477 - Is Increased Resource Utilization Associated with Improved Neurodevelopmental Outcome in Hypoxic Ischemic Encephalopathy? A Report from the Children’s Hospitals Neonatal Consortium HIE Focus Group

Poster Number: 477
Publication Number: 477.343

Vilmaris Quinones Cardona, Drexel University College of Medicine/St Christopher’s Hospital for Children, Philadelphia, PA, United States; AMIT CHANDEL, Atrium Health Wake Forest Baptist Medical Center, Winston -Salem, NC, United States; Amy R. Distler, St. Louis Children's Hospital, St. Louis, MO, United States; Robert DiGeronimo, Seattle Children's Hospital, Seattle, WA, United States; John Flibotte, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Shannon E. Hamrick, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States; Tanzeema Hossain, Boston Children's Hospital, Boston, MA, United States; Priscilla Joe, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Yvette R. Johnson, Texas Christian University-University of North Texas Medical School, Westworth Village, TX, United States; Kyong-Soon Lee, The Hospital for Sick Children, Toronto, ON, Canada; An N. Massaro, Children's National Health System, Washington, DC, DC, United States; Ulrike Mietzsch, University of Washington School of Medicine, Seattle, WA, United States; Girija Natarajan, Central Michigan University College of Medicine, Detroit, MI, United States; Eric S. Peeples, University of Nebraska Medical Center/Children's Hospital & Medical Center, 8200 Dodge Street, NE, United States; Rakesh Rao, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States; Jeffrey S. Shenberger, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Tai-Wei Wu, Childrens hospital los angeles, keck school of medicine, Los Angeles, CA, United States; Isabella Zaniletti, Children's Hospitals Association, Lenexa, KS, United States; Maria L V. Dizon, Lurie Childrens Hospital, Chicagl, IL, United States

Background: Intercenter cost variation (ICV) exists in the medical management of neonates with hypoxic-ischemic encephalopathy (HIE). It remains unclear whether increased resource utilization, reflecting more intensive neonatal neurocritical care (NNCC) costs, translates into improved neurodevelopmental outcomes.

Objective: To determine if higher resource utilization (measured by standardized costs) is associated with survival without neurodevelopmental impairment (NDI) among infants with perinatal HIE who underwent therapeutic hypothermia (TH).

Design/Methods: Retrospective cohort analysis of patients with neonatal HIE who underwent TH in 11 regional children’s hospitals participating in the Children’s Hospital Neonatal Database (CHND) between 7/2010 and 7/2016. Infants were included if they had neurodevelopmental outcome assessments recorded at >11 months (either by Bayley III, Capute or Ireton standardized tests). NDI was defined as Bayley III Motor or Cognitive Composite Score < 85, GMFCS≥2, Capute/Ireton DQ < 70, deafness or blindness. Data was linked with Pediatric Health Information Systems to quantify standardized hospitalization and NNCC (including laboratory, EEG, neuroimaging and anti-seizure drug) costs. Univariable and multivariable (covariates: HIE severity, seizures, iNO, ECMO, gastrostomy tube, center) analyses were performed to assess the relationships between costs and outcome groups.

Results: Of the 446 infants included, 145 infants died. Among the survivors who underwent developmental assessment, 64 (21.3%) had NDI and 237 (78.7%) did not. Mild/moderate HIE severity was more common in survivors without NDI than survivors with NDI or died (p < 0.001). Survivors with NDI compared to those without NDI more often had 10-minute Apgar

≤
5 (p=0.009), longer median length of stay (p=0.027), EEG confirmed seizures at ≤3 days (p=0.044) and gastrostomy tube (p=0.019) (Table 1). Total hospitalization costs and NNCC costs per case are included in Table 2. Among NNCC costs, laboratory costs were the highest followed by EEG. Multivariable analyses showed no association between total hospitalization costs or individual NNCC costs and NDI after adjusting for the listed covariates among survivors (p >0.05).Conclusion(s): Total hospitalization and NNCC costs were similar among surviving neonates with and without NDI. The bulk of NNCC costs were related to laboratory tests and EEG monitoring, which represent modifiable practices. Future directions include analyzing ICV and cost-effective practices for optimizing survival without NDI in neonates with HIE.
Table 1. Baseline and clinical characteristics of study population
Table 2. Unadjusted costs per case in US dollars