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Costs and End-of-Life Care in the NICU: Lessons for the MICU?

Published online by Cambridge University Press:  01 January 2021

John D. Lantos  and
William L. Meadow
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Extract

Providing care for a baby born at 24 weeks of gestation in a neonatal intensive care unit (NICU) is one of the most expensive medical treatments in the United States today. The cost can easily run over $300,000 for one baby. Furthermore, many extremely premature babies who survive are left with chronic diseases or disabilities that require further medical expenses and other specialized services throughout childhood or throughout life. When all these expenditures are totaled up, it can seem that neonatal intensive care is just not worth it.

Concerns about the cost-effectiveness of NICUs have led to persistent critical scrutiny of these specialized units by physicians, economists, and epidemiologists. These analysts have examined NICUs and the patients in them in order to determine whether there are subpopulations of babies for whom neonatal intensive care is so demonstrably ineffective or so costly that it should not be provided. Such examinations have been carried out in many different countries, at many times over the last 30 years, and have analyzed outcomes for babies by gestational age, birthweight, and illness severity.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 39 , Issue 2 , Summer 2011 , pp. 194 - 200
Copyright
Copyright © American Society of Law, Medicine and Ethics 2011

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References

Korvenranta, E., Linna, M., and Rautava, L. et al., “Hospital Costs and Quality of Life during 4 Years after Very Preterm Birth,” Archives of Pediatric & Adolescent Medicine 164, no. 3 (2010): 657–663.10.1001/archpediatrics.2010.99CrossRefGoogle Scholar
Doyle, L. W., “Victorian Infant Collaborative Study Group: Evaluation of Neonatal Intensive Care for Extremely Low Birth Weight Infants in Victoria over Two Decades: II. Efficiency,” Pediatrics 113, no. 2 (2004): 510–514.10.1542/peds.113.3.510CrossRefGoogle Scholar
Eriksson, M., Bodin, L., Finnström, O., and Schollin, J., “Can Severity-of-Illness Indices for Neonatal Intensive Care Predict Outcome at 4 Years of Age?” Acta Paediatrica 91, no. 10 (2002): 1093–1100.10.1111/j.1651-2227.2002.tb00105.xCrossRefGoogle Scholar
Cuttler, D. M. and Meara, E., “The Technology of Birth: Is It Worth It?” Forum for Health Economics & Policy, Frontiers in Health Policy Research 3 (2000), available at <http://www.bepress.com/fhep/3/3> (last visited February 22, 2011).+(last+visited+February+22,+2011).>Google Scholar
Lantos, J. D., Mokalla, M., and Meadow, W., “Resource Allocation in Neonatal and Medical ICUs: Epidemiology and Rationing at the Extremes of Life,” American Journal of Respiratory and Critical Care Medicine 156, no. 1 (1997): 185–189.10.1164/ajrccm.156.1.9510103CrossRefGoogle Scholar
Health Resources and Services Administration, The Critical Care Workforce: A Report to Congress, 2003, available at <http://bhpr.hrsa.gov/healthworkforce/reports/criticalcare/cc3.htm> (last visited February 22, 2011).+(last+visited+February+22,+2011).>Google Scholar
Lee, K. S., “Infant Mortality Decline in the Late 19th and Early 20th Centuries: The Role of Market Milk,” Perspectives in Biology and Medicine 50, no. 3 (2007): 585–602.10.1353/pbm.2007.0051CrossRefGoogle Scholar
Henderson-Smart, D. J., Wilkinson, A., and Raynes-Greenow, C. H., “Mechanical Ventilation for Newborn Infants with Respiratory Failure Due to Pulmonary Disease,” Cochrane Database System Review 4 (2002): CD002770.Google Scholar
Duff, R. S. and Campbell, A. G., “Moral and Ethical Dilemmas in the Special-Care Nursery,” New England Journal of Medicine 289, no. 8 (1973): 890–894.10.1056/NEJM197310252891705CrossRefGoogle Scholar
In Re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976).10.1177/003803857601000213CrossRefGoogle Scholar
Lasswell, S. M., Barfield, W. D., Rochat, R. W., and Blackmon, L., “Perinatal Regionalization for Very Low-Birth-Weight and Very Preterm Infants: A Meta-Analysis,” JAMA 304, no. 8 (2010): 992–1000.10.1001/jama.2010.1226CrossRefGoogle Scholar
Verhagen, A. A., Janvier, A., Leuthner, S. R., Andrews, B., Lagatta, J., Bos, A. F., and Meadow, W., “Categorizing Neonatal Deaths: A Cross-Cultural Study in the United States, Canada, and The Netherlands,” Journal of Pediatrics 156, no. 1 (2010): 33–37.10.1016/j.jpeds.2009.07.019CrossRefGoogle Scholar
Dolk, H., Loane, M., and Garne, E. et al., “Trends and Geographic Inequalities in the Prevalence of Down Syndrome in Europe, 1980–1999,” Revue d Épidémiologie et de Santé Publique 53, spec. no. 2 (2005): 2S87–S95.10.1016/S0398-7620(05)84771-6CrossRefGoogle Scholar
