P1.211: Trends in Mortality and Resource Utilization Among Extremely Low Birth Weight Neonates in the United States

Background: Extremely Low Birth Weight (ELBW) neonates, defined as infants born weighing < 1000 grams, present significant challenges for neonatal care. Despite medical advancements, these infants are still at high risk for mortality, health complications, and increased healthcare use. Understanding trends related to their outcomes and resources used is important for shaping clinical practices and healthcare policy decisions.

Methods: This study analyzed data from the National Inpatient Sample for the years 2016 to 2022, focusing on all live births and specifically on those classified as ELBW. We calculated the annual incidence of ELBW and evaluated trends using the Cochran-Armitage trend test. Analysis of ELBW cases included assessments of mortality rates, comorbidities, and the extent of healthcare use. Hospital costs were adjusted to 2022 values using the Consumer Price Index.

Results: Out of 25,092,952 live births, 133,300 (531 per 100,000) were identified as ELBW. The incidence of ELBW declined from 553/ 100,000 in 2016 to 508/ 100,000 in 2022 ( p< 0.01. Compared to non-ELBW infants, ELBW infants had higher rates of prematurity (17.4% vs. 8.8%), multiple births (21.4% vs. 3.1%), chromosomal anomalies (0.9% vs. 0.2%), and congenital heart defects such as atrial septal defect (28.3% vs. 1.6%), ventricular septal defect (3.1% vs. 0.5%), and Tetralogy of Fallot (0.14% vs. 0.04%) (all p< 0.01). The majority of ELBW births came from the lowest income quartile (36.7%). Neonatal sepsis was present in 25.0% of ELBW cases. The average hospital stay and the mortality rate for ELBW infants were 56.1 days and 27.4%, compared to 3.2 days and 0.1% for non-ELBW infants (p < 0.01). Mortality rates decreased from 28.3% in 2018 to 25.3% in 2021, with a slight increase to 26.8% in 2022. Hospital costs peaked in 2020 and slightly decreased thereafter. Total costs over the study period amounted to $21.8 billion, averaging $3.1 billion per year.

Conclusion: While there have been modest improvements in the incidence and mortality rates of ELBW infants, they continue to experience significant complications prolonging hospital stay, and high healthcare costs. Ongoing efforts to implement preventive strategies and optimize resource utilization are crucial for improving outcomes in this vulnerable population.