title: Economic and health consequences of non-invasive respiratory support in newborn infants: a difference-in-difference analysis using data from the Norwegian patient registry.
abstract: BACKGROUND
  Newborn infants with respiratory failure are often treated with intubation and mechanical ventilation for prolonged periods of time. Our objective was to evaluate whether increasing use of non-invasive respiratory support in newborn infants can improve patient health and reduce costs.
  
  
  METHODS
  We utilized a natural experiment that took place in October 2008 when a large neonatal intensive care unit in Norway moved into a new hospital building with new medical equipment. A change in respiratory support towards increasing use of nasal biphasic positive airway pressure (n-BiPAP) instead of invasive mechanical ventilation treatment followed the acquisition of the new equipment. We used a difference-in-difference method and data from the Norwegian National Patient Registry to assess morbidity, mortality, number of hospital days and hospital costs in our unit following this change. We stratified the results according to gestational age groups.
  
  
  RESULTS
  We found a reduction in morbidity including bronchopulmonary dysplasia, retinopathy of prematurity and intraventricular hemorrhage. No change in mortality was found. We found a reduction in number of hospital days and hospital costs for preterm infants with gestational age <28 weeks and for term infants with diagnoses affecting respiration.
  
  
  CONCLUSIONS
  We conclude that increasing use of n-BiPAP may improve health and reduce costs. However, more research is needed to establish best practice. Comparing hospitals where treatment practices change to hospitals where the same change does not occur may be a useful way to evaluate the efficacy of such a change, especially when hospitals can be studied over time.
authors.affiliation: The Health Services Research Centre HØKH, Akershus University Hospital, Lørenskog, Norway. Inger.Cathrine.Kann@ahus.no.
authors.forename: Inger Cathrine
authors.initials: IC
authors.lastname: Kann
authors.affiliation: The Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway. a.l.solevag@medisin.uio.no.
authors.forename: Anne Lee
authors.initials: AL
authors.lastname: Solevåg
mesh_terms: D000367:Age Factors; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009017:Morbidity; D063087:Noninvasive Ventilation / Q000191:economics*; D009664:Norway; D012042:Registries / Q000706:statistics & numerical data; D012127:Respiratory Distress Syndrome, Newborn / Q000191:economics* / Q000628:therapy*