Yousef K. Abu-Osba, M.D.

1
VLBW NEWBORN RESUSCITATION PROS AND CONS

• Yousef K. Abu-Osba, M.D.
• Neonatal Intensive Care, Jordan Hospital
• Amman, Jordan

2
Perinatal Statistics in 12 Hospitals, Jordan
(1995)
Low Birth Weight Survey MOH, Jordan Samir
Faouri et al
3
Low Birth Weight Newborns lt 2500Neonatal
Survival
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Perinatal Statistics Survey in 12 Hospitals in
Jordan (1995)Percentage of Neonatal Deaths by
Birth Weight
Low Birth Weight Survey MOH, Jordan Samir
Faouri et al
5
Perinatal Statistics Survey in 12 Hospitals in
Jordan (1995)Major Causes of Neonatal Deaths ()
Low Birth Weight Survey MOH, Jordan Samir
Faouri et al
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NEONATAL MORTALITY AT JORDAN HOSPITAL
7
Jordan Hospital Neonatal Mortality Inborn
Deliveries

• Total number of live births during the three
  years were 4116 newborns.
• Total number of admissions (including inborn, in
  utero transfer, and transferred neonates) to NICU
  were 811 patients.
• Total number of NICU inborn admission deaths were
  51 patients. Average gestational age was 30.74
  weeks, birth weight 1,551 gm, age at death 13.3
  days.
• Uncorrected Neonatal Mortality 12.3/1000
  deliveries
• Total number of NICU out-born admission deaths
  were 13 patients. Average gestational age was
  33.77 weeks, birth weight 2,382 gm, age at death
  10.8 days.

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Neonatal Mortality At Jordan Hospital Causes of
Death of Inborn NB Congenital Anomalies

• Congenital anomalies contributed to death of 16
  infants (30).
• Average gestational age was 35.33 weeks
• Average birth weight 2,218 gm.
• All died within the neonatal period. Average age
  at death 3.13 days

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Neonatal Mortality At Jordan Hospital Causes of
Death of Inborn NB Complications
Major medical problems that contributed to the
death of the other 35 infants (70) were

• Average gestational age was 28.59 weeks,
• Average birth weight 1,265 gm,
• Average age at death 17.66 days.

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Neonatal Mortality At Jordan Hospital Inborn
Causes of Death Abandoned Neonates

• Three newborns were not resuscitated actively
  after delivery but had full support later and
  survived for 14, 22 and 35 days.
• Birth weight was 1450 gm, 700 gm and 650 gm, and
  gestation was 27, 23, and 23 weeks respectively.
  
• Hospital cost mean charges was US 16,596.

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Neonatal Mortality At Jordan Hospital Causes of
Death of Out-born NB
Thirteen out-born infants died in the NICU.
Congenital anomalies contributed to death of 10
infants (77).

• Average birth weight 2,382 gms.
• Average gestation 33.8 weeks.
• Average age at death 10.8 days.

12
USA and Jordan Hospital NICU Comparative
Survival Rate by Birth Weight ()
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Neonatal Mortality At Jordan Hospital Mortality
Summary

• Neonatal mortality at Jordan Hospital (as a
  tertiary center with a high percentage of high
  risk pregnancies) is relatively low, corrected
  neonatal mortality was 5.8/1000 deliveries.
• RDS, sepsis and major congenital anomalies are
  the major causes of death.
• Financial limitations of use of surfactant and
  other expensive drugs, as well as unaffordable
  cost for corrective surgery is a major factor of
  death.

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What is needed .?

• Appropriate and adequate care for the mother, the
  fetus, and the neonate
• Appropriate and adequate conditions must be
  fulfilled
• Transparent annual perinatal statistics.
• Training for health care providers.
• Education for the public.
• Physical facilities.
• Trained staff.
• Follow up programs.

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COST OF NEONATAL CARE
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Cost of Neonatal Intensive CareMajor
Neurodevelopmental Sequelae of Prematures

• Major complications which may be evident at 1-2
  years of age
• Cerebral palsy
• Developmental retardation
• Sensorineural hearing loss
• Blindness
• Hydrocephalus
• Chronic lung disease.

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Cost of Neonatal Intensive Care Incidence of
Major Neurodevelopmental Sequelae of Prematures

• Infants weighing lt 1,500 gm ranges from 5 to
  10.
• Infants weighing lt 1,000 gm ranges from 10 to
  20.
• Infants weighing lt 750-800 gm ranges from 10 to
  40.
• Infants weighing lt 1,500 gm 80-95 are free of
  major sequelae.
• Infants weighing lt 1,000 gm 70-80 are free of
  major sequelae.
• Less than 50 of infants weighing lt 600 gm or
  23-24 weeks gestation are free of major sequelae.

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Cost of Neonatal Intensive CareNICU Charges for
Prematures In USA

• Mean charges per survivor for infants weighing
  lt 1000 gm US 250,654.
• Mean charges per survivor for infants weighing
  1,000 -1,500 gm 74,101.
• Nonsurvivors median charges 10,706 with a
  median stay of 2 days 5,353 per day.

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Cost Of Intensive Care For Prematures In Jordan
Hospital Average Charges (JD) For All Patients
By Category
20
Jordan Hospital NICUAverage Hospital Stay ( Days
) and Daily Cost (JD) by Birth Weight Groups (Gm)
- All Patients
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Cost of Neonatal Intensive Care - Jordan Hospital
Average Charges For 500-1000 Gm Patients By
Survival
22
Cost of Neonatal Intensive Care - Jordan Hospital
Average Charges For 1000-1500 Gm Patients By
Survival
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Cost of Neonatal Intensive CareSummary of
Survival-Cost

• Survival rate for all resuscitated infants with
  birth weight 500-1250 gm was 65. Survivors mean
  charges 7632 JD, non-survivor mean charges 5736
  JD.
• Three infants not resuscitated initially, but
  were managed later on parents request, all died,
  mean charges 11617 JD.

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Cost of Neonatal Intensive CareSummary of
Survival-Cost

• Average charges for all patients was 139 JD per
  day, and average total charges was 1046 JD.
• Average hospital stay for all patients was 5.7
  days.

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Jordan Estimated Cost of Neonatal Intensive
CareRequirement for Neonatal Intensive/
Intermediate Care

• 150,000 newborns are delivered in Jordan.
• About 15,000 infants will require intensive/
  intermediate care.
• Estimated national cost for neonatal care for all
  infants is about 15,000 X 1,046 15,690,000 JD
• Estimated hospital days needed for NICU care for
  all infants is about 15,000 X 5.7 85500
  hospital days. Approximately 240-250 beds NICU
  and Intermediate Care are needed.

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Cost of Neonatal Intensive CareAffordable Price
for Jordan

• 15,690,000 JD per year
• OR
• 85,500 hospital days
• 240-250 NICU and Intermediate Care beds
• A cheap and affordable price for giving
  optimal care for our future generations. Any
  community can determine its own death rate.