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HIGH MORTALITY AFTER DISCHARGE FROM NEONATAL ICUS.

To many, neonatal intensive-care units are a prime example of medical technology's ability to perform life- saving miracles, prolong tragedies, and generate costs. Doubts about the public health benefits of neonatal ICUs will only deepen with this follow-up report on 6190 infants who were admitted to state-funded units in Georgia from 1980 to 1982.

Of nearly 5300 infants who were discharged home, 120 died during the following year, for a mortality rate of 22.7 per 1000 discharges. This rate was more than five times the overall postneonatal mortality rate for Georgia. The most frequent causes of death included congestive heart failure (23 percent), sudden infant death syndrome (21 percent), and infection (13 percent). Race, maternal age and education, and birth weight did not significantly affect the risk of postdischarge death.

These data indicate that the apparent benefits of neonatal ICUs may fade once infants are discharged. If so, the long range costs can be expected to rise. This study does not answer the important questions of how much neonatal ICUs improve outcome and how much extra costs society must bear as a result. Instead, the study forcefully restates them and increases the importance of consideration of these issues.

— THL

Published in Journal Watch General Medicine March 31, 1989

Citation(s):

Allen DM et al. Mortality in infants discharged from neonatal intensive care units in Georgia. JAMA 1989 Mar 24 261 1763-1766.

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