Study data clearly demonstrate the effects of prematurity and low birth weight on health care charges, showing that the charges for initial hospitalizations increased as birth weights and gestational ages decreased.
Mean hospital charges ranged from $5,816 for infants born at normal weight (including one infant with complications who incurred a charge of $57,537) to $205,204 for the 1,250-g-or-less group (including an infant with lower charges who died at 18 days).
A similar picture is seen when comparing charges across gestational ages. Mean hospital charges ranged from $4,788 for those born after 37 or more completed weeks of gestation to $239,749 for infants born between 26 and 28 weeks’ gestation. These findings are consistent with those reported previously.1–4,6–8
Previous research on acute care visits and rehospitalization of low-birth-weight infants in the first year of life indicates that such infants have a higher rate of rehospitalization and acute care visits than normal-weight infants. In this study, 22% of normal-weight infants were rehospitalized in the first year of life, compared with 31 % of low-birth-weight infants, and 23% of full-term infants were hospitalized, compared with 27% of infants born preterm, although neither difference was statistically significant. These findings are similar to those of McCormick and colleagues.16
This analysis also indicated a higher rate of acute care visits in full-term infants (67%), compared with preterm infants (54%), and a higher rate of acute care visits in normal-weight infants (69%) than in low-birth-weight infants (45%). The latter difference, which was statistically significant, may be due to the fact that lower-birth-weight infants are seen more frequently for regularly scheduled visits because of their high-risk status. Also, parents of normal-birth-weight infants may be anxious to have their infants seen by health care providers. Normal-weight infants aren’t routinely seen as often as low-birth-weight or preterm infants. Another possibility is that a larger proportion of normal-birth-weight and full-term infants may be enrolled in family or organized day care, where they come into contact with other children, resulting in more upper respiratory and ear infections.
This study clearly demonstrates that even small increases in gestational age at birth and in birth weight result in cost savings for the initial hospital stay and fewer rehospitalizations in the first year of life. The rates of preterm births and low-birth-weight births as percentages of all births have increased over the past decade.4
Advances in prenatal and neonatal care have resulted in more infants surviving at increasingly shorter gestations, increasing health care costs. Interventions to improve prenatal care targeted to women at high risk for delivering preterm or low-birth-weight infants might not only reduce health care costs, but might improve health outcomes of infants as well.15
Maternal conditions, such as infection, hypertension, diabetes, and history of preterm birth, and behaviors associated with poor health, such as smoking, inadequate nutrition, and substance abuse, are strongly associated with low birth weight.4
With adequate prenatal care, high-risk physiologic conditions and behaviors can be monitored and treated. In 2000 data indicated that the proportion of pregnant women who received timely prenatal care was improving because of aggressive outreach programs and alternative methods of prenatal care delivery such as off-site clinics and mobile vans. However, despite these efforts, in 2003, 3.5% of all mothers received late or no prenatal care.4
Many women receive inadequate prenatal care because of a lack of child care or transportation, long waiting periods in a provider’s office or clinic, and other financial and personal hurdles. Waiting times in one study averaged 3.22 hours, while provider time often is as little as five minutes.17
Pregnant women at high risk for delivering low-birth-weight infants are often seen very frequently, increasing these difficulties. Reducing the number of preterm and low-birth-weight births will require more comprehensive education of infertile couples who seek technologic solutions to their infertility, and better application of that technology by providers. Local, regional, and national efforts to improve the education of childbearing couples and those considering becoming pregnant, as well as efforts to reduce barriers to care, could reduce initial health care costs associated with preterm and low-birth-weight infants. Such efforts should also pay dividends by reducing health care and educational costs in the longer term for these children and their families.