatrics and Child Health Department, University of Manitoba, Winnipeg, Manitoba
| | - Abrar Hussain
- Neonatology Section, Pediatric, and Child Health Department, Winnipeg Regional Health Authority, Winnipeg, Manitoba
| | - R John Baier
- Neonatology Section, Pediatrics and Child Health Department, University of Manitoba, Winnipeg, Manitoba
| |
Collapse
|
16
|
von Saint André-von Arnim AO, Attebery J, Kortz TB, Kissoon N, Molyneux EM, Musa NL, Nielsen KR, Fink EL. Challenges and Priorities for Pediatric Critical Care Clinician-Researchers in Low- and Middle-Income Countries. Front Pediatr 2017; 5:277. [PMID: 29312909 PMCID: PMC5744187 DOI: 10.3389/fped.2017.00277] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 12/06/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is need for more data on critical care outcomes and interventions from low- and middle-income countries (LMIC). Global research collaborations could help improve health-care delivery for critically ill children in LMIC where child mortality rates remain high. MATERIALS AND METHODS To inform the role of collaborative research in health-care delivery for critically ill children in LMIC, an anonymous online survey of pediatric critical care (PCC) physicians from LMIC was conducted to assess priorities, major challenges, and potential solutions to PCC research. A convenience sample of 56 clinician-researchers taking care of critically ill children in LMIC was targeted. In addition, the survey was made available on a Latin American PCC website. Descriptive statistics were used for data analysis. RESULTS The majority of the 47 survey respondents worked at urban, public teaching hospitals in LMIC. Respondents stated their primary PCC research motivations were to improve clinical care and establish guidelines to standardize care. Top challenges to conducting research were lack of funding, high clinical workload, and limited research support staff. Respondent-proposed solutions to these challenges included increasing research funding options for LMIC, better access to mentors from high-income countries, research training and networks, and higher quality medical record documentation. CONCLUSION LMIC clinician-researchers must be better empowered and resourced to lead and influence the local and global health research agenda for critically ill children. Increased funding options, access to training and mentorship in research methodology, and improved data collection systems for LMIC PCC researchers were recognized as key needs for success.
Collapse
Affiliation(s)
- Amelie O von Saint André-von Arnim
- Department of Pediatrics, Division of Pediatric Critical Care, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jonah Attebery
- Department of Pediatrics, Division of Critical Care, Washington University, St. Louis, MO, United States
| | - Teresa Bleakly Kortz
- Department of Pediatrics, Division of Pediatric Critical Care, University of California, San Francisco, San Francisco, CA, United States.,Institute of Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Niranjan Kissoon
- Department of Pediatrics and Emergency Medicine, University of British Columbia and British Columbia Children's Hospital, Vancouver, Canada
| | | | - Ndidiamaka L Musa
- Department of Pediatrics, Division of Pediatric Critical Care, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Katie R Nielsen
- Department of Pediatrics, Division of Pediatric Critical Care, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Ericka L Fink
- Division of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States
| | | |
Collapse
|
17
|
Kahr MK, Suter MA, Ballas J, Ramphul R, Lubertino G, Hamilton WJ, Aagaard KM. Preterm birth and its associations with residence and ambient vehicular traffic exposure. Am J Obstet Gynecol 2016; 215:111.e1-111.e10. [PMID: 26827876 PMCID: PMC4940124 DOI: 10.1016/j.ajog.2016.01.171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/08/2016] [Accepted: 01/20/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preterm birth (PTB) is a multifactorial disorder, and air pollution has been suggested to increase the risk of occurrence. However, large population studies controlling for multiple exposure measures in high-density settings with established commuter patterns are lacking. OBJECTIVE We performed a geospatial analysis with the use of a publicly available database to identify whether residence during pregnancy, specifically with regard to exposure to traffic density and