Pediatrics
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Comparative Study
Restricting access to neonatal intensive care: effect on mortality and economic savings.
Neonatal intensive care for very low birth weight (VLBW) infants is expensive, and cost-containment policies have been proposed that would restrict care according to birth weight. We examined the potential reduction in neonatal intensive care unit (NICU) VLBW charges and the impact on survivors if care were not offered to infants of extremely low birth weights or gestational ages. ⋯ To attain significant reduction in NICU charges, policies offering care to the larger or more mature VLBW infants only will result in denying care to many infants who would otherwise survive.
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The efficiency and access to existing perinatal resources has become a focus of debate. Despite inconsistent references to the number of neonatologists and unsubstantiated personnel requirement recommendations, recent commentaries have suggested a current 30% to 50% excess in workforce. ⋯ Significant discrepancies between earlier projected neonatologist requirements and current neonatology workforce and service responsibilities are discussed in relation to demands of reallocation of subspecialty resources within an evolving health care system.