Cost estimate of hospital stays for premature newborns of adolescent mothers in a Brazilian public hospital

Direct costs of prematurity and factors associated with birth and maternal conditions

OBJECTIVE

To estimate the direct costs due to hospital care for extremely, moderate, and late preterm newborns, from the perspective of a public hospital in 2018. The second objective was to investigate whether factors associated with birth and maternal conditions explain the costs and length of hospital stay.

METHODS

This is a cost-of-illness study, with data extracted from hospital admission authorization forms and medical records of a large public hospital in the Federal District, Brazil. The association of characteristics of preterm newborns and mothers with costs was estimated by linear regression with gamma distribution. In the analysis, the calculation of the parameters of the estimates (B), with a confidence interval of 95% (95%CI), was adopted. The uncertainty parameters were estimated by the 95% confidence interval and standard error using the Bootstrapping method, with 1,000 samples. Deterministic sensitivity analysis was performed, considering lower and upper limits of 95%CI in the variation of each cost component.

RESULTS

A total of 147 preterm newborns were included. We verified an average cost of BRL 1,120 for late preterm infants, BRL 6,688 for moderate preterm infants, and BRL 17,395 for extremely preterm infants. We also observed that factors associated with the cost were gestational age (B = -123.00; 95%CI: -241.60 to -4.50); hospitalization in neonatal ICU (B = 6,932.70; 95%CI: 5,309.40-8,556.00), and number of prenatal consultations (B = -227.70; 95%CI: -403.30 to -52.00).

CONCLUSIONS

We found a considerable direct cost resulting from the care of preterm newborns. Extreme prematurity showed a cost 15.5 times higher than late prematurity. We also verified that a greater number of prenatal consultations and gestational age were associated with a reduction in the costs of prematurity.

Admission patterns and risk factors linked with neonatal mortality: A hospital-based retrospective study

Objective

This research was conducted to analyze the elements and factors that link with newborn deaths at Neonatal Intensive Care Unit (NICU) of a public teaching hospital in Jordan.

Methods

A retrospective study was conducted by reviewing the medical records of all the neonates admitted to the NICU over a one- year period from 1^st of March, 2018 to 28^th of February, 2019 at Princess Rahma Pediatric Hospital, Jordan.

Results

Overall, the medical records of 1247 neonates were included in this study. The common causes of admission were sepsis (27.3%), followed by respiratory distress syndrome (RDS) (24.9%) and asphyxia (13.1%). The majority of the admitted neonates survived (91.9%), and the overall mortality rate was 8.1%. According to the cause-specific death rate analysis, RDS was the most common cause of death rate (35.6%), followed by sepsis (27.7%). Logistic regression analysis results show that gestational age, weight of the baby at birth, and the quick clinical assessment (Apgar) within the first five minutes were the strongest predictors of neonatal mortality (P<0.05).

Conclusion

Sepsis, RDS, and asphyxia were the leading causes of morbidity in neonates. These diseases were also responsible for a high rate of mortality. Understanding the cause of morbidity and mortality of neonates admitted at NICU is useful for prioritizing and planning health services, re-allocating resources, and improving the quality of care.

Costs of hospitalization in preterm infants: impact of antenatal steroid therapy

OBJECTIVE

To estimate the costs of hospitalization in premature infants exposed or not to antenatal corticosteroids (ACS).

METHOD

Retrospective cohort analysis of premature infants with gestational age of 26-32 weeks without congenital malformations, born between January of 2006 and December of 2009 in a tertiary, public university hospital. Maternal and neonatal demographic data, neonatal morbidities, and hospital inpatient services during the hospitalization were collected. The costs were analyzed using the microcosting technique.

RESULTS

Of 220 patients that met the inclusion criteria, 211 (96%) charts were reviewed: 170 newborns received at least one dose of antenatal corticosteroid and 41 did not receive the antenatal medication. There was a 14-37% reduction of the different cost components in infants exposed to ACS when the entire population was analyzed, without statistical significance. Regarding premature infants who were discharged alive, there was a 24-47% reduction of the components of the hospital services costs for the ACS group, with a significant decrease in the length of stay in the neonatal intensive care unit (NICU). In very-low birth weight infants, considering only the survivors, ACS promoted a 30-50% reduction of all elements of the costs, with a 36% decrease in the total cost (p=0.008). The survivors with gestational age <30 weeks showed a decrease in the total cost of 38% (p=0.008) and a 49% reduction of NICU length of stay (p=0.011).

CONCLUSION

ACS reduces the costs of hospitalization of premature infants who are discharged alive, especially those with very low birth weight and <30 weeks of gestational age.