title: The prediction and cost of futility in the NICU.
abstract: OBJECTIVE
  To quantify the cost and prediction of futile care in the Neonatal Intensive Care Unit (NICU).
  
  
  METHODS
  We observed 1813 infants on 100,000 NICU bed days between 1999 and 2008 at the University of Chicago. We determined costs and assessed predictions of futility for each day the infant required mechanical ventilation.
  
  
  RESULTS
  Only 6% of NICU expenses were spent on nonsurvivors, and in this sense, they were futile. If only money spent after predictions of death is considered, futile expenses fell to 4.5%. NICU care was preferentially directed to survivors for even the smallest infants, at the highest risk to die. Over 75% of ventilated NICU infants were correctly predicted to survive on every day of ventilation by every caretaker. However, predictions of 'die before discharge' were wrong more than one time in three. Attendings and neonatology fellows tended to be optimistic, while nurses and neonatal nurse practitioners tended to be pessimistic.
  
  
  CONCLUSIONS
  Criticisms of the expense of NICU care find little support in these data. Rather, NICU care is remarkably well targeted to patients who will survive, particularly when contrasted with care in adult ICUs. We continue to search for better prognostic tools for individual infants.
authors.affiliation: Department of Pediatrics, Maclean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL 60637, USA. wlm1@uchicago.edu
authors.forename: William
authors.initials: W
authors.lastname: Meadow
authors.forename: Sally
authors.initials: S
authors.lastname: Cohen-Cutler
authors.forename: Bridget
authors.initials: B
authors.lastname: Spelke
authors.forename: Anna
authors.initials: A
authors.lastname: Kim
authors.forename: Melissa
authors.initials: M
authors.lastname: Plesac
authors.forename: Kirsten
authors.initials: K
authors.lastname: Weis
authors.forename: Joanne
authors.initials: J
authors.lastname: Lagatta
mesh_terms: D001291:Attitude of Health Personnel; D002641:Chicago; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000191:economics*; D018447:Medical Futility; D011379:Prognosis; D012121:Respiration, Artificial / Q000191:economics*