Crider, K. S., Olney, R. S., and Cragan, J. D., “Trisomies 13 and 18: Population Prevalences, Characteristics, and Prenatal Diagnosis, Metropolitan Atlanta, 1994–2003,” American Journal of Medical Genetics A 146, no. 4 (2008): 820–826.10.1002/ajmg.a.32200CrossRefGoogle Scholar
Rasiah, S. V., Ewer, A. K., and Miller, P. et al., “Antenatal Perspective of Hypoplastic Left Heart Syndrome: 5 Years On,” Archives of Disease in Childhood Fetal and Neonatal Edition 93, no. 3 (2008): F192–F197.10.1136/adc.2006.112482CrossRefGoogle Scholar
Cragan, J. D., Roberts, H. E., and Edmonds, L. D. et al., “Surveillance for Anencephaly and Spina Bifida and the Impact of Prenatal Diagnosis—United States, 1985–1994,” MMWR CDC Surveillance Summary 44, no. 1 (1995): 1–13.Google Scholar
Singh, J., Lantos, J., and Meadow, W., “End-of-Life after Birth: Death and Dying in a Neonatal Intensive Care Unit,” Pediatrics 114, no. 6 (2004): 1620–1626.10.1542/peds.2004-0447CrossRefGoogle Scholar
See supra notes 1 and 4.Google Scholar
See Mokalla, Lantos, and Meadow, supra note 5.Google Scholar
Meadow, W., “Epidemiology, Economics, and Ethics in the NICU: Reflections from 30 Years of Neonatology Practice,” Journal of Pediatric Gastroenterology and Nutrition 45, Supp. 3 (2007): S215–S217.10.1097/01.mpg.0000302975.98491.7fCrossRefGoogle Scholar
Buchh, B., Graham, N., and Harris, B. et al., “Neonatology Has Always Been a Bargain – Even When We Weren't Very Good at It,” Acta Paediatrica 96, no. 4 (2007): 659–663.10.1111/j.1651-2227.2007.00247.xCrossRefGoogle Scholar
Tyson, J. E., Parikh, N. A., Langer, J., Green, C., and Higgins, R. D., National Institute of Child Health and Human Development Neonatal Research Network, “Intensive Care for Extreme Prematurity – Moving beyond Gestational Age,” New England Journal of Medicine 358, no. 14 (2008): 1672–1681.10.1056/NEJMoa073059CrossRefGoogle Scholar
Singh, J., Fanaroff, J., and Andrews, B. et al., “Resuscitation in the ‘Gray Zone’ of Viability: Determining Physician Preferences and Predicting Infant Outcomes,” Pediatrics 120, no. 3 (2007): 519–526.10.1542/peds.2006-2966CrossRefGoogle Scholar
Lagatta, J., Andrews, B., and Caldarelli, L. et al., “Early NICu Therapy Improves Predictive Power for the Outcomes of Ventilated ELBW Infants,” Journal of Pediatrics (in press, 2011).Google Scholar
Meadow, W. L., Lantos, J. D., Reimschisel, T., and Mokalla, M., “Distributive Justice across Generations: Epidemiology of ICU Care for the Very Young and the Very Old,” Clinics in Perinatology 23, no. 3 (1996): 597–608.10.1016/S0095-5108(18)30231-8CrossRefGoogle Scholar
Meadow, W., Pohlman, A., and Frain, L. et al., “Power and Limitations of Daily Prognostications of Death in the MICU,” Critical Care Medicine (in press, 2011).10.1097/CCM.0b013e318205df9bCrossRefGoogle Scholar
Meadow, W., Hall, J., Frain, L., Ren, Y., Pohlman, A., Plesha-Troyke, S., Gresens, W., and Lantos, J., “Some Are Old, Some Are New: Life and Death in the ICU,” Seminars in Perinatology 27, no. 6 (2003): 471–479.10.1053/j.semperi.2003.10.006CrossRefGoogle Scholar
Kopelman, L. M., “Disputes over Moral Standards Guiding Treatments for Imperiled Infants,” Seminars in Perinatology 33, no. 2 (2009): 372–376.10.1053/j.semperi.2009.07.004CrossRefGoogle Scholar
Vavasseur, C., Foran, A., and Murphy, J. F., “Consensus Statements on the Borderlands of Neonatal Viability: From Uncertainty to Grey Areas,” Irish Medical Journal 100 (2007): 561–564.Google Scholar
Janvier, A., Leblanc, I., and Barrington, K. J., “Nobody Likes Preemies: The Relative Value of Patients' Lives,” Journal of Perinatology 28, no. 4 (2008): 821–826.10.1038/jp.2008.103CrossRefGoogle Scholar
Wunsch, H., Guerra, C., Barnato, A. E., Angus, D. C., Li, G., and Linde-Zwirble, W. T., “Three-Year Outcomes for Medicare Beneficiaries Who Survive Intensive Care,” JAMA 303, no. 5 (2010): 849–856.10.1001/jama.2010.216CrossRefGoogle Scholar
Barnato, A. E., Albert, S. M., Angus, D. C., Lave, J. R., and Degenholtz, H. B., “Disability among Elderly Survivors of Mechanical Ventilation,” American Journal of Respiratory and Critical Care Medicine (November 5, 2010).Google Scholar
Wilson-Costello, D., Friedman, H., and Minich, N. et al., “Improved Neurodevelopmental Outcomes for Extremely Low Birth Weight Infants in 2000–2002,” Pediatrics 119, no. 1 (2007): 37–45.10.1542/peds.2006-1416CrossRefGoogle Scholar
Hennessy, D., Juzwishin, K., Yergens, D., Noseworthy, T., and Doig, C., “Outcomes of Elderly Survivors of Intensive Care: A Review of the Literature,” Chest 127, no. 10 (2005): 1764–174.10.1378/chest.127.5.1764CrossRefGoogle Scholar
Ehlenbach, W. J., Barnato, A. E., and Curtis, J. R. et al., “Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly,” New England Journal of Medicine 361, no. 1 (2009): 22–31.10.1056/NEJMoa0810245CrossRefGoogle Scholar