Delivery in a tertiary care perinatal center reduces neonatal intensive care costs

We retrospectively analyzed medical records and inpatient hospital bills for 191 infants with birth weights of 1750 grams or less who were admitted to the St. Paul Children's Hospital Newborn Intensive Care Unit between July 1, 1981, and June 30, 1983. Ninety were born in the United-Children's Hospitals Perinatal Center (inborn); 101 were born in hospitals without tertiary care facilities and transferred (outborn). Eighty-eight of 101 outborn patients were born within the seven-county Twin Cities metropolitan area - most within St. Paul. Birth weight, gestational age, and Apgar scores were similar. Although there was no difference in mortality between the groups, respiratory compromise was less common in the inborn patients (P <0.01). Hospital costs were significantly less for inborn patients (inborn mean $38,964; outborn mean $49,118; P <0.05). Catastrophic hospital bills were also less common in the inborn patients. Fourteen of 15 patients whose hospital bills exceeded $100,000 were born outside the perinatal center (P < 0.01). We conclude that even within an affluent, medically sophisticated metropolitan community, low birth weight neonates should be delivered in tertiary care perinatal centers. Such a policy is medically and fiscally superior to their postnatal transfer.