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Neonatal intensive care at borderline viability--is it worth it?
1The Royal Women's Hospital, Melbourne, Australia. lwd@unimelb.edu.au
Insights
Increased intensive care for extremely preterm infants in the 1990s improved survival rates. The costs for these advancements were comparable to those for slightly more mature infants, indicating efficient resource allocation for borderline viability cases.
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.
Background:
Very preterm infants at the borderline of viability, especially those <25 weeks of gestational age, have survived in increasing numbers in recent years, but concerns persist about their long-term outcome and their consumption of scarce hospital resources.
Aims:
To determine incremental changes in long-term outcome and consumption of resources by very preterm infants in the 1990s.
Design:
Cohort study.
Patients:
Consecutive livebirths with gestational ages 23-27 weeks born in the state of Victoria in two discrete eras, 1991-1992 (n=401) and 1997 (n=208), and randomly selected contemporaneous normal birthweight (NBW, birthweight >2499 g) controls (1991-1992 n=265, 1997 n=198).
Main Outcome Measures:
Survival, and neurosensory impairments, disabilities and utilities, and consumption of hospital resources to 2 years of age.
Results:
Compared with 1991-1992, in 1997 more infants were offered intensive care and the survival rate was higher at each week of gestation, and overall (absolute increase in survival 16%; 95% confidence interval, 8%, 24%). The largest increases in the survival and quality-adjusted survival rates were in infants at 23 weeks (31% and 20%, respectively). The incremental resource costs of improving survival and quality-adjusted survival were similar in infants of 23-24 weeks compared with those of 25-27 weeks (e.g., 112 vs. 105 days of assisted ventilation per additional survivor, or 167 vs. 180 days of assisted ventilation per additional quality-adjusted survivor, respectively).
Conclusions:
Increased intensive care in the late 1990s for infants at the borderline of viability was associated with improved outcomes, at incremental costs that were not excessive compared with slightly more mature infants.