mobility in urban and suburban neighborhoods, may be a contributing risk factor for premature delivery. STUDY DESIGN In our cohort study, we analyzed 9004 pregnancies with as many as 4900 distinct clinical and demographic variables from Harris County, Texas. On the basis of primary residency and occupational zip code information, geospatial analysis was conducted. Data on vehicle miles traveled (VMT) and percentages of inhabitants traveling to work were collected at the zip code level and additionally grouped by the three recognized regional commuter loop high-density thoroughfares resulting from two interstate/highway belts (inner, middle, and outer loops). PTB was categorized as late (34 1/7 to 36 6/7 weeks) and early PTB (22 1/7 to 33 6/7 weeks), and unadjusted odds ratios (OR) and adjusted ORs were ascribed. RESULTS PTB prevalence in our study population was 10.1% (6.8% late and 3.3% early preterm), which is in accordance with our study and other previous studies. Prevalence of early PTB varied significantly between the regional commuter loop thoroughfares [OR for inner vs outer loop: 0.58 (95% confidence interval, 0.39-0.87), OR for middle vs outer loop, 0.74 (0.57-0.96)]. The ORs for PTB and early PTB were shown to be lower in gravidae from neighborhoods with the highest VMT/acre [OR for PTB, 0.82 (0.68-0.98), OR for early PTB, 0.78 (0.62-0.98)]. Conversely, risk of PTB and early PTB among subjects living in neighborhoods with a high percentage of inhabitants traveling to work over a greater distance demonstrated a contrary tendency [OR for PTB, 1.18 (1.03-1.35), OR for early PTB, 1.48 (1.17-1.86)]. In logistic regression models, the described association between PTB and residence withstood and could not be explained by differences in maternal age, gravidity or ethnicity, tobacco use, or history of PTB. CONCLUSION While PTB is of multifactorial origin, the present study shows that community-based risk factors (namely urban/suburban location, differences in traffic density exposure, and need for traveling to work along high-vehicle density thoroughfares) may influence risk for PTB. Further research focusing on previously unrecognized community-based risk factors may lead to innovative future prevention measures.
Collapse
Affiliation(s)
- Maike K Kahr
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas
| | - Melissa A Suter
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas
| | - Jerasimos Ballas
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas
| | - Ryan Ramphul
- Environmental Health Section, Chronic Disease Prevention and Control Research Center, Baylor College of Medicine, Houston, Texas
| | | | - Winifred J Hamilton
- Environmental Health Section, Chronic Disease Prevention and Control Research Center, Baylor College of Medicine, Houston, Texas
| | - Kjersti M Aagaard
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
18
|
Biskup T, Phan P, Grunauer M. Lessons from the Design and Implementation of a Pediatric Critical Care and Emergency Medicine Training Program in a Low Resource Country-The South American Experience. J Pediatr Intensive Care 2016; 6:60-65. [PMID: 31073426 DOI: 10.1055/s-0036-1584678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 02/15/2016] [Indexed: 10/21/2022] Open
Abstract
For more than 60 years, the world has recognized the need for pediatric critical care (PCC). Today, most low- and middle-income countries (LMICs) still lack access to pediatric intensive care units (PICUs) and specialists, resulting in high rates of morbidity and mortality. These disparities result from several infrastructure and socioeconomic factors, chief among them being the lack of trained PCC and emergency medicine (PCCEM) frontline providers. In this article, we describe a continuing medical education model to increase frontline PCC capacity in Ecuador. The Laude in PCCEM is a program created by a team of Ecuadorian physicians at the University San Francisco de Quito School of Medicine. The program is aimed at providers with no formal training in PCC and who, nonetheless, care for critically ill children. The program resulted in stronger, more cohesive PICU teams with improved resuscitation times and coordination during simulation rounds. In hospitals that implemented the program, we saw decreased PICU mortality rates. Our aim is to identify the opportunities and challenges learned and to offer lessons for other countries that use similar models to cope with the lack of local resource availability.
