Published online December 1, 2005
PEDIATRICS
Vol. 116
No. 6
December 2005, pp.
1598
(doi:10.1542/peds.2005-2232)
Grade 3 to 4 Intraventricular Hemorrhage and Bayley Scores Predict Outcome: In Reply
Maureen Hack, MB, ChB
H. Gerry Taylor, PhD
Dennis Drotar, PhD
Mark Schluchter, PhD
Nancy Klein, PhD
Deanne Wilson-Costello, MD
Department of Pediatrics,
Case Western Reserve University,
Cleveland, OH 44106
In Reply.—
Ment et al estimate the enormous lifetime costs of care for children born with very low birth weight (VLBW; <1500 g) who develop mental retardation as a result of grade 3 to 4 intraventricular hemorrhage (IVH). However, the costs of care of prematurely born children go far beyond those associated with the sequelae of grade 3 to 4 IVH and other types of perinatal brain injury.1 Pulmonary and other sequelae of prematurity also contribute considerably to the long-term cost of care.2 We recently reported on the special health care needs of the same cohort of 8-year-old extremely low birth weight (ELBW; <1 kg) children that we described in Pediatrics.3 The total population included 219 ELBW children, of whom 183 were free of severe neurosensory impairments (ie, cerebral palsy, deafness, or blindness). Even among these relatively "intact" children, 22% had asthma that required therapy compared with 9% of the normal birth weight comparison children. Overall, 58% of the children in our ELBW cohort who were free of neurosensory impairments had a chronic condition of 
12 months and special health care needs that required services above those routinely required by children, compared with 27% of the normal birth weight children (P < .001).
Newacheck and Kim4 recently provided national representative data on the total health care expenditures for children younger than 18 years of age with special health care needs as identified in the 2000 Medical Expenses Panel Survey. Expenditures, or costs, included those for hospital inpatient and outpatient services, physician and dental services, services provided by health care professionals other then physicians (eg, nurse practitioners, physical therapists, psychologists, social workers), prescribed medications, diagnostic tests, and medical equipment and supplies including eyeglasses. Some specialized long-term care and services provided in schools are excluded from the Medical Expenses Panel Survey. Even with these exclusions, compared with other children, children with special health care needs had 3 times higher annual health care expenditures, and the average out-of-pocket expenses (those paid directly by the family) were twice those for other children.
The rates of low birth weight (<2500 g) and VLBW births increased in the United States between 1990 and 2003.5 Although there is information on the costs of neonatal intensive care for VLBW children,6 the later medical and educational costs of care for recent survivors has not been evaluated yet. The impact on families of children with special health care needs is not only financial but includes other, less easily measurable effects on the lives of their parents and siblings.7 Thus, we suggest that one of the major pediatric public health problems of our time is premature birth rather than grade 3 to 4 IVH per se.
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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
Related articles in Pediatrics:
- Grade 3 to 4 Intraventricular Hemorrhage and Bayley Scores Predict Outcome
- Laura R. Ment, Walter C. Allan, Robert W. Makuch, and Betty Vohr
Pediatrics 2005 116: 1597-1598.
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