Neonatal intensive care and cost effectiveness.

During the past decade the rate of death among newborns weighing less than 1500 g at birth has decreased by approximately half. This dramatic reduction has resulted from the application of research findings and technologic advances, but it has proved expensive. Perhaps as a consequence of articles demonstrating the costs as well as the recognition that the overall prevalence of disabilities in infants is relatively unchanged, neonatal intensive care has recently been viewed as a possible area for cost containment. We reviewed the literature on the cost of neonatal intensive care and the limited information on other expensive medical programs and found that the cost of neonatal intensive care compared favourably, especially for infants whose birth weight was 1000 to 1500 g. Better information on the outcome of infants of very low birth weight and comparable rigorous studies of the cost effectiveness of other expensive medical programs are required, and other less easily quantified factors must be considered before decisions are made to limit neonatal intensive care on the basis of gestational age or birth weight.