Collapse
Affiliation(s)
- Toni Biskup
- Department of Pediatrics, Universidad San Francisco de Quito Medical School, Cumbayá, Ecuador.,Hospital de los Valles, Ecuador
| | - Phillip Phan
- The Johns Hopkins Carey Business School, Baltimore, Maryland, United States.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Michelle Grunauer
- Department of Pediatrics, Universidad San Francisco de Quito Medical School, Cumbayá, Ecuador.,Hospital de los Valles, Ecuador.,The Johns Hopkins Carey Business School, Baltimore, Maryland, United States
| |
Collapse
|
19
|
Zepeda-Romero LC, Meza-Anguiano A, Barrera-de León JC, Angulo-Castellanos E, Ramirez-Ortiz MA, Gutiérrez-Padilla JA, Gilbert CE. Case series of infants presenting with end stage retinopathy of prematurity to two tertiary eye care facilities in Mexico: underlying reasons for late presentation. Matern Child Health J 2016; 19:1417-25. [PMID: 25452216 DOI: 10.1007/s10995-014-1648-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To describe the characteristics of infants with bilateral Stage 4b or 5 ROP (i.e. with subtotal or total retinal detachment) who presented to eye departments in two major cities in Mexico, to identify reasons why they may have become blind in order to recommend how programs could be improved. A large case-series of infants with Stage 4b or 5 ROP in both eyes confirmed by ultrasound who attended the ROP Clinic, Hospital Civil de Guadalajara from September 2010 to November 2012, and the Department of Ophthalmology, Hospital Infantil de Mexico Federico Gomez from December 2011 to December 2012 were identified from the diagnostic databases of each hospital. Mothers of infants in Guadalajara had a telephone interview. 89/94 eligible infants were included in the study, 48 in Guadalajara and 41 in Mexico City. Cases came from 22 of the 32 states in Mexico. Half of the infants attending Guadalajara 24/48 (50 %) had been cared for in NICUs without ROP screening programs and were not examined. Among the 24 infants cared for in NICUs with ROP programs, 7/24 (29.1 %) mothers reported that their infant had not been examined while in the NICU, and a further 9/24 (37.5 %) were either not referred for screening after discharge or they did not attend. Two infants had failed laser treatment. Strategies and resources to prevent end stage ROP have not been firmly established in Mexico. There is an urgent need to expand the coverage and quality of ROP programs, to ensure that existing screening guidelines are better adhered to, and to improve communication with parents.
Collapse
Affiliation(s)
- Luz C Zepeda-Romero
- Clinic of Retinopathy of Prematurity and Blindness Prevention, Hospital Civil de Guadalajara, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico, Boulevard Puerta de Hierro 5150, C.P. 45116, Zapopan, Jalisco, Mexico,
| | | | | | | | | | | | | |
Collapse
|
20
|
Gunn JKL, Rosales CB, Center KE, Nuñez A, Gibson SJ, Christ C, Ehiri JE. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open 2016; 6:e009986. [PMID: 27048634 PMCID: PMC4823436 DOI: 10.1136/bmjopen-2015-009986] [Citation(s) in RCA: 359] [Impact Index Per Article: 44.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the effects of use of cannabis during pregnancy on maternal and fetal outcomes. DATA SOURCES 7 electronic databases were searched from inception to 1 April 2014. Studies that investigated the effects of use of cannabis during pregnancy on maternal and fetal outcomes were included. STUDY SELECTION Case-control studies, cross-sectional and cohort studies were included. DATA EXTRACTION AND SYNTHESIS Data synthesis was undertaken via systematic review and meta-analysis of available evidence. All review stages were conducted independently by 2 reviewers. MAIN OUTCOMES AND MEASURES Maternal, fetal and neonatal outcomes up to 6 weeks postpartum after exposure to cannabis. Meta-analyses were conducted on variables that had 3 or more studies that measured an outcome in a consistent manner. Outcomes for which meta-analyses were conducted included: anaemia, birth weight, low birth weight, neonatal length, placement in the neonatal intensive care unit, gestational age, head circumference and preterm birth. RESULTS 24 studies were included in the review. Results of the meta-analysis demonstrated that women who used cannabis during pregnancy had an increase in the odds of anaemia (pooled OR (pOR)=1.36: 95% CI 1.10 to 1.69) compared with women who did not use cannabis during pregnancy. Infants exposed to cannabis in utero had a decrease in birth weight (low birth weight pOR=1.77: 95% CI 1.04 to 3.01; pooled mean difference (pMD) for birth weight=109.42 g: 38.72 to 180.12) compared with infants whose mothers did not use cannabis during pregnancy. Infants exposed to cannabis in utero were also more likely to need placement in the neonatal intensive care unit compared with infants whose mothers did not use cannabis during pregnancy (pOR=2.02: 1.27 to 3.21). CONCLUSIONS AND RELEVANCE Use of cannabis during pregnancy may increase adverse outcomes for women and their neonates. As use of cannabis gains social acceptance, pregnant women and their medical providers could benefit from health education on potential adverse effects of use of cannabis during pregnancy.
