http://www.jsonline.com/features/health/130510013.html
Empty Cradles: Confronting Our Infant Mortality Crisis
Sept. 24, 2011
[...]
The main cause of respiratory distress in premature babies is a
lack of surfactant, a natural coating that plays a vital role in
preventing the baby's air sacs from collapsing. Development of
artificial surfactant in the mid- to late 80s has had a profound
effect on infant mortality in general & respiratory distress in
specific. Surfactant lowered the odds of death for very low-birth
weight babies by 30%. The substance was solely responsible for 80%
of the decline in U.S. infant mortality between 1989-90, according
to a paper in the New England Journal of Medicine. In that single
year, infant deaths dropped by 1,300. "We know that outcomes are
certainly better than they were 20 to 30 years ago, and that's
largely because of technical advances in the NICU," said Allison
Bryant Mantha, a doctor of obstetrics/gynecology who specializes
in high-risk pregnancies at Mass General Hospital. In addition to
surfactant, Mantha cited two other factors that have increased
survival of very premature babies: improvements in ventilation for
newborns; and steroids that promote fetal lung development. In the
last half-century, medical advances helped cut the mortality rate
for low-weight babies to 55.7 deaths per 1,000 live births, about
1/3 of the 1960 rate. But the technology that's saving tiny babies
in the NICU has not come cheaply. Today, one of every 8 American
babies is premature. The annual economic cost of prematurity is at
least $26.2 billion, according to a 2006 report by the Institute of
Medicine.
That conservative estimate includes lifetime indirect costs, such
as special education and lost productivity, from four conditions
known to affect premature infants at higher rates - cerebral palsy,
mental disability, impaired vision & hearing loss. The calculation
does not include indirect costs related to lower intelligence,
learning disabilities or behavioral problems, which also occur at
higher rates among children who are born months prematurely. Still,
the estimate works out to more than $250 billion over a decade -
more than $2,000 for every single household. In the workplace,
prematurity affects one in 10 babies covered by employer health
plans, driving up birth-associated health care costs to employers
by more than 300%, according to the March of Dimes. The cost of
prematurity is borne by everyone in the form of higher insurance
premiums - and indirectly in lower wages for people who get health
benefits through an employer - and in higher taxes.
[...]