title: The epidemic of multiple gestations and neonatal intensive care unit use: the cost of irresponsibility.
abstract: OBJECTIVE
  To determine the proportion of infants admitted to our neonatal intensive care unit (NICU) from multiple gestations resulting from artificial reproductive technology (ART), the complications experienced and interventions required by these infants, and the estimated effect of a mandatory policy of single embryo transfer on admissions and complication rates in our hospital and across Canada.
  
  
  METHODS
  We conducted a review of a prospectively maintained database and of hospital records and calculated excess complications compared with either universal single embryo transfer or a policy allowing transfer of two embryos in as many as 33% of women.
  
  
  RESULTS
  Of our NICU admissions, 17% are infants from multiple gestations after ART, a significant increase in 10 years. In a 2-year period, the excess NICU use that would have been saved by mandatory single embryo transfer included 3082 patient days and 270 patient ventilator days. Extrapolated across Canada, a policy of single embryo transfer would prevent 30 to 40 deaths, 34 to 46 severe intracranial haemorrhages, and 13 to 19 retinal surgeries annually. Savings in NICU resources would be 5424 to 7299 patient-days of assisted ventilation and 35 219 to 42 488 patient-days of NICU care.
  
  
  CONCLUSIONS
  A mandatory policy of single embryo transfer would be of substantial benefit to the health of Canadian babies while still benefiting infertile couples.
authors.affiliation: Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Janvier
authors.forename: Bridget
authors.initials: B
authors.lastname: Spelke
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Barrington
mesh_terms: D000328:Adult; D002170:Canada; D016208:Databases, Factual; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006291:Health Policy; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D018529:Nutritional Support / Q000706:statistics & numerical data; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D011247:Pregnancy; D011272:Pregnancy, Multiple; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012178:Retinopathy of Prematurity / Q000453:epidemiology / Q000601:surgery; D014310:Triplets; D014427:Twins