Collapse
Affiliation(s)
- J K L Gunn
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - C B Rosales
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Phoenix, Arizona, USA
| | - K E Center
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
| | - A Nuñez
- Arizona Health Sciences Library, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - S J Gibson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - C Christ
- Arizona Department of Health Services, Phoenix, Arizona, USA
| | - J E Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| |
Collapse
|
21
|
Weiss KJ, Kowalkowski MA, Treviño R, Cabrera-Meza G, Thomas EJ, Kaplan HC, Profit J. Needs assessment to improve neonatal intensive care in Mexico. Paediatr Int Child Health 2015; 35:213-9. [PMID: 26134488 DOI: 10.1179/2046905515y.0000000044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND At the time of the research, Dr Weiss was a clinical fellow in neonatal-perinatal medicine at Baylor College of Medicine, Texas Children's Hospital. Dr Profit was on faculty at Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Section of Neonatology. He held a secondary appointment in the Department of Medicine, Section of Health Services Research and conducted his research at the VA Health Services Research and Development Center of Excellence where he collaborated with Dr Kowalkowski.: Improving the quality of neonatal intensive care is an important health policy priority in Mexico. A formal assessment of barriers and priorities for quality improvement has not been undertaken. AIM To provide guidance to providers and policy makers with regard to addressing opportunities for better care delivery in Mexican neonatal intensive care units. OBJECTIVE To conduct a needs assessment regarding improvement of quality of neonatal intensive care delivery in Mexico. METHODS Spanish-language survey administered to a volunteer sample of Mexican neonatal care providers attending a large paediatric conference in Mexico in June 2011. Survey domains included institutional context of quality improvement, barriers, priorities, safety culture, and respondents' characteristics. Results were analysed using descriptive analyses of frequencies, proportions and percentage positive response (PPR) rates. RESULTS Of 91 respondents, the majority identified neonatology as their primary specialty (n = 48, 65%) and were physicians (n = 55, 73%). Generally, providers expressed a desire to improve quality of care (PPR 69%) but reported notable deterrents. Respondents (n, %) identified family inability to pay (38, 48%), overcrowded work areas (38, 44%), insufficient financial reimbursement (25, 36%), lack of availability of nurses (26, 30%), ancillary staff (25, 29%), and subspecialists (22, 25%) as the principal barriers. Respiratory care (27, 39%)--reduction of mechanical ventilation and initiation of nasal continuous positive airway pressure--and reduction in frequency of late-onset infections (19, 28%) were selected as top clinical priorities. There were substantial opportunities for improving safety (PPR 48%) and teamwork climate (PPR 58%). CONCLUSION These findings may guide efforts to improving quality of care delivery in Mexican neonatal intensive care units.
