Theoretical model for reducing neonatal morbidity and mortality and associated costs

Twin births have increased at twice the rate of singletons in the decade between 1978 and 1988, due to changes in maternal age at childbearing and increased use of fertility enhancing drugs. In 1985, nearly 45% of twin births occurred before 37 weeks' gestation compared to 10% of singletons. Three-fourths of all twins born before 37 weeks' gestation were also low birthweight, compared to one-third of singletons. We propose a theoretical shift in the twin birthweight distribution by 500 grams for birthweights between 500-2,999 grams, through the encouragement of gestational weight gains of 24 pounds by 24 weeks' gestation and total gains of 35-45 pounds. This change would result in 60% fewer twins with birthweights below 1,500 grams and 85% fewer deaths among twins in this weight category. Among survivors, the shift in birthweights would result in a 41% overall reduction in length of stay (LOS) for all twins (345,000 days), as well as a 60% reduction in LOS for twin infants with birthweights below 2,500 grams (419,000 NICU days). A conservative estimate of annual savings from NICU day costs for birthweights below 2,500 grams would be $419 million. The proposed shift would also result in a 41% reduction in the number of twin children with moderate and severe handicap, and a 58% reductions in lifetime costs of special services for handicapped twin children, amounting to $219 million.