Preterm Birth Health and Economic Impacts

Preterm birth is associated with health conditions that can impact babies at birth and throughout the rest of their lifetime. These issues affect not only the babies themselves, but also their families, communities, healthcare providers, and payers.

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The Health Impacts of Preterm Birth

The medical burdens associated with preterm birth have spurred U.S. and global health organizations to describe prematurity as an urgent problem to be addressed by focused prevention efforts.1

Mortality

Preterm birth is one of the most common causes of newborn mortality. In the United States, prematurity has been estimated to account for one third of all infant deaths. Most preterm infants who do not survive are born before 32 weeks of gestation. 2

In a large US study of singleton preterm births, researchers found that each week of gestational age accounted for significant reductions in the neonatal mortality rate. 3

Gestational Age at Birth (Weeks)	Neonatal Mortality
23-24	35.0%
25-27	10.4%
28-30	1.8%
31-33	0.4%
34-36	0.0%

Source: Manuck TA, et al. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. AM J Obstet Gynecol. 2016;215(1):103.

Each day in the womb is critical for health and development. Learn more about fetal development.

Morbidity

Babies who are born preterm face a host of short and long-term medical challenges that affect a variety of systems in the body.1

Short-term health impacts

In the short term, premature babies often require special care through a NICU or special care nursery.

These are some of the most common short-term health impacts caused by preterm delivery:

Short-term Health Impact	Example
Respiratory	ApneaBronchopulmonary dysplasiaPersistent pulmonary hypertensionRespiratory distress syndrome
Cardiovascular	BradycardiaHeart valve abnormalitiesPatent ductus arteriosusSeptal defects
Gastrointestinal	Feeding problemsNecrotizing enterocolitis
Metabolic	HypoglycemiaJaundiceBody temperature dysregulation
Brain	Intraventricular hemorrhage
Infectious	PneumoniaSepsis
Vision	Retinopathy of prematurity

Source: March of Dimes

Long-term health impacts

Preterm infants are at increased risk of long-term health problems. Even babies born in the later preterm range (32-38 weeks’ gestation) face increased odds of long-term health problems5.

Preterm infants can continue to experience a range of medical issues as they grow up, including:

• Cerebral palsy
  
• Intellectual disabilities
  
• Mental health issues
  
• Chronic lung diseases
  
• Vision loss
  
• Hearing loss
  
• Greater risk of hypertension
  
• Greater risk of diabetes
  

“Despite the high rate of child death and disability due to prematurity, little is known about how to prevent preterm birth and how best to scale up essential care proven to be practical and affordable. It is, thus, critical to harness recent advances in science and technology and growing global political will to identify novel solutions and to rapidly translate research results into effective global health action.”

World Health Organization Report, Born Too Soon

The Economic Impacts of Preterm Birth

The high cost of preterm births begins in the NICU, but often continues into later life.

Newborn Care Costs of Premature Birth

The costs of delivering and caring for a premature newborn are staggering. In one restrospective analysis in California, costs were calculated by gestational age6.

Gestational Age at Birth (Weeks)	Newborn Care Costs
Full-term (37+)	$2,433
Late preterm (32-36)	$22,102
Very preterm (28-31)	$223,931
Extremely preterm (<28)	$317,982

Source: Phibbs CS, et al. Birth Hospitalization Costs and Days of Care for Mothers and Neonates in Califorina, 2009-2011. J Pediatr. 2019 Jan; 204:118-125. e14.

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Lifetime Care Costs of Premature Birth

The long-term health conditions that can accompany premature birth translate into increased expenses long after the initial hospital discharge.

In 2016, the cost associated with prematurity in the United States was estimated at $25.2 billion 7. The per-child incremental lifetime costs (above those term births) were calculated by gestational age:

Gestational Age at Birth (Weeks)	Incremental Lifetime Cost
All preterm (<37)	$64,815
Late preterm (32-26)	$28,367
Very preterm (28-31)	$186,731
Extremely preterm (<28)	$344,355

Source: Waitzman NJ, Jalali A, Grosse SD. Preterm birth lifetime costs in the United States in 2016: An update. Semin Perinatol. 2021 Apr, 45(3):151390

The best way to avoid the short-and-long-term consequences of of preterm birth is to predict and prevent it. A better chance at reaching full term in the womb means a better chance for a healthier start in life. Learn more about fetal development. 

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