Late-Preterm Infants Pose Significant Clinical And Economic Burden

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Main Category: Pediatrics / Children's Health
Also Included In: Public Health
Article Date: 16 Oct 2008 - 2:00 PST

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Late-preterm infants require more medical care throughout the first year of life than full-term infants, and, as a result, incur three times the cost, investigators announced at the American Academy of Pediatrics (AAP) 2008 National Conference & Exhibition.

Kimmie K. McLaurin, M.S., Manager, Health Outcomes and Pharmacoeconomics at MedImmune in Gaithersburg, Maryland, and colleagues examined the use of medical resources by late-preterm infants (infants born 33 to 35 weeks gestation) and full-term infants during the first year of life. Data for the retrospective study were drawn from a nationwide employer claims database that represents 17 million individuals in the U.S.

"Late preterm infants are often not recognized as being different than full-term infants and are therefore managed like full-term infants," McLaurin observed. "Nonetheless, there is growing evidence that late-preterm infants are at increased risk of morbidity and mortality than full-term infants."

A recent report from the Institute of Medicine called for additional research in the acute and long-term outcomes and costs for late-preterm infants, she added.

The present study included 1,683 late-preterm and 33,745 full-term infants born in 2004 who survived their first year of life. All infants had been identified by diagnosis-related group and ICD-9 codes.

Results showed that 66 percent of late-preterm infants were discharged four or more days after birth, which is defined as a late discharge. The late pre-term group had higher birth hospitalization costs ($26,054) than full-term infants ($2,087) and also had three times the medical costs throughout the first year of life ($12,247 versus $4,069 for the two groups, respectively).

The investigators also examined costs in a variety of service categories after discharge from birth. The categories included inpatient hospital, well baby physician office visits, outpatient hospital, home health/private nurse, acute care physician visits, prescription drugs, and other professional costs. For every category, late-preterm infants had substantially greater costs than full-terms infants.

The study additionally found that late-preterm infants had twice the rate of re-hospitalization as full-term infants (15.2 percent versus 7.8 percent for the two groups, respectively). The most frequent causes of re-hospitalization for late-preterm infants were respiratory syncytial virus bronchiolitis, esophageal reflux, and unspecified bronchiolitis.

"The findings are particularly important given that recent data from the National Center for Health Statistics show that late-preterm infants are the largest and fastest growing subgroup of preterm infants and currently account for 75 percent of all preterm infants," McLaurin said. "In fact, the number of late-preterm infants has increased by 25 percent since 1990 and 11 percent since 2000."

Based on the results, the researchers urged pediatricians to draw up plans for follow-up and preventive care for late-preterm infants before they are discharged after the birth admission.

The study was supported by MedImmune.

Written by Jill Steing
Jill Stein is a Paris-based freelance medical writer.
jillstein03(at)gmail.com
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