Collapse
|
22
|
Khan KA, Petrou S, Dritsaki M, Johnson SJ, Manktelow B, Draper ES, Smith LK, Seaton SE, Marlow N, Dorling J, Field DJ, Boyle EM. Economic costs associated with moderate and late preterm birth: a prospective population-based study. BJOG 2015. [PMID: 26219352 DOI: 10.1111/1471-0528.13515] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to determine the economic costs associated with moderate and late preterm birth. DESIGN An economic study was nested within a prospective cohort study. SAMPLE Infants born between 32(+0) and 36(+6) weeks of gestation in the East Midlands of England. A sample of infants born at ≥37 weeks of gestation acted as controls. METHODS Data on resource use, estimated from a National Health Service (NHS) and personal social services perspective, and separately from a societal perspective, were collected between birth and 24 months corrected age (or death), and valued in pounds sterling, at 2010-11 prices. Descriptive statistics and multivariable analyses were used to estimate the relationship between gestational age at birth and economic costs. MAIN OUTCOME MEASURES Cumulative resource use and economic costs over the first two years of life. RESULTS Of all eligible births, 1146 (83%) preterm and 1258 (79%) term infants were recruited. Mean (standard error) total societal costs from birth to 24 months were £12 037 (£1114) and £5823 (£1232) for children born moderately preterm (32(+0) -33(+6) weeks of gestation) and late preterm (34(+0) -36(+6) weeks of gestation), respectively, compared with £2056 (£132) for children born at term. The mean societal cost difference between moderate and late preterm and term infants was £4657 (bootstrap 95% confidence interval, 95% CI £2513-6803; P < 0.001). Multivariable regressions revealed that, after controlling for clinical and sociodemographic characteristics, moderate and late preterm birth increased societal costs by £7583 (£874) and £1963 (£337), respectively, compared with birth at full term. CONCLUSIONS Moderate and late preterm birth is associated with significantly increased economic costs over the first 2 years of life. Our economic estimates can be used to inform budgetary and service planning by clinical decision-makers, and economic evaluations of interventions aimed at preventing moderate and late preterm birth or alleviating its adverse consequences. TWEETABLE ABSTRACT Moderate and late preterm birth is associated with increased economic costs over the first 2 years of life.
Collapse
Affiliation(s)
- K A Khan
- University of Warwick, Coventry, UK
| | - S Petrou
- University of Warwick, Coventry, UK
| | | | | | | | | | - L K Smith
- University of Leicester, Leicester, UK
| | | | - N Marlow
- University College London, London, UK
| | - J Dorling
- University of Nottingham, Nottingham, UK
| | - D J Field
- University of Leicester, Leicester, UK
| | - E M Boyle
- University of Leicester, Leicester, UK
| |
Collapse
|
23
|
Neogi SB. How cost-effective is facility-based newborn care in India? Indian Pediatr 2014; 50:829-30. [PMID: 24096841 DOI: 10.1007/s13312-013-0223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sutapa Bandyopadhyay Neogi
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Plot number 34, Sector 44, Gurgaon -122 002, India.
| |
Collapse
|
24
|
Yang F, Lorch SA, Small DS. Estimation of causal effects using instrumental variables with nonignorable missing covariates: Application to effect of type of delivery NICU on premature infants. Ann Appl Stat 2014. [DOI: 10.1214/13-aoas699] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
25
|
Reichert J, Schemken M, Manthei R, Steinbronn R, Bucher U, Albrecht M, Rüdiger M. [Health insurance expenses for children in the first five years of life - a cohort-based analysis]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2013; 107:451-60. [PMID: 24238022 DOI: 10.1016/j.zefq.2013.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 07/26/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The development of paediatrics is characterised by several changes in the past few years, concerning, in particular holistic treatments or preventive check-ups, but also the transfer of treatment from the inpatient to the outpatient sector. There are no reference values for assessing emerging health insurance expenses. The aim of this study was to obtain a frame of reference for the costs of the treatment for neonates, infants, and young children using the example of the expenditures of one health insurance fund. METHODS The individual health insurance expenditures were analysed for the first five years of life of children insured with the AOK PLUS in Saxony, Germany, in 2005. Costs of hospital treatment, ambulatory care, remedies, tools, medicines and care were included. RESULTS The costs per insured child and year amounted to approximately 1,277 Euro (N = 11,147), with the highest costs arising in the first two years. 858 Euro were spent annually for an "average" child; 5,691 Euro per year incurred for a child with special medical needs. DISCUSSION The present cost analysis describes both the height and structure of a health insurance's spendings on children within the first five years of their life in consideration of regional medical care offers. The question of whether this analysis provides valid reference values for other health insurances or other service areas will have to be answered by other analyses.
