Pediatric Resident The University of Chicago Medical Center The University of Chicago Medical Center Chicago, Illinois, United States
Background: Neonatologists and obstetricians engage in complex ethical decision-making about delivery room resuscitation at the margin of viability (22 to 24 weeks of gestation). Justice-based moral concern about the cost of providing care to the most premature infants has been invoked as an argument against active resuscitation in the 22nd week.
Objective: To examine the relative cost of neonatal intensive care for infants born at 22, 23, and 24 weeks’ GA.
Design/Methods: We conducted a retrospective cohort study at six tertiary hospitals with both maternal fetal medicine (MFM) and neonatology services (NICU) (2011-2015). The cohort included mothers evaluated between 22 0/7 and 24 6/7 weeks’ EGA, analyzed by completed weeks of GA at delivery. For infants admitted to the NICU, the length of stay (LOS) in days was calculated from time of birth to disposition (death or NICU discharge). Descriptive statistics and ANOVA were used for analysis.
Results: 129 infants were born at 22 weeks’ GA; 72 were liveborn, 25 were admitted to the NICU and 5(20%) survived to discharge. Of 179 infants born at 23 weeks’ GA, 153 were liveborn, 99 were admitted to the NICU and 43(43%) survived to discharge. 261 infants were born at 24 weeks’ GA; 253 were liveborn, 246 were admitted to the NICU and 145(59%) survived to discharge (Table 1). For non-survivors, there was no significant difference in mean or median LOS between GA groups (mean 6-27d/ median 1-2d). Similarly, for infants surviving to discharge, mean/median LOS did not differ significantly between GA groups (mean 130-159d/ median 124-144d) (Figure 1). Across 22-24 weeks, 88% (26,861/30,566 days) of NICU care was utilized by survivors (Figure 2). During this 5-year period infants born at these six sites at 22 weeks’ GA used 0.2% of total bed days, only 837 of 540,802 days (Figure 3). Conclusion(s): When using LOS as a proxy for NICU care costs, these results provide early data that the cost of allowing resuscitation of 22 weeks did not present a disproportionate resource burden and this argument should be reconsidered as a deterrent to offering resuscitation. An examination of the more recent five years of care is planned.
Table 1. Clinical Characteristics of the INDEED 1.0 STUDY GROUP 2011-2015
Figure 1. Mean and Median NICU Length of Stay
Figure 2. NICU Bed Day Use by Disposition
Figure 3. 540,802 NICU Bed Days at 6 Academic Centers: All Gestational Ages
Authors/Institutions: Samantha Millikan, The University of Chicago Medicine, Bloomingdale, Illinois, United States; Allison Schuh, University of Chicago, Chicago, Illinois, United States; Leah Thomas, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States; Naomi T. Laventhal, University of Michigan, Ann Arbor, Michigan, United States; Christine Carlos, University of Chicago, Chicago, Illinois, United States; Dalia M. Feltman, NorthShore University HealthSystem Evanston Hospital, Evanston, Illinois, United States; Bree Andrews, The University of Chicago, Chicago, Illinois, United States