VLBW NEWBORN RESUSCITATION: PROS AND CONS

Yousef K. Abu-Osba, M.D.

Neonatal Intensive Care, Jordan Hospital Amman, Jordan

Perinatal Statistics in 12 Hospitals, Jordan (1995)

300 250
232.9

Per 1000

200
145.0

150 100 50

118.0

Early NNMR

NNMR

PNMR

Low Birth Weight Survey MOH, Jordan: Samir Faouri et al

Low Birth Weight Newborns < 2500

Neonatal Survival %
100 95.1 89.6 90 82.29 80

70 USA All Del. Jordan Hospital NICU Al Basheer H. All Del.

Perinatal Statistics Survey in 12 Hospitals in Jordan (1995)

Percentage of Neonatal Deaths by Birth Weight

60 50 40 184 (26.8) 30 20 10 0 <2500 <1500 15012000 20012500 25013000 30013500 >3500 103(15) 143 (20.8)) 124 (18) 88 (12.8) 45 (6.6) 430 (62.6)

Low Birth Weight Survey MOH, Jordan: Samir Faouri et al

Perinatal Statistics Survey in 12 Hospitals in Jordan (1995)

Major Causes of Neonatal Deaths (%)

50 45 40 35 30 25 20 15 10 5 0

43.4

12.4

11.5 5.7 4.8

M.C. Anomalies

3.2
MAS

HMD

Sepsis

Asphyxia

CHD

Low Birth Weight Survey MOH, Jordan: Samir Faouri et al

NEONATAL MORTALITY AT JORDAN HOSPITAL

Jordan Hospital Neonatal Mortality

Inborn Deliveries
Total number of live births during the three years were 4116 newborns. Total number of admissions (including inborn, in utero transfer, and transferred neonates) to NICU were 811 patients. Total number of NICU inborn admission deaths were 51 patients. Average gestational age was 30.74 weeks, birth weight 1,551 gm, age at death 13.3 days. Uncorrected Neonatal Mortality 12.3/1000 deliveries Total number of NICU out-born admission deaths were 13 patients. Average gestational age was 33.77 weeks, birth weight 2,382 gm, age at death 10.8 days.

Neonatal Mortality At Jordan Hospital Causes of Death of Inborn NB: Congenital Anomalies
Potter's Syndrome Complicated C. Heart Dis. Diaphragmatic Hernia
0 2 4

4 (7.8% )

5 (9.8% ) 7(13.7% )

Congenital anomalies contributed to death of 16 infants (30%).

Average gestational age was 35.33 weeks Average birth weight 2,218 gm. All died within the neonatal period. Average age at death 3.13 days

Neonatal Mortality At Jordan Hospital

Causes of Death of Inborn NB: Complications Major medical problems that contributed to the death of the other 35 infants (70%) were:
Salting Hydrops F. NEC ICH Sepsis RDS
0 5 10 15

1 (1.9% ) 1 (1.9% ) 1 (1.9% ) 6 (12% ) 21 (41% ) 26(51% )

20 25 30

Average gestational age was 28.59 weeks, Average birth weight 1,265 gm, Average age at death 17.66 days.

Neonatal Mortality At Jordan Hospital Inborn Causes of Death : Abandoned Neonates

Three newborns were not resuscitated actively after delivery but had full support later and survived for 14, 22 and 35 days. Birth weight was 1450 gm, 700 gm and 650 gm, and gestation was 27, 23, and 23 weeks respectively. Hospital cost mean charges was US $ 16,596.

Neonatal Mortality At Jordan Hospital Causes of Death of Out-born NB

Thirteen out-born infants died in the NICU. Congenital anomalies contributed to death of 10 infants (77%).
Brain Malf. RDS Sepsis-Nec P. Asphyxia M. C. Heart Dis M. C. Anomalies
0 1 2 3 4 1 (7.7%) 2 (15.4%) 2 (15.4%) 4 (30.7%) 4 (30.7%) 5 (38.4%) 5 6

Average birth weight 2,382 gms. Average gestation 33.8 weeks. Average age at death 10.8 days.

