How Fetal Cocaine Exposure Increases Neonatal Hospital Costs

Author:

Behnke Marylou1,Eyler Fonda Davis1,Conlon Michael2,Casanova Olga Quiros3,Woods Nanci Stewart4

Affiliation:

1. From the Departments of Pediatrics, and

2. Biostatistics, University of Florida, Gainesville, Florida;

3. Lawnwood Regional Medical Center, Vero Beach, Florida; and

4. Department of Psychology, Austin Peay State University, Clarksville, Tennessee.

Abstract

Objective. Our goals were to document hospital costs associated with prenatal cocaine exposure in an understudied population—women using rural county public health units who had minimal access to drug rehabilitation and whose cocaine of choice was crack with little other illicit drug use—and to explore why increased costs occur in an effort to identify cost-reduction strategies. Methods. We identified a sample of cocaine-exposed infants who were computer-matched to a control group with no history or evidence of cocaine exposure. Matching was performed one-to-one on the variables of maternal race, age, parity, time of entry into prenatal care, and alcohol and nicotine use. There were 327 live births, for whom 311 were correctly classified as to their prenatal cocaine use and had billing and medical records available for review (156 exposed, 155 nonexposed). Results. Hospital charges were positively correlated with length of stay. Cocaine-exposed infants had an across-the-board increase in utilization of hospital resources as well as higher hospital charges and longer lengths of stay. Cocaine-exposed infants were significantly younger in gestational age and lower in birth weight. Significantly more cocaine-exposed infants were admitted to the neonatal intensive care unit, had more social and family problems delaying discharge, and received more septic work-ups. In addition, of those infants urine-screened for cocaine at delivery, 92% were screened secondary to a maternal history of prenatal use. Conclusions. Cost-reduction strategies should be aimed at measures that reduce length of stay by addressing problems identified prenatally as an outpatient before delivery and by influencing objective decision-making regarding the need for medical interventions with the infant after birth.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference8 articles.

1. Hospital costs for cocaine-exposed infants.;Chiu;J Florida Med Assoc.,1990

2. The cost of maternal cocaine abuse: I. Perinatal cost.;Calhoun;Obstet Gynecol.,1991

3. The neonatal costs of maternal cocaine use.;Phibbs;JAMA.,1991

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