Escalating consumption of nursery resources by extremely immature infants

Over a 9-year period at one tertiary perinatal centre there were 59,650 livebirths; although only 1,123 (1.9%) were born at or before 30 weeks' gestation, this small minority of infants consumed 71.7% of total patient-days in the neonatal intensive care unit (NICU) and an inordinate 87.9% of total patient-days of assisted ventilation. Infants born at 24 weeks required 39 times the patient-days of assisted ventilation and 19 times the patient-days in the NICU per survivor compared with those born at 30 weeks' gestation. In infants born before 28 weeks, for each week of decrease in gestation, survivors averaged an extra 13.0 days of assisted ventilation, stayed in the NICU 13.8 days more, and in hospital 14.9 days longer. Any therapy before 28 weeks which can keep infants safely in the uterus could save approximately 2 weeks of nursery resources for each extra intrauterine week and would be beneficial economically, even if it meant hospitalization of the mother over that time.