Neonatology has always been a bargain--even when we weren't very good at it!
OBJECTIVE
We wondered whether Neonatal Intensive Care Unit resources for Extremely Low Birth Weight infants have always been disproportionately devoted to survivors, even when ELBW infants were very likely to die.


METHODS
We documented survival and length of stay (LOS) for 2354 ELBW infants (BW 450-1000 g) admitted to the NICU at the University of Chicago between 1978 and 2003. NICU bed-days were a proxy for medical expenses.


RESULTS
Over the past 25 years, ELBW admissions have risen four-fold from 25 to 100/year, and ELBW bed-days have risen ten-fold, from 700 to 7000/year. In 1978, when ELBW mortality was 80%, only 30% of ELBW bed-days were expended on non-survivors. Currently, the percentage of ELBW non-survivor bed days (NSBD) is below 10%. Even more striking, as soon as there were any survivors with BW 450-750 g, the NSBD index fell below 30%, and settled quickly around 10%.


CONCLUSIONS
It is almost self-evident that there are no credible distributive justice arguments to deflect NICU care for ELBW infants now, when survival is so good. But, surprisingly, even when NICU survival was much worse, there have never been credible distributive justice arguments against NICU care for infants with BW <1000 g, whether dollars spent on survivors or 'intact survivors' is the outcome measure.
Buchh
Basharat
B
Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA.
Graham
Neil
N
Harris
Barbara
B
Sims
Sherrol
S
Corpuz
Maria
M
Lantos
John
J
Meadow
William
W
D002641:Chicago; D003422:Critical Care; D006785:Hospitals, University; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000941:ethics / Q000706:statistics & numerical data*; D007902:Length of Stay; D009359:Neonatology / Q000941:ethics; D040841:Resource Allocation; D012189:Retrospective Studies; D012935:Social Justice; D016019:Survival Analysis