USA and Jordan Hospital NICU Comparative Survival Rate by Birth Weight (%)
110 100 90 80 70 60 50 40 30 20 10 0 501-750 751-1000 1001-1250 1251-1500 1501-2000 2001-2500

88.2

94.6

96.7 79 67

98 95

99.3 97.3

58.4 62 47

USA

Jordan Hospital

Neonatal Mortality At Jordan Hospital

Mortality Summary
Neonatal mortality at Jordan Hospital (as a tertiary center with a high percentage of high risk pregnancies) is relatively low, corrected neonatal mortality was 5.8/1000 deliveries. RDS, sepsis and major congenital anomalies are the major causes of death.
Financial limitations of use of surfactant and other expensive drugs, as well as unaffordable cost for corrective surgery is a major factor of death.

What is needed .?
Appropriate and adequate care for the mother, the fetus, and the neonate:
Appropriate and adequate conditions must be fulfilled :

Transparent annual perinatal statistics. Training for health care providers. Education for the public. Physical facilities. Trained staff. Follow up programs.

COST OF NEONATAL CARE

Cost of Neonatal Intensive Care Major Neurodevelopmental Sequelae of Prematures

Major complications which may be evident at 1-2 years of age: Cerebral palsy Developmental retardation Sensorineural hearing loss Blindness Hydrocephalus Chronic lung disease.

Cost of Neonatal Intensive Care

Incidence of Major Neurodevelopmental Sequelae of Prematures

Infants weighing < 1,500 gm ranges from 5% to 10%. Infants weighing < 1,000 gm ranges from 10% to 20%. Infants weighing < 750-800 gm ranges from 10% to 40%. Infants weighing < 1,500 gm; 80-95% are free of major sequelae. Infants weighing < 1,000 gm; 70-80% are free of major sequelae. Less than 50% of infants weighing < 600 gm or 23-24 weeks gestation are free of major sequelae.

Cost of Neonatal Intensive Care

NICU Charges for Prematures In USA

Mean charges per survivor for infants weighing < 1000 gm US $ 250,654.

Mean charges per survivor for infants weighing 1,000 -1,500 gm $ 74,101.
Nonsurvivors median charges $ 10,706 with a median stay of 2 days; $5,353 per day.

Cost Of Intensive Care For Prematures In Jordan Hospital Average Charges (JD) For All Patients By Category

Average Radiology Laboratory Con Non Med Stay Charges

1

139
6 22 3

43 19
36 18

1046
267 133 84

Med. Proc Pharmacy Med. Cons 11

44

328 100 1000

10

X Total Stay

X Per Day

Jordan Hospital NICU

Average Hospital Stay ( Days ) and Daily Cost (JD) by Birth Weight Groups (Gm) - All Patients
1000

386 166 129 86 139

100

28.1

28.8 9.2 6.8 5.7

10

1 500-1000 1000-1500 1500-2000 2000-2500 Total

Cost of Neonatal Intensive Care - Jordan Hospital

Average Charges For 500-1000 Gm Patients By Survival
Total Mean (JD)

11617 7395
6712

Mean/Day (JD)

540 321
370

B.W. Mean (Gm)

680 910
770

Days

23.5 36
21

10

100

1000

10000

100000

Expired

Survived

Neglected

Cost of Neonatal Intensive Care - Jordan Hospital

Average Charges For 1000-1500 Gm Patients By Survival
Total Mean (JD)

6048
4272

175
Mean/Day (JD) 328

B.W. Mean (Gm)

1300
1080

Days

30
14

10

100

1000

10000

100000

Expired

Survived

Cost of Neonatal Intensive Care Summary of Survival-Cost

Survival rate for all resuscitated infants with birth weight 500-1250 gm was 65%. Survivors mean charges 7632 JD, nonsurvivor mean charges 5736 JD.
Three infants not resuscitated initially, but were managed later on parents request, all died, mean charges 11617 JD.

Cost of Neonatal Intensive Care Summary of Survival-Cost

Average charges for all patients was 139 JD per day, and average total charges was 1046 JD.
Average hospital stay for all patients was 5.7 days.

Jordan Estimated Cost of Neonatal Intensive Care

Requirement for Neonatal Intensive/ Intermediate Care

150,000 newborns are delivered in Jordan. About 15,000 infants will require intensive/ intermediate care. Estimated national cost for neonatal care for all infants is about: 15,000 X 1,046 =

15,690,000 JD
Estimated hospital days needed for NICU care for all infants is about 15,000 X 5.7 = 85500 hospital days. Approximately 240-250 beds NICU and Intermediate Care are needed.

Cost of Neonatal Intensive Care Affordable Price for Jordan

15,690,000 JD per year OR 85,500 hospital days 240-250 NICU and Intermediate Care beds

A cheap and affordable price for giving optimal care for our future generations.

Any community can determine its own death rate.