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Financial Burden of Neonatal Micrognathia
Hillary E. Jenny, BS, Benjamin B. Massenburg, BA, E. Hope Weissler, BA, Paymon Sanati-Mehrizy, BA, Peter J. Taub, MD.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: Micrognathia is a common congenital anomaly that may pose breathing and feeding limitations in newborns, sometimes necessitating invasive measures to maintain ventilation and enable breastfeeding. The following abstract discusses the financial burden of a diagnosis of micrognathia during the birth admission, the prevalence of complications associated with micrognathia in newborns, the frequency with which invasive measures are utilized for these complications during the birth admission, and the risk factors for requiring these measures.
Methods: A retrospective cohort study was performed using the 2000-2012 Kids' Inpatient Database. Newborn patients were included if they were delivered following either normal vaginal births or Caesarean sections. The burden of the diagnosis was measured by the total charge to the patient and the length of hospital stay. Complications assessed included diagnosis of a feeding problem, apnea and cyanosis. Invasive management included intubation, prolonged mechanical ventilation, tracheostomy, and mandibular surgery. Data was analyzed using SPSS v20 software.
Results: Of the 19,638,453 births recorded between 2000-2012, 998 were diagnosed with micrognathia. This diagnosis was associated with a significant increase in total charge to the patient for the birth admission: average charge was \,098 for each micrognathic patient compared to \,785 for those without the diagnosis (p<0.001). Patients with micrognathia also had a significantly longer hospital stay during their birth admission, averaging 14.3 days compared to 3.3 for other patients (p<0.001). Feeding problems were encountered in 7.6% of the micrognathic patients, compared to 0.7% in the unaffected population (p<0.001). Incidence of apnea and cyanosis was also significantly higher in the micrognathic population (6.8% and 2.5% vs. 1.3% and 0.3%, respectively, p<0.001). Due to these respiratory complications, 12% of micrognathic patients were intubated, 6.3% required continuous mechanical ventilation for over 96 hours, and 4.5% required tracheostomy (vs. 2.1%, 0.5%, and <0.01% respectively, all p<0.001). In addition, 40 of the 998 patients underwent mandibular reconstruction during the birth stay; average day of procedure was day 36 of admission. In fact, micrognathia was the single most predictive diagnosis leading to mandibular surgery during birth admission in the entire population--out of the 74 infants with mandibular surgeries in the total population, 40 underwent surgery due to micrognathia. Factors associated with a significantly increased need for mandibular surgery included cleft palate (OR 5, 95% CI 2.58-9.75), intubation (OR 7.8, 95% CI 4.03-14.92), requiring mechanical ventilation for over 96 hrs (OR 27.3, 95% CI 13.6-54.89), and apnea (OR 5.3, 95% CI 2.45-11.30). Diagnosis of a feeding problem was not contributory.
Conclusions: Micrognathia is associated with a significant burden in terms of cost, length of stay following birth, and complications including feeding problems, apnea, and cyanosis. These conditions lead to an increased need for invasive respiratory interventions and, in some cases, mandibular surgery before discharge. This population-based study should inform practitioners of the prevalence of micrognathia, its immediate complications and their impact on the healthcare system, and the risk factors that may predispose a newborn with micrognathia to require invasive measures during birth admission, including mandibular surgery.

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