Mowitz Meredith E, Ayyagari Rajeev, Gao Wei, Zhao Jing, Mangili Alexandra, Sarda Sujata P
Division of Neonatology, College of Medicine, University of Florida, Gainesville, FL, United States.
Analysis Group Inc., Boston, MA, United States.
Front Pediatr. 2019 Dec 12;7:510. doi: 10.3389/fped.2019.00510. eCollection 2019.
Infants born extremely preterm are at high risk of developing bronchopulmonary dysplasia (BPD). This study aimed to assess the incremental health care burden of BPD and associated comorbidities among extremely preterm infants in the United States. Health service claims in the Premier Perspective database were retrospectively analyzed for infants born at ≤28 weeks gestation who were admitted to neonatal intensive care during birth hospitalization and survived to a postmenstrual age of ≥36 weeks. Gestational age (GA) at birth and BPD status of infants was determined based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes recorded in the database. Of the 12,017 infants included, 4,904 (40.8%) had BPD. BPD increased with decreasing GA: 67.4% of infants born at <24 weeks GA had BPD vs. 28.7% of those born at 27-28 weeks. Infants with BPD had significantly longer hospital stays following birth than those without (mean [standard deviation (SD)] 102 [34] vs. 83 [24] days, respectively, < 0.001), and incurred higher total charges (mean [SD] $799,499 [$535,528] vs. $588,949 [$377,137], respectively, < 0.001). Mean total charges incurred during index hospitalization decreased as GA at birth increased, with GA having a bigger effect than presence or absence of BPD. During their first year, infants with BPD had a higher in-hospital late mortality rate than those without (1.9 vs. 0.6%), and were more likely to have two or more hospital encounters following birth hospitalization (58.0 vs. 48.2%). Among infants who had two or more encounters after discharge, those with BPD experienced a higher percentage of pulmonary symptoms than those without (46.3 vs. 38.9%). Comparison with infants who did not have BPD, retinopathy of prematurity, or intraventricular hemorrhage showed that BPD is the main complication contributing to increased length of stay, costs, in-hospital mortality, and additional health care encounters. BPD is a key contributor to the large health care burden associated with extremely preterm birth. However, GA at birth has a bigger effect on health care costs for extremely preterm infants than the presence of BPD.
极早产儿患支气管肺发育不良（BPD）的风险很高。本研究旨在评估美国极早产儿中BPD及相关合并症增加的医疗负担。对Premier Perspective数据库中妊娠≤28周、出生住院期间入住新生儿重症监护病房且存活至孕龄≥36周的婴儿的医疗服务索赔进行回顾性分析。根据数据库中记录的国际疾病分类第九版临床修订本（ICD-9-CM）编码确定婴儿的出生孕周（GA）和BPD状态。在纳入的12,017名婴儿中，4,904名（40.8%）患有BPD。BPD的发生率随GA的降低而增加：孕龄<24周的婴儿中67.4%患有BPD，而孕龄27-28周的婴儿中这一比例为28.7%。与未患BPD的婴儿相比，患BPD的婴儿出生后的住院时间明显更长（平均[标准差（SD）]分别为102[34]天和83[24]天，<0.001），总费用更高（平均[SD]分别为799,499美元[535,528美元]和588,949美元[377,137美元]，<0.001）。出生时的GA越高，首次住院期间的平均总费用越低，GA对费用的影响比是否患有BPD更大。在出生后的第一年，患BPD的婴儿住院晚期死亡率高于未患BPD的婴儿（1.9%对0.6%），出生住院后更有可能有两次或更多次住院经历（58.0%对48.2%）。在出院后有两次或更多次住院经历的婴儿中，患BPD的婴儿出现肺部症状的比例高于未患BPD的婴儿（46.3%对38.9%）。与未患BPD、早产儿视网膜病变或脑室内出血的婴儿相比，BPD是导致住院时间延长、费用增加、住院死亡率升高和额外医疗服务的主要并发症。BPD是与极早产相关的巨大医疗负担的关键因素。然而，出生时的GA对极早产儿医疗费用的影响比是否患有BPD更大。
