Resource utilization and convalescent care cost in neonatal opioid withdrawal syndrome.

BACKGROUND: Neonatal opioid withdrawal syndrome (NOWS) is a growing public health problem associated with complex and prolonged medical care and a significant resource utilization burden. The objective of this study was to compare the cost of different convalescent care settings for infants with NOWS. METHODS: Retrospective comparison study of infants with NOWS discharged directly from NICU, transferred to an acute care pediatric floor (PPCU) or rehabilitation hospital (PRH). Primary outcomes were length of stay (LOS) and cost of stay (COS). RESULTS: Infants had 1.3 (95% CI: 1.1,1.6) times and 2.5 (95% CI: 2.1,3.1) times significantly longer mean LOS for PPCU and RH discharges compared to NICU discharges. NICU discharged infants had the lowest mean COS ($25,745.00) and PRH the highest ($60,528.00), despite PRH having a lower cost per day. PRH discharged infants had higher rates of methadone and benzodiazepine and less buprenorphine exposure than NICU/PPCU discharged. Infants born to mothers on marijuana and buprenorphine had a 28% lower mean COS compared to unexposed infants. Median treatment cumulative morphine doses were six-fold higher for PRH than NICU discharge. CONCLUSIONS: Infants transferred to convalescence care facilities had longer and more costly admissions and received more medication. However, there may be a role for earlier transfer of a subset of infants at-risk for longer LOS as those exposed to methadone and/or benzodiazepines. Further studies exploring differences in resource utilization, convalescent care delivery and cost expenditure are recommended.

Management of asymptomatic neonates born in the setting of chorioamnionitis: a safety comparison of the well-baby and intensive care setting.

BACKGROUND: Evaluate the safety of a change in care setting for asymptomatic neonates born to mothers with chorioamnionitis from the neonatal intensive care unit to the well baby nursery.Local problem:The neonatal intensive care unit evaluation and management of babies born to mothers with chorioamionitis often involves separation of the mother-baby dyad and more invasive interventions. METHODS: A single-center pre/post-intervention study of neonates born from January 2011 to November 2016, comparing safety outcomes in the neonatal intensive care unit (pre-intervention) and well baby nursery (post-intervention), following initiation of a triage protocol. INTERVENTIONS: A protocolized, systematic change was done in the practice location. RESULTS: Groups were similar for time to first antibiotic administration, sepsis symptom development and positive blood cultures. Length of stay (median 73.5 vs 64.4 h, P=0.0192) and % of neonates with intravenous fluid exposure (50.4% vs 7.6%, P<0.0001) were lower in the post-intervention group. Exclusive breastfeeding rates improved (pre-7.3% vs post-46.1%, P<0.0001). CONCLUSIONS: Asymptomatic neonates born to mothers with chorioamnionitis were safely treated in a well baby nursery under the guidance of a protocol for triage, thereby reducing NICU exposure for these neonates.

Scrotoschisis in a neonate with meconium peritonitis and periorchitis.

We present the case of an infant born with scrotoschisis and evidence of meconium periorchitis and peritonitis. A scrotal defect was noted with exposure of the left testis and spermatic cord. Meconium peritonitis and periorchitis were confirmed on operative exploration. Given the history, cystic fibrosis was suspected, but initial screening and diagnostic tests were negative.

Congenital hypoventilation syndrome and Hirschsprung's disease - Haddad syndrome: A neonatal case presentation.

Congenital central hypoventilation syndrome (CCHS) is an uncommon cause of apnea in the newborn characterized by the occurrence of apnea predominantly during sleep. Haddad syndrome is CCHS with Hirschsprung's disease. We report a newborn with Haddad syndrome that had a family history of spinal muscular atrophy and discuss aspects of CCHS and important considerations in the evaluation of apnea in the term newborn.

Survival and neonatal morbidity at the limits of viability in the mid 1990s: 22 to 25 weeks.

OBJECTIVE: We determined neonatal survival and morbidity rates based on both fetal (stillborn) and neonatal deaths for infants delivered at 22 to 25 weeks' gestation. STUDY DESIGN: Two hundred seventy-eight deliveries at 22 to 25 weeks' completed gestation were analyzed by gestational age groups between January 1993 and December 1997. Logistic regression models were used to identify maternal and neonatal factors associated with survival. RESULTS: The rate of fetal death was 24%; 76% of infants were born alive and 46% survived to discharge. Survival rates including fetal death at 22, 23, 24, and 25 weeks were 1.8%, 34%, 49%, and 76%; and survival rates excluding fetal death were 4.6%, 46%, 59%, and 82%, respectively. Logistic regression analyses showed that higher gestational age (P<.0002), higher birth weight (P<.001), female sex (P<.005), and surfactant (P<.003) were associated with neonatal survival. Cesarean section was associated with decreased survival (P <.006). CONCLUSION: Hospital neonatal survival rates of infants at the limits of viability are significantly lower with the inclusion of fetal deaths. This information should be considered when providing prognostic advice to families when mothers are in labor at 22 to 25 weeks' gestation.