Emmi Korvenranta

The Effect of Birth in Secondary- or Tertiary-Level Hospitals in Finland on Mortality in Very Preterm Infants: A Birth-Register Study

OBJECTIVE. Our goal was to test the hypothesis that the level of the delivery hospital affects 1-year mortality of very preterm infants in Finland. PATIENTS AND METHODS. This retrospective national medical birth-register study included 2291 very preterm infants (gestational age of <32 weeks at birth or birth weight of ≤1500 g) born in 14 level II (central) and 5 level III (university) hospitals in 2000–2003. The main outcome measures were adjusted total mortality (including stillbirths) and mortality of live-born infants until the age of 1 year. RESULTS. Both the total 1-year mortality and the 1-year mortality of live-born infants were higher in level II hospitals compared with level III hospitals. Total mortality was higher in very preterm infants who were not born during office hours. In theory, delivery of all very preterm infants in level III instead of level II hospitals translates into an annual prevention of 69 of the 170 total deaths and prevention of 18 of the 45 deaths of live-born infants. CONCLUSIONS. Resources in neonatal intensive care should be increased, especially during non–office hours, to have an equally distributed service through the 24-hour day. More efficient regionalization of very preterm deliveries may improve 1-year survival of very preterm infants in Finland.

Morbidities and Hospital Resource Use During the First 3 Years of Life Among Very Preterm Infants

OBJECTIVE: The objective of this study was to determine how the use of hospital resources during the first 3 years of life was associated with prematurity-related morbidity in very preterm infants (gestational age of <32 weeks or birth weight of <1501 g). METHODS: The study was a retrospective, national register study including all very preterm infants born alive in Finland between 2000 and 2003 (N = 2148). Infants who died before the age of 3 years (n = 264) or who had missing register data (n = 88) were excluded from the study. The relationship between 6 morbidity groups and the need for hospital care during the first 3 years of life was studied by using a negative binomial model. RESULTS: A total of 66.2% of the infants did not have any of the morbidities studied. Infants who were subsequently diagnosed as having cerebral palsy (6.1% of the study group), later obstructive airway disease (20.0%), hearing loss (2.5%), visual disturbances or blindness (3.8%), or other ophthalmologic problems (13.4%) had initial hospital stays that were a mean of 7, 8, 12, 17, and 3 days longer, respectively, than those for infants without these conditions. All morbidity groups were associated with increased numbers of hospital visits during either the second or third year of life, compared with infants without these morbidities. The need for hospitalizations and outpatient hospital care decreased with postnatal age for infants with later morbidities and for infants without later morbidities. CONCLUSIONS: Most very preterm infants born in Finland survived without severe morbidities and required relatively little hospital care after the initial discharge. However, those with later morbidities had a long initial length of stay and more readmissions and outpatient visits during the 3-year follow-up period.

Impact of Very Preterm Birth on Health Care Costs at Five Years of Age

OBJECTIVE: We assessed the effects of very preterm birth (gestational age <32 weeks or birth weight <1501 g) and prematurity-related morbidities on health care costs during the fifth year of life. METHODS: The study population consisted of 588 very preterm children and 176 term control subjects born in 2001–2002. Costs of hospitalizations, visits to health care professionals and therapists, and the use of other social welfare services were assessed during the fifth year of life. Hospital visits were derived from register data and other health care contacts, and the use of social welfare services were derived from parental reports. The effects of 6 prematurity-related morbidities (cerebral palsy [CP], seizure disorder, obstructive airway disease, hearing loss, visual disturbances or blindness, and other ophthalmologic problems) on the costs of health care were studied. RESULTS: The average health care costs during the fifth year of life were 749€ in the term control subjects, 1023€ in the very preterm children without morbidities, and 3265€ in those with morbidities. The costs of social welfare services and therapies exceeded the hospitalization costs in all groups. Among children who were born preterm, CP was associated with 5125€ higher costs, whereas later obstructive airway diseases increased the costs by 819€ compared with individuals without these morbidities. CONCLUSIONS: The health care costs during the fifth year of life in very preterm children with morbidities were 4.4-fold and in those without morbidities 1.4-fold compared with those of term control subjects. This emphasizes the importance of prevention of morbidities, especially CP, to reduce the long-term costs of prematurity.

Health-Related Quality of Life in 5-Year-Old Very Low Birth Weight Infants

OBJECTIVE To investigate the effect of preterm birth, the time of birth, and birth hospital level and district on health-related quality of life (HRQoL) and quality-adjusted life years (QALYs). STUDY DESIGN This national study included all very low birth weight infants (VLBWIs; birth weight <or= 1500 g or gestational age < 32 weeks) born in Finland between 2000 and 2003 (n = 1169; live-born, n = 900) and full-term controls (n = 368). Register data and parental questionnaires were used. The relationships among HRQoL and QALYs at age 5 years and preterm birth, time of birth, and the level and district of the birth hospital were studied. RESULTS HRQoL at age 5 years was lower and 1.3 QALYs were lost in VLBWIs compared with controls. Regional differences in the QALYs of VLBWIs were found among the 5 university hospital districts. Birth hospital level or birth outside office hours had no effect on the QALYs of live-born VLBWIs. The adjusted HRQoL total score was not affected by birth outside office hours or by the birth hospital level or district. CONCLUSIONS Differences in QALYs related to hospital district suggest variation in the care of VLBWIs that needs to be addressed.

Hospital costs and quality of life during 4 years after very preterm birth.

OBJECTIVE To evaluate the effect of gestational age and prematurity-related morbidities on hospital costs and cost per quality-adjusted life-year (QALY) during the first 4 years of life. DESIGN Population-based study using national register data and parental questionnaires. SETTING Finland. PARTICIPANTS All 2064 very preterm children (gestational age <32 weeks or birth weight <1501 g) and all 200 609 full-term control individuals (mean [SD] gestational age, 37 [0] to 41 [6] weeks) born from January 1, 2000, through December 31, 2003. MAIN EXPOSURE Prematurity. MAIN OUTCOME MEASURES Costs of hospital care and cost per QALY at 4 years of age according to gestational age and prematurity-related morbidities. RESULTS By 4 years of age, the cost per QALY for full-term controls (in 2008 currency) was euro1181 (US

Health and the use of health care services in 5-year-old very-low-birth-weight infants

1736). In very preterm children, the average cost per QALY was euro19 245 (

Differences in the length of initial hospital stay in very preterm infants

28 290), ranging from euro11 824 to euro54 324 (

PERFECT preterm infant study

17 381 to

Development and behaviour of 5-year-old very low birthweight infants

79 856) and increasing with decreasing gestational age. The cost per QALY was euro14 368 (

PERFECT - Keskoset : Hyvin ennenaikaisten keskosten hoito, kustannukset ja vaikuttavuus

21 121) for those without any of the studied morbidities and euro36 110 (