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Published on: October 28, 2022
Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic
Vilmaris Quinones Cardona1, Rakesh Rao2, Isabella Zaniletti3
1St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Insights
Higher hospital costs for hypoxic-ischemic encephalopathy (HIE) care did not improve neurodevelopmental outcomes. Increased EEG costs were linked to better survival, while lab and medication costs showed no benefit.
Area of Science:
- Neonatal neurology
- Pediatric critical care
- Neurodevelopmental outcomes
Background:
- Intercenter variation exists in managing hypoxic-ischemic encephalopathy (HIE).
- The relationship between resource utilization and neurodevelopmental outcomes in HIE is unclear.
Purpose of the Study:
- To determine if higher resource utilization, quantified by hospital costs in the first 4 days of life, is associated with survival without neurodevelopmental impairment (NDI) in infants with HIE.
Main Methods:
- Retrospective cohort analysis of 381 neonates with HIE treated with therapeutic hypothermia (TH) at US children's hospitals (2010-2016).
- Resource utilization was defined by hospitalization costs, including neonatal neurocritical care (NNCC), categorized by terciles.
- Outcomes assessed were death or NDI versus survival without NDI.
Main Results:
- No association was found between higher overall hospitalization costs and death or NDI.
- Higher EEG costs were associated with lower odds of death or NDI (OR, 0.30).
- Higher laboratory costs (OR, 2.35) and antiseizure medication costs (OR, 3.72) were associated with higher odds of death or NDI.
Conclusions:
- Hospitalization costs in the first 4 days of HIE treatment do not correlate with neurodevelopmental outcomes.
- Specific cost centers, like EEG, may indicate better outcomes, while others, like laboratory tests and antiseizure medications, do not.
- Further research is needed to identify specific NNCC aspects associated with improved HIE outcomes.
Importance:
Intercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes.
Objective:
To determine if higher resource utilization during the first 4 days of age, quantified by hospital costs, is associated with survival without neurodevelopmental impairment (NDI) among infants with HIE.
Design, Setting, And Participants:
Retrospective cohort analysis of neonates with HIE who underwent therapeutic hypothermia (TH) at US children's hospitals participating in the Children's Hospitals Neonatal Database between 2010 and 2016. Data were analyzed from December 2021 to December 2022.
Exposures:
Infants who survived to 4 days of age and had neurodevelopmental outcomes assessed at greater than 11 months of age were divided into 2 groups: (1) death or NDI and (2) survived without NDI. Resource utilization was defined as costs of hospitalization including neonatal neurocritical care (NNCC). Data were linked with Pediatric Health Information Systems to quantify standardized costs by terciles.
Main Outcomes And Measures:
The main outcome was death or NDI. Characteristics, outcomes, hospitalization, and NNCC costs were compared.
Results:
Among the 381 patients who were included, median (IQR) gestational age was 39 (38-40) weeks; maternal race included 79 (20.7%) Black mothers, 237 (62.2%) White mothers, and 58 (15.2%) mothers with other race; 80 (21%) died, 64 (17%) survived with NDI (combined death or NDI group: 144 patients [38%]), and 237 (62%) survived without NDI. The combined death or NDI group had a higher rate of infants with Apgar score at 10 minutes less than or equal to 5 (65.3% [94 of 144] vs 39.7% [94 of 237]; P < .001) and a lower rate of infants with mild or moderate HIE (36.1% [52 of 144] vs 82.3% [195 of 237]; P < .001) compared with the survived without NDI group. Compared with low-cost centers, there was no association between high- or medium-hospitalization cost centers and death or NDI. High- and medium-EEG cost centers had lower odds of death or NDI compared with low-cost centers (high vs low: OR, 0.30 [95% CI, 0.16-0.57]; medium vs low: OR, 0.29 [95% CI, 0.13-0.62]). High- and medium-laboratory cost centers had higher odds of death or NDI compared with low-cost centers (high vs low: OR, 2.35 [95% CI, 1.19-4.66]; medium vs low: OR, 1.93 [95% CI, 1.07-3.47]). High-antiseizure medication cost centers had higher odds of death or NDI compared with low-cost centers (high vs. low: OR, 3.72 [95% CI, 1.51-9.18]; medium vs low: OR, 1.56 [95% CI, 0.71-3.42]).
Conclusions And Relevance:
Hospitalization costs during the first 4 days of age in neonates with HIE treated with TH were not associated with neurodevelopmental outcomes. Higher EEG costs were associated with lower odds of death or NDI yet higher laboratory and antiseizure medication costs were not. These findings serve as first steps toward identifying aspects of NNCC that are associated with outcomes.
