OUTCOME OF INFANTS BORN AT 24-26 WEEKS GESTATION .1. SURVIVAL AND COST

Objective: To determine neonatal survival, short-term morbidities, and cost per survivor in pregnancies delivered at 24-26 weeks' gestation in a center in which antenatal steroids and exogenous surfactant are s tandard care. Methods: A retrospective cohort study compared survival, short-term outcome, and initial hospital charges for pregnancies deli vered at 24-26 weeks during 1990-1994. We calculated hospital costs fo r each year by using the corresponding institutional cost-charge ratio . Results: There were 138 infants after excluding those with severe an omalies. Survival was 43%, 74%, and 83% at 24, 25, and 26 weeks, respe ctively (P = .006). The majority of women received antenatal steroids, and the majority of surviving neonates received exogenous surfactant. Severe retinopathy of prematurity and chronic lung disease decreased significantly from 24 to 26 weeks (P less than or equal to .026). The likelihood of having a surviving infant without chronic lung disease o r severe retinopathy of prematurity was 35% at 24 weeks and 78% at 26 weeks. Hospital costs for the 29 nonsurvivors were $1.46 million and f or the 94 surviving infants were $16.9 million. The cost per day was s imilar at each gestational age, whereas the cost to produce a survivor was $294,749, $181,062, and $166,215 at 24, 25, and 26 weeks, respect ively. Conclusion: Survival at 24 weeks was only 43% despite treatment with antenatal steroids and exogenous surfactant. The cost per surviv or for infants born at 24 weeks was higher than the cost for those bor n after 1 more week in utero. Outcome improved markedly between 24 and 26 weeks, and small differences in gestational age lead to large econ omic differences. All efforts should be attempted to prolong pregnancy , and if prolongation is unsuccessful, treatment options including non intervention should be available to parents of 24-week gestations. (C) 1997 by The American College of Obstetricians and Gynecologists.