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Birth weight, neonatal care, and infant mortality: Evidence from macrosomic babies
Ylenia Brilli1, Brandon J Restrepo2
1Department of Economics, University of Verona, Via Cantarane 24, 37129 Verona, Italy; Department of Economics, University of Gothenburg, Vasagatan 1, SE 405 30 Gothenburg, Sweden; CHEGU, Sweden; CHILD-Collegio Carlo Alberto, Italy.
Insights
Rule-of-thumb decisions impact neonatal care for high-birth-weight infants. Infants over 5000 grams receive more intensive care and experience reduced mortality, suggesting targeted interventions improve outcomes.
Area of Science:
- Neonatal Medicine
- Health Economics
- Biostatistics
Background:
- Macrosomic newborns (extremely high birth weight) present unique challenges in healthcare allocation.
- Understanding the impact of birth weight thresholds on neonatal care utilization and outcomes is crucial for evidence-based practice.
Purpose of the Study:
- To investigate rule-of-thumb health treatment decision-making for macrosomic newborns.
- To estimate the short-run health returns of neonatal intensive care for infants at the upper end of the birth weight distribution.
Main Methods:
- Utilized a regression discontinuity design to analyze treatment assignment and health outcomes.
- Compared infants just above and below a 5000-gram birth weight threshold.
Main Results:
- Infants exceeding 5000 grams showed a 2% higher likelihood of neonatal intensive care unit admission and a 1% higher probability of receiving antibiotics.
- Birth weight above 5000 grams was associated with a 0.15% lower risk of first-week mortality and a 0.20% lower risk of first-month mortality.
- No significant changes in treatment or mortality were observed at lower macrosomic cutoffs.
Conclusions:
- Treatment decisions for macrosomic infants appear guided by a 5000-gram threshold, reflecting perceived risks.
- The 5000-gram cutoff demonstrates a positive health return in terms of reduced mortality for high-birth-weight infants.
Abstract:
This study demonstrates that rule-of-thumb health treatment decision-making exists when assigning medical care to macrosomic newborns with an extremely high birth weight and estimates the short-run health return to neonatal care for infants at the high end of the birth weight distribution. Using a regression discontinuity design, we find that infants born with a birth weight above 5000 grams have a 2 percentage-point higher probability of admission to a neonatal intensive care unit and a 1 percentage-point higher probability of antibiotics receipt, compared to infants with a birth weight below 5000 grams. We also find that being born above the 5000-gram cutoff has a mortality-reducing effect: infants with a birth weight larger than 5000 grams face a 0.15 percentage-point lower risk of mortality in the first week and a 0.20 percentage-point lower risk of mortality in the first month, compared to their counterparts with a birth weight below 5000 grams. We do not find any evidence of changes in health treatments and mortality at macrosomic cutoffs lower than 5000 grams, which is consistent with the idea that such treatment decisions are guided by the higher expected morbidity and mortality risk associated with infants weighing more than 5000 grams.