Collapse
|
26
|
Shillcutt SD, Lefevre AE, Lee ACC, Baqui AH, Black RE, Darmstadt GL. Forecasting burden of long-term disability from neonatal conditions: results from the Projahnmo I trial, Sylhet, Bangladesh. Health Policy Plan 2012; 28:435-52. [PMID: 23002251 DOI: 10.1093/heapol/czs075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The burden of disease resulting from neonatal conditions is substantial in developing countries. From 2003 to 2005, the Projahnmo I programme delivered community-based interventions for maternal and newborn health in Sylhet, Bangladesh. This analysis quantifies burden of disability and incorporates non-fatal outcomes into cost-effectiveness analysis of interventions delivered in the Projahnmo I programme. METHODS A decision tree model was created to predict disability resulting from preterm birth, neonatal meningitis and intrapartum-related hypoxia ('birth asphyxia'). Outcomes were defined as the years lost to disability (YLD) component of disability-adjusted life years (DALYs). Calculations were based on data from the Projahnmo I trial, supplemented with values from published literature and expert opinion where data were absent. RESULTS 195 YLD per 1000 neonates [95% confidence interval (CI): 157-241] were predicted in the main calculation, sensitive to different DALY assumptions, disability weights and alternative model structures. The Projahnmo I home care intervention may have averted 2.0 (1.3-2.8) YLD per 1000 neonates. Compared with calculations based on reductions in mortality alone, the cost-effectiveness ratio decreased by only 0.6% from $105.23 to $104.62 ($65.15-$266.60) when YLD were included, with 0.6% more DALYs averted [total 338/1000 (95% CI: 131-542)]. DISCUSSION A significant burden of disability results from neonatal conditions in Sylhet, Bangladesh. Adding YLD has very little impact on recommendations based on cost-effectiveness, even at the margin of programme adoption. This model provides guidance for collecting data on disabilities in new settings.
Collapse
Affiliation(s)
- Samuel D Shillcutt
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Gilbert C, Muhit M. Eye conditions and blindness in children: priorities for research, programs, and policy with a focus on childhood cataract. Indian J Ophthalmol 2012; 60:451-5. [PMID: 22944758 PMCID: PMC3491274 DOI: 10.4103/0301-4738.100548] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 07/25/2012] [Indexed: 11/23/2022] Open
Abstract
The major causes of blindness in children encompass intrauterine and acquired infectious diseases, teratogens and developmental and molecular genetics, nutritional factors, the consequences of preterm birth, and tumors. A multidisciplinary approach is therefore needed. In terms of the major avoidable causes (i.e., those that can be prevented or treated) the available evidence shows that these vary in importance from country to country, as well as over time. This is because the underlying causes closely reflect socioeconomic development and the social determinants of health, as well as the provision of preventive and therapeutic programs and services from the community through to tertiary levels of care. The control of blindness in children therefore requires not only strategies that reflect the local epidemiology and the needs and priorities of communities, but also a well functioning, accessible health system which operates within an enabling and conducive policy environment. In this article we use cataract in children as an example and make the case for health financing systems that do not lead to 'catastrophic health expenditure' for affected families, and the integration of eye health for children into those elements of the health system that work closely with mothers and their children.
