Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr. 2022 Jun;245:72-80.e6. doi: 10.1016/j.jpeds.2022.02.055. Epub 2022 Mar 16.
To describe the trend in costs over 10 years for tertiary-level neonatal care of infants born 22-28 weeks of gestation during an ongoing Canadian national quality improvement project.
Clinical characteristics, outcomes, and third-party payor costs for the tertiary neonatal care of infants born 22-28 weeks of gestation between the years 2010 and 2019 were analyzed from the Canadian Neonatal Network database. Costs were estimated using resource use data from the Canadian Neonatal Network and cost inputs from hospitals, physician billing, and administrative databases in Ontario, Canada. Cost estimates were adjusted to 2017 Canadian dollars (CAD). A generalized linear mixed-effects model with gamma regression was used to estimate trends in costs.
Between 2010 and 2019, the number of infants born <24 weeks of gestation increased from 4.4% to 7.7%. The average length of stay increased from 68 days to 75 days. Unadjusted average ± SD total costs per neonate were $120 717 ± $93 062 CAD in 2010 and $132 774 ± $93 161 CAD in 2019. After adjustment for year, center, and gestation, total costs and length of stay increased significantly, by $13 612 CAD (P < .01) and 8.1 days (P < .01) over 10 years, respectively; whereas costs accounting for LOS remained stable.
The total costs and length of stay for infants 22-28 weeks of gestation have increased over the past decade in Canada during an ongoing national quality improvement initiative; however, there was an increase in the number and survival of neonates at the age of periviability.
在加拿大持续进行的国家质量改进项目中，描述 22-28 孕周早产儿在三级新生儿护理中 10 年的成本趋势。
从加拿大新生儿网络数据库中分析了 2010 年至 2019 年期间 22-28 孕周出生婴儿的三级新生儿护理的临床特征、结局和第三方支付者成本。使用来自加拿大新生儿网络的资源使用数据以及安大略省医院、医生计费和行政数据库的成本投入来估计成本。成本估计调整为 2017 年加元（CAD）。使用具有伽马回归的广义线性混合效应模型来估计成本趋势。
2010 年至 2019 年间，<24 孕周出生婴儿的数量从 4.4%增加到 7.7%。平均住院时间从 68 天增加到 75 天。未经调整的每位新生儿的平均±SD 总费用在 2010 年为 120717 美元±93062 CAD，在 2019 年为 132774 美元±93161 CAD。在调整年份、中心和胎龄后，总费用和住院时间分别显著增加 13612 CAD（P<.01）和 8.1 天（P<.01），而与 LOS 相关的成本保持稳定。
在加拿大持续进行的国家质量改进计划中，22-28 孕周婴儿的总费用和住院时间在过去十年中有所增加；然而，围生期前的新生儿数量和存活率有所增加。
