Resource utilization patterns using non-invasive ventilation in neonates with respiratory distress syndrome

Thomas A Chavez; Ashwini Lakshmanan; Lizzette Figueroa; Narayan Iyer; Theodora A Stavroudis; Arlene Garingo; Philippe S Friedlich; Rangasamy Ramanathan

doi:10.1038/s41372-018-0122-y

Resource utilization patterns using non-invasive ventilation in neonates with respiratory distress syndrome

J Perinatol. 2018 Jul;38(7):850-856. doi: 10.1038/s41372-018-0122-y. Epub 2018 May 24.

Authors

Thomas A Chavez¹, Ashwini Lakshmanan^{2

3

4}, Lizzette Figueroa¹, Narayan Iyer¹, Theodora A Stavroudis¹, Arlene Garingo¹, Philippe S Friedlich¹, Rangasamy Ramanathan^{1

5}

Affiliations

¹ Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
² Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. alakshmanan@chla.usc.edu.
³ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. alakshmanan@chla.usc.edu.
⁴ Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States. alakshmanan@chla.usc.edu.
⁵ Division of Neonatology, Department of Pediatrics, LAC USC Medical Center, University of Southern California, Los Angeles, CA, USA.

Abstract

Objectives: To describe the frequency of non-invasive ventilation (NIV) and endotracheal intubation use in neonates diagnosed with respiratory distress syndrome (RDS); to describe resources utilization (length of stay (LOS), charges, costs) among NIV and intubated RDS groups.

Study design: Retrospective study from the national Kid's Inpatient Database of the Healthcare Cost and Utilization Project, for the years 1997-2012. Propensity scoring and multivariate regression analysis used to describe differences.

Results: A total of 595,254 out of 42,912,090 cases were identified with RDS. There was an increase in NIV use from 6% in 1997 to 17% in 2012. After matching, patients receiving NIV only were associated with shorter LOS: (95%CI) 25 (25.3,25.7) vs. 35 (34.2,34.9) days, decreased costs: ($/1k) 46.1 (45.5,46.8) vs. 65.0 (64.1,66.0), decreased charges: 130.3 (128.6,132.1) vs. 192.1 (189.5,194.6) compared to intubated neonates.

Conclusion: There was a three-fold increase in NIV use within the 15-year study period. NIV use was associated with decreased LOS, charges and costs compared to intubated patients.

Publication types

Comparative Study
Research Support, N.I.H., Extramural

MeSH terms

Cohort Studies
Cost Savings
Databases, Factual
Female
Health Resources / economics
Hospital Costs*
Hospitals, Pediatric
Humans
Infant, Newborn
Infant, Premature*
Intensive Care Units, Neonatal / economics
Intubation, Intratracheal / economics*
Intubation, Intratracheal / methods
Length of Stay / economics
Linear Models
Los Angeles
Male
Multivariate Analysis
Noninvasive Ventilation / economics*
Noninvasive Ventilation / methods*
Noninvasive Ventilation / mortality
Propensity Score
Respiratory Distress Syndrome, Newborn / economics
Respiratory Distress Syndrome, Newborn / mortality
Respiratory Distress Syndrome, Newborn / therapy*
Retrospective Studies

Grants and funding

KL2 TR001854/TR/NCATS NIH HHS/United States