RESUMO
To determine the impact of the use of synthetic surfactant on hospital resource use and charges, we analyzed the economic data from a multicenter, randomized, placebo-controlled clinical trial of synthetic surfactant in infants with neonatal respiratory distress syndrome and birth weights between 700 and 1350 gm. Two 5 ml/kg doses of a synthetic surfactant (Exosurf Neonatal) or air placebo were administered to 419 infants who were receiving mechanical ventilation and had an arterial/alveolar oxygen tension ratio < 0.22. In addition to the clinical endpoints for safety and efficacy, data were collected on length of hospital stay, days in the neonatal intensive care unit, days of mechanical ventilation, days of oxygen supplementation, and hospital charges until the infant reached 1 year adjusted age. Growth and development of infants who received synthetic surfactant therapy in the study and survived to 1 year adjusted age were equivalent to those of the survivors in the air placebo group. For 1-year survivors, synthetic surfactant reduced the average length of stay at the different levels of care needed during the hospitalization such as neonatal intensive care unit days, days of mechanical ventilation, and days of oxygen supplementation. For nonsurvivors, synthetic surfactant increased the average length of stay, especially at more intense levels of care. Total hospital charges for the initial hospitalization and through 1 year adjusted age for a hypothetic cohort of 100 infants treated with synthetic surfactant were, on average, the same as those for a comparable cohort of infants in the air placebo group. These results indicate that rescue therapy with synthetic surfactant in infants with respiratory distress syndrome and birth weights from 700 to 1350 gm can result in significantly improved survival without significant increases in hospital charges.
Assuntos
Unidades de Terapia Intensiva Neonatal/economia , Tempo de Internação/economia , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Custos Hospitalares , Humanos , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Oxigenoterapia , Placebos , Respiração Artificial , Estados UnidosRESUMO
The observed joint distribution of births and child deaths for a cohort of women at a given point in time depends on the number of children that would have been born had the family experienced no deaths, the number of child deaths experienced, and the proportion of these deaths that are replaced by a subsequent birth. In this paper we estimate the parameters of the assumed distributions of these three events using a minimum distance estimation model and data from the 1970 Brazilian census. The parameter estimates are shown to be similar to those obtained previously using a maximum likelihood estimation model. When the data are subdivided according to women's years of schooling, estimates of probability of a child death and mean and variance of children born if no deaths decrease while estimates of probability of replacement of a dead child increase as years of schooling increase.
Assuntos
Fertilidade , Modelos Teóricos , Adulto , Coeficiente de Natalidade , Brasil , Criança , Escolaridade , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Pessoa de Meia-Idade , Mortalidade , Gravidez , Processos EstocásticosRESUMO
"The individual household's fertility response to an experienced child death, the replacement probability, is estimated for Brazil using a maximum likelihood estimation model.... The model allows the distribution of births, deaths, and replacement births to vary with included exogenous variables. The replacement probabilities estimated for Brazil were between .4 and .9 and varied systematically with women's education, rural-urban residence, and household electrification. Increased development was shown to be correlated with a lower number of surviving children."