Neonatal intensive care at borderline viability--is it worth it?

Area of Science:

• Neonatalogy
• Perinatal Medicine
• Public Health

Background:

• Survival rates for very preterm infants (<25 weeks gestational age) have increased, raising concerns about long-term outcomes and resource utilization.
• Assessing changes in long-term outcomes and resource consumption for very preterm infants during the 1990s is crucial.

Purpose of the Study:

• To evaluate the incremental changes in long-term outcomes and hospital resource consumption for very preterm infants during the 1990s.
• To compare outcomes and resource use between two distinct periods within the 1990s.

Main Methods:

• A cohort study design was employed.
• Consecutive livebirths with gestational ages of 23-27 weeks in Victoria were analyzed from 1991-1992 and 1997.
• Data on survival, neurosensory impairments, disabilities, utilities, and hospital resource consumption up to 2 years of age were collected and compared with normal birthweight controls.

Main Results:

• Increased intensive care in 1997 led to higher survival rates across all gestational ages compared to 1991-1992 (16% absolute increase).
• The most significant improvements in survival and quality-adjusted survival were observed in infants born at 23 weeks gestation.
• Incremental resource costs for improving survival and quality-adjusted survival were similar for infants of 23-24 weeks and 25-27 weeks gestation.

Conclusions:

• Enhanced intensive care for borderline viability infants in the late 1990s correlated with improved outcomes.
• The incremental costs associated with these improved outcomes were not excessive when compared to slightly more mature infants.
• These findings suggest that increased intensive care for extremely preterm infants is a worthwhile investment with manageable resource implications.