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Levels of Neonatal Care at Birth Hospital Don’t Affect Severity of Cerebral Palsy

Feb. 15, 2017

The implementation of new medical technology in neonatal care is associated with improved neonatal outcomes… and growing healthcare costs.

The level of technology available at birth determines the type of therapy newborns receive, which is critical to treat adverse events around labor and delivery. For Economics Clinical Assistant Professor Corneliu Bolbocean, this provided a research opportunity.

According to Bolbocean, the assessment of long-term impacts is necessary to weigh the value of increased medical innovation in neonatal-perinatal care against its costs.

In particular, his article, "Perinatal Regionalization and Implications for Long-Term Health Outcomes in Cerebral Palsy," which was published in the Canadian Journal of Neurological Sciences," evaluates the impact of the perinatal-neonatal level of care and technology on the long-term health outcomes of children with Cerebral Palsy (CP) within the Canadian healthcare system.

"There are growing concerns about the high costs of neonatal intensive care, as well as the substantial financial burden survivors of neonatal intensive care might pose on their families and healthcare system," Bolbocean said. "While the overall efficacy of specific advances in neonatal-perinatal medicine has been established in the literature, limited evidence exists on the overall effectiveness of technological change in neonatal care and particularly its impact on long-term health outcomes."

The study compared the availability of the three levels of neonatal care (Level I, II and III) in Canada with CP non-ambulatory status.

The researchers found the differences in the levels of care at birth sites, and associated complexity of available neonatal-perinatal technology, are not associated with differences in eventual CP severity.

"Our research provides evidence that level of care at birth hospital does not prevent the incidence of the most severe and costliest CP outcomes," he said. "Our main result was surprising, as it goes against the conventional wisdom. This means that increasing the level of care at delivery hospital is unlikely to prevent the incidence of the most severe and costliest CP outcomes."

The preliminary estimates suggest a total of $36 million in savings to the Canadian healthcare system if CP-related births were transferred to hospitals with advanced neonatal care, only if necessary. The research suggests secondary efforts should focus on prenatal services, and, in particular, interventions designed to reduce the incidence of risk factors leading to severe CP outcomes.

"My vision is to make pediatric healthcare more efficient and focused on reducing the early life deficits. It is essential to advance our understanding of how to create environments that mitigate differences in early life health outcomes, skills and abilities that decrease social productivity and increase overall societal costs. I am passionate, in particular, to study children with neurodevelopmental disorders, as they are extremely costly to the healthcare system and society overall," he concluded.

Bolbocean, who is in his second year at Baylor, has helped start the new PhD Program in Health Services housed in the Robbins Institute for Health Policy and Leadership. This is the program’s inaugural year.

"I feel happy to be at Robbins and the Department of Economics and to conduct research with a mission-driven team," he continued. "The support here is amazing. It’s great to work together with my colleagues and students, collaborate with hospital administrators, and to develop and advance a research agenda focused on transforming pediatric healthcare delivery. I share my success with my colleagues, and I gratefully acknowledge their support."

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