Intensive care for high-risk infants in Calcutta. Efficacy and cost

C. Subramanian, C. Clark-Prakash, Z. K. Dadina, B. Ferrara and D. E. Johnson

The efficacy and cost of implementing an intermediate level of newborn intensive care (INIC) was retrospectively evaluated over a four-year period in Calcutta to see if survival could be improved at low cost using indigenous human and material resources. The patient population (94.7% less than or equal to 2500 g) included all infants admitted to the facilities operated by the International Mission of Hope (India) Society. Survival was compared within 250-g increments in 1980 and 1981, when infants with major medical problems were hospitalized in outside facilities (mortality, 100%) and 1982 and 1983, when INIC was provided completely within the facility. Overall survival increased from 37.9% (n = 504) in 1980 and 1981 to 70.5% (n = 581) in 1982 and 1983. Infants weighing 1251 to 2000 g benefited greatly (34.4% [n = 279], 74.8% [n = 322]) from INIC. Survival of infants weighing 1250 g or less, although improved, remained low (5.6% [n = 89] to 23.1% [n = 108]). The average daily cost for the entire period of hospitalization was $7.75. These data indicate that survival in infants of low birth weight can be improved with INIC at modest cost using resources already available within the community. However, the application of this type of program must still be considered in relation to strategies designed to reduce the number of infants of low birth weight as well as to the long-term goals and available financial resources in non-industrialized countries.