HOW FETAL COCAINE EXPOSURE INCREASES NEONATAL HOSPITAL COSTS

Objective. Our goals were to document hospital costs associated with p renatal cocaine exposure in an understudied population - women using r ural county public health units who had minimal access to drug rehabil itation and whose cocaine of choice was crack with little other illici t drug use - and to explore why increased costs occur in an effort to identify cost-reduction strategies. Methods. We identified a sample of cocaine-exposed infants who were computer-matched to a control group with no history or evidence of cocaine exposure. Matching was performe d one-to-one on the variables of maternal race, age, parity, time of e ntry into prenatal care, and alcohol and nicotine use. There were 327 live births, for whom 311 were correctly classified as to their prenat al cocaine use and had billing and medical records available for revie w (156 exposed, 155 nonexposed). Results. Hospital charges were positi vely correlated with length of stay. Cocaine-exposed infants had an ac ross-the-board increase in utilization of hospital resources as well a s higher hospital charges and longer lengths of stay. Cocaine-exposed infants were significantly younger in gestational age and lower in bir th weight. Significantly more cocaine-exposed infants were admitted to the neonatal intensive care unit, had more social and family problems delaying discharge, and received more septic work-ups. In addition, o f those infants urine-screened for cocaine at delivery, 92% were scree ned secondary to a maternal history of prenatal use. Conclusions. Cost -reduction strategies should be aimed at measures that reduce length o f stay by addressing problems identified prenatally as an outpatient b efore delivery and by influencing objective decision-making regarding the need for medical interventions with the infant after birth.