Collapse
Affiliation(s)
- Clare Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine and Medical Advisor, Sightsavers, UK
| | - Mohammed Muhit
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine and Medical Advisor, Sightsavers, UK
- Department of Public Health and Life Sciences, University of South Asia, Dhaka, Bangladesh and Child Sight Foundation (CSF), Dhaka, Bangladesh
| |
Collapse
|
28
|
Petrou S, Khan K. Economic costs associated with moderate and late preterm birth: primary and secondary evidence. Semin Fetal Neonatal Med 2012; 17:170-8. [PMID: 22364679 DOI: 10.1016/j.siny.2012.02.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Despite constituting the vast majority of preterm births, relatively little is known about the clinical and economic outcomes of children born either moderately or late preterm. This paper outlines the economic consequences of moderate and late preterm birth for the health services, for other sectors of the economy, for families and carers and, more broadly, for society. The paper reviews both the peer-reviewed literature and additional sources for information on the economic consequences of moderate and late preterm birth. It then goes on to present the results of a decision-analytic modelling study that aimed to estimate the societal costs associated with moderate and late preterm birth throughout the childhood years. Finally, the requirements for future methodological and applied research in this area are briefly outlined.
Collapse
Affiliation(s)
- Stavros Petrou
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
| | | |
Collapse
|
29
|
Economic analysis of a pediatric ventilator-associated pneumonia prevention initiative in nicaragua. Int J Pediatr 2012; 2012:359430. [PMID: 22518174 PMCID: PMC3299287 DOI: 10.1155/2012/359430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 10/31/2011] [Accepted: 11/02/2011] [Indexed: 12/04/2022] Open
Abstract
We performed an economic analysis of an intervention to decrease ventilator-associated pneumonia (VAP) prevalence in pediatric intensive care units (PICUs) at two Nicaraguan hospitals to determine the cost of the intervention and how effective it needs to be in order to be cost-neutral. A matched cohort study determined differences in costs and outcomes among ventilated patients. VAP cases were matched by sex and age for children older than 28 days and by weight for infants under 28 days old to controls without VAP. Intervention costs were determined from accounting and PICU staff records. The intervention cost was approximately $7,000 for one year. If VAP prevalence decreased by 0.5%, hospitals would save $7,000 and the strategy would be cost-neutral. The finding that the intervention required only modest effectiveness to be cost-neutral and has potential to generate substantial cost savings argues for implementation of VAP prevention strategies in low-income countries like Nicaragua on a broader scale.
Collapse
|
30
|
Sicuri E, Bardají A, Sigauque B, Maixenchs M, Nhacolo A, Nhalungo D, Macete E, Alonso PL, Menéndez C. Costs associated with low birth weight in a rural area of Southern Mozambique. PLoS One 2011; 6:e28744. [PMID: 22174885 PMCID: PMC3236214 DOI: 10.1371/journal.pone.0028744] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/14/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Low Birth Weight (LBW) is prevalent in low-income countries. Even though the economic evaluation of interventions to reduce this burden is essential to guide health policies, data on costs associated with LBW are scarce. This study aims to estimate the costs to the health system and to the household and the Disability Adjusted Life Years (DALYs) arising from infant deaths associated with LBW in Southern Mozambique. METHODS AND FINDINGS Costs incurred by the households were collected through exit surveys. Health system costs were gathered from data obtained onsite and from published information. DALYs due to death of LBW babies were based on local estimates of prevalence of LBW (12%), very low birth weight (VLBW) (1%) and of case fatality rates compared to non-LBW weight babies [for LBW (12%) and VLBW (80%)]. Costs associated with LBW excess morbidity were calculated on the incremental number of hospital admissions in LBW babies compared to non-LBW weight babies. Direct and indirect household costs for routine health care were 24.12 US$ (CI 95% 21.51; 26.26). An increase in birth weight of 100 grams would lead to a 53% decrease in these costs. Direct and indirect household costs for hospital admissions were 8.50 US$ (CI 95% 6.33; 10.72). Of the 3,322 live births that occurred in one year in the study area, health system costs associated to LBW (routine health care and excess morbidity) and DALYs were 169,957.61 US$ (CI 95% 144,900.00; 195,500.00) and 2,746.06, respectively. CONCLUSIONS This first cost evaluation of LBW in a low-income country shows that reducing the prevalence of LBW would translate into important cost savings to the health system and the household. These results are of relevance for similar settings and should serve to promote interventions aimed at improving maternal care.
Collapse
Affiliation(s)
- Elisa Sicuri
- Barcelona Centre for International Health Research CRESIB, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|