The Impact of Maternal Obesity on NICU and Newborn Nursery Costs.

Background: Research on the effects of maternal obesity on neonates has focused on clinical outcomes. Despite growing interest in obesity as a driver of healthcare expenditure, the financial impact of maternal obesity in the neonatal setting is little understood. Objective: To determine if maternal obesity is associated with higher incurred costs in NICU and full-term nursery. Methods: Data for all live births (1/1/14-12/31/19) at our academic medical center was obtained from the New York State Perinatal Data System for infants >23 weeks gestational age. Financial data was obtained from the hospital's cost-processing application. Infants with missing clinical and/or financial data were excluded. The NIH definition of obesity was used (BMI ≥ 30 kg/m2) to separate infants born to obese and non-obese mothers. Student's t-tests and chi square tests were used to compare maternal data, delivery, and infant outcomes between both groups. A logistic regression model was used to compare infant outcomes using odds ratios while controlling for maternal risk factors (smoking status, pre-pregnancy and gestational diabetes, pre-pregnancy and gestational hypertension). Multivariate regression analysis adjusting for maternal risk factors was also used to compare length-of-stay, total and direct costs in the NICU and full-term nursery between infant groups. Results: Of the 11,610 pregnancies in this retrospective study, obese mothers more frequently had other risk factors (smoke, pre-pregnancy and gestational diabetes, and pre-pregnancy and gestational hypertension). Infants born to obese mothers were more often preterm, had Cesarean delivery, lower APGAR scores, required assisted ventilation in the delivery room, and required NICU admission. Adjusting for maternal risk factors, infants born to obese mothers were less frequently preterm (OR 0.82 [0.74-0.91], p < 0.01) and had NICU stays (OR 0.98 [0.81-0.98], p = 0.02), but more frequently had Cesarean births (OR 1.54 [1.42-1.67], p < 0.01). They also had longer adjusted LOS (2.03 ± 1.51 vs. 1.92 ± 1.45 days, p < 0.01) and higher mean costs per infant in the full-term nursery ($3,638.34 ± $6,316.69 vs. $3,375.04 ± $4,994.18, p = 0.03) but not in NICU. Conclusions: Maternal obesity correlates with other risk factors. Prolonged maternal stay may explain increased LOS and costs in the full-term nursery for infants born to obese mothers, as infants wait to be discharged with mothers.

Physical examination score predicts need for surgery in neonates with necrotizing enterocolitis.

OBJECTIVE: To evaluate the utility of a standardized physical exam score (PE-NEC) in predicting need for surgery or death in neonates with necrotizing enterocolitis (NEC). METHODS: This prospective, multicenter, observational study was conducted from 3/1/14 to 2/29/16 with three regional perinatal centers in upstate New York. Infants with NEC Bell's Stage ≥ 2 had physical exams and laboratory data recorded at 12-24 h intervals for 48 h following diagnosis. PE-NEC score was comprised of seven components: bowel sounds, capillary refill time, abdominal wall erythema, girth, discoloration, induration, and tenderness. Surgical timing was determined by surgeons blinded to the PE-NEC score. Optimal sensitivity and specificity of PE-NEC score for surgery/death (primary outcome) was determined by receiver operating characteristic curve analysis. RESULTS: Of 100 infants with NEC, 5 had pneumoperitoneum at diagnosis and were excluded yielding 95 for analyses. Of those, 35 infants experienced the primary outcome: 3 died from NEC prior to surgery and 32 had surgery (30 laparotomies, 2 drains). The PE-NEC score was found to be sensitive and specific for need for surgery/death (AUC = 0.89, 95% CI 0.82-0.97); a score of ≥3 had a sensitivity of 0.88 (95% CI 0.72-0.97), specificity of 0.81 (95% CI 0.69-0.90). All components of the PE-NEC score were more likely to be present among infants with surgical NEC or who died. CONCLUSION: PE-NEC score is sensitive and specific in predicting need for surgery in infants with NEC and should be validated as a clinical decision-making tool.

Surfactant administration by transient intubation in infants 29 to 35 weeks' gestation with respiratory distress syndrome decreases the likelihood of later mechanical ventilation: a randomized controlled trial.

OBJECTIVE: To assess, among premature infants with early respiratory distress syndrome (RDS), the effect of one dose of intratracheally administered surfactant followed by extubation to nasal continuous positive airway pressure (NCPAP) on subsequent mechanical ventilation (MV), when compared with NCPAP alone. STUDY DESIGN: Randomized, blinded trial in infants 29 to 35 weeks' gestation with mild-to-moderate RDS requiring supplemental oxygen and NCPAP. Infants were randomized to intubation, surfactant treatment, and immediate extubation (surfactant group N=52), or to no intervention (control group N=53). All infants were subsequently managed with NCPAP. RESULTS: Need for later MV was 70% in the control group and 50% in the surfactant group. Surfactant group subjects had lower inspired oxygen fraction (FiO(2)) after study intervention and were less likely to require subsequent surfactant. Overall surfactant use, duration of O(2) therapy, length of stay, and bronchopulmonary dysplasia were unaffected. CONCLUSION: Among premature infants with mild-to-moderate RDS, transient intubation for surfactant administration reduces later MV.