Neonatal Intensive Care Unit Costs of Morbidities in Very Low Birthweight Infants

OBJECTIVES: Very low birthweight (VLBW; <1500 g birthweight) infants are among the most expensive hospitalized patients, primarily because they are at high risk for multiple morbidities that translate into longer hospital stays, generally in the neonatal intensive care unit. The purpose of this study was to determine the hospital cost, charges and payments for morbidities experienced by VLBW infants during their initial hospitalization.

METHODS: This retrospective, cross-sectional analysis examined all VLBW infants discharged between July 1, 2005 and June 30, 2009 at an academic medical center. Mean hospital costs, charges and payments were analyzed across individual morbidities and the most common combinations of morbidities, including necrotizing entercolitis (NEC), sepsis, retinopathy of prematurity (ROP), chronic lung disease (CLD) and respiratory distress syndrome (RDS).

RESULTS: Of the 587 premature, VLBW infants, 72.2% were diagnosed with RDS, 59.6% with ROP, 44.8% with CLD, 32.4% with sepsis and 7.3% with NEC. The most common combinations of morbidities were RDS, ROP and CLD (20.6%); sepsis, RDS, ROP and CLD (12.4%) and RDS only (9.5%),while 18.2% had none of the five morbidities. The average hospital costs and payments ranged from $29,453 (costs) and $67,043 (payments) for infants with RDS to $127,240 and $269,691, respectively, for infants with all five morbidities.

CONCLUSIONS: These findings indicate that VLBW infants who experience more morbidities have substantially higher costs than those without morbidities. Average costs for individual morbidities provide an incomplete picture of the costs associated with VLBW infants. The combination of morbidities is important drivers of costs.