VLBW NEWBORN RESUSCITATION: PROS AND CONS

1. VLBW NEWBORN RESUSCITATION: PROS AND CONS Yousef K. Abu-Osba, M.D. Neonatal Intensive Care, Jordan Hospital Amman, Jordan

2. Perinatal Statistics in 12 Hospitals, Jordan (1995) Low Birth Weight Survey MOH, Jordan: Samir Fa’ouri et al

3. Low Birth Weight Newborns < 2500Neonatal Survival %

4. Perinatal Statistics Survey in 12 Hospitals in Jordan (1995)Percentage of Neonatal Deaths by Birth Weight Low Birth Weight Survey MOH, Jordan: Samir Fa’ouri et al

5. Perinatal Statistics Survey in 12 Hospitals in Jordan (1995)Major Causes of Neonatal Deaths (%) Low Birth Weight Survey MOH, Jordan: Samir Fa’ouri et al

6. NEONATAL MORTALITY AT JORDAN HOSPITAL

7. 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.

8. Neonatal Mortality At Jordan HospitalCauses of Death of Inborn NB: Congenital Anomalies • 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

9. Neonatal Mortality At Jordan HospitalCauses of Death of Inborn NB: Complications Major medical problems that contributed to the death of the other 35 infants (70%) were: • Average gestational age was 28.59 weeks, • Average birth weight 1,265 gm, • Average age at death 17.66 days.

10. Neonatal Mortality At Jordan HospitalInborn 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.

11. Neonatal Mortality At Jordan HospitalCauses of Death of Out-born NB Thirteen out-born infants died in the NICU. Congenital anomalies contributed to death of 10 infants (77%). • Average birth weight 2,382 gms. • Average gestation 33.8 weeks. • Average age at death 10.8 days.

12. USA and Jordan Hospital NICU Comparative Survival Rate by Birth Weight (%)

13. Neonatal Mortality At Jordan HospitalMortality 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.

14. 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.

15. COST OF NEONATAL CARE

16. Cost of Neonatal Intensive CareMajor 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.

17. Cost of Neonatal Intensive CareIncidence 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.

18. Cost of Neonatal Intensive CareNICU 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.

19. Cost Of Intensive Care For Prematures In Jordan HospitalAverage Charges (JD) For All Patients By Category

20. Jordan Hospital NICUAverage Hospital Stay ( Days ) and Daily Cost (JD) by Birth Weight Groups (Gm) - All Patients

21. Cost of Neonatal Intensive Care - Jordan HospitalAverage Charges For 500-1000 Gm PatientsBy Survival

22. Cost of Neonatal Intensive Care - Jordan HospitalAverage Charges For 1000-1500 Gm PatientsBy Survival

23. Cost of Neonatal Intensive CareSummary of Survival-Cost • Survival rate for all resuscitated infants with birth weight 500-1250 gm was 65%. Survivors mean charges 7632 JD, non-survivor mean charges 5736 JD. • Three infants not resuscitated initially, but were managed later on parents request, all died, mean charges 11617 JD.

24. Cost of Neonatal Intensive CareSummary 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.

25. Jordan Estimated Cost of Neonatal Intensive CareRequirement 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.

26. Cost of Neonatal Intensive CareAffordable 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.