NK Ho

The cost of neonatal care, in particular intensive care, can be enormous. Most problems in neonatal care come from premature infants. The smaller the baby is or the lower the gestational age, the longer the hospitalization and the higher the expenditures will be. This will have a significant impact on the national resource utilization.

Physicians can help to reduce the costs of neonatal care. They should consider a lower limit, below which no resuscitation should be done for small newborns. Some criteria may be required for withholding and withdrawal of treatment.

Medical and technological advances have helped to keep the small infants alive. Nevertheless, associated problems still occur. Medical technology unfortunately does not always produce more efficient operations and often adds to existing systems rather than replacing them. Physicians are always tempted to use newer technologies where available. Sadly, doctors may forego their acquired experience when a new machine arrives. They have to relearn new skills. Not all the new and expensive ventilatory equipment is superior. Simple assisted ventilatory procedures, such as nasal continuous positive airway pressure, continue to be useful. Many unnecessary investigations have been ordered. Physicians should be well informed about the costs of medications. Expensive drugs, the effect of which is only marginally better than that of the cheaper ones, should be reconsidered. Povidone iodine, magnesium sulphate, enteral indomethacin and even bovine lung extract surfactants are preferred to silver nitrate, tolazoline, intravenous indomethacin, and other biological and synthetic exogenous surfactants. Antenatal care can help prevent the expense of the neonatal intensive care unit after deliveries and the lifetime expense of poor health, including poor neurodevelopmental outcome, that accompanies a premature baby. Prevention of premature births should be the primary goal in neonatal management. Antenatal corticosteroid is a cheaper way of reducing the mortality and the frequency of respiratory distress, and is feasible in developing countries. Regionalization of neonatal care pools the resources cost effectively. Transfer of high-risk pregnant mothers, or transfer in utero, to the regional centres should be encouraged; however, a trend of deregionalization has been observed recently. Nosocomial neonatal infections account for a huge expenditure on antibiotics. Hand-washing and aseptic methods should be strictly observed. Recently, a programme for early discharge of high-risk infants from the neonatal intensive care unit has been introduced; this has led to a decrease in hospital charge without causing excessive morbidity. Also, is there a role for neonatal nurse practitioners in developing countries?