049
Birth Tourism and Neonatal ICU Care: A Children's Hospital Experience

Friday, October 23, 2015
Renaissance East (Renaissance Washington, DC Downtown Hotel)
Michel Mikhael, MD, Children's Hospital of Orange County, Orange, CA

Background:

Recent news reports have shown increasing incidence of birth tourism in the United States, when pregnant mothers travel for the purpose of delivering in the US to obtain benefits and rights of citizenship for their children. Approximately 10% of all live birth neonates are admitted to neonatal ICU due prematurity, congenital anomalies or other neonatal illness. To date, there have been no reports in the literature regarding birth tourism and NICU hospitalization.

Purpose:

To investigate the incidence of birth tourism in the NICU of a children's hospital serving a large metropolitan area, examine its medical, social and financial aspects.

Methods:

Retrospective study of all admissions to our NICU, Feb 2012-Jan 2015. Neonates born to families who visited the US with plan to deliver and return to their home countries after birth were identified through medical records review. Relevant perinatal, medical and social data were collected and compared to a control group of neonates.

Results:

During study period there were 50 admissions for 46 neonates, due to birth tourism. 37 neonates (80%) were admitted in the latter half of study period. In comparison to a control group of 100 neonates, there were no differences in birth weight, gestational age, gender or 5 min Apgar score. However there were significance differences in maternal age, delivery mode, referral reason and source. The birth tourism group had higher mortality rate, longer length of stay and were more likely to be rehospitalized within 30d of discharge, indicates medical complexity. Although all birth tourism neonates were uninsured upon delivery, one third was enrolled in public health care program, after families changed their residencies to the US due to the complex health care of their children. Four (9.8%) neonates were placed for adoption, which was not planned before delivery.

Birth Tourism Group (46)

Control Group

(100)

P value

Maternal Age

33.84.5

29.67.1

<0.001

Caesarean Section n, (%)

33 (71.7)

48(48)

0.001

Referral sources n, (%)

<0.0001

Inborn

Referral NICU

ER

7 (14)

37 (74)

6 (12)

55 (55)

32 (32)

13 (13)

Primary reason for admission n, (%)

<0.0001

Surgical evaluation

Respiratory evaluation

Neurologic evaluation

Cardiac evaluation

Prematurity

Others

20(40)

13(26)

0

6(12)

2(4)

9(18)

10 (10)

13 (13)

5 (5)

13 (13)

25 (25)

34 (34)

Length of stay (median, IQR)

14 (5-34)

7 (3-17)

0.02

Medical disposition

0.0006

Alive

Died

Transferred

43(86)

3(6)

4(8)

95(95)

1(1)

4(4)

Rehospitalization within 30d of discharge

7 (16.2)

5 (5.2)

0.001

Social disposition n, (%)

<0.0001

Adoptive or foster care family

Biological family

4 (9.8)

37(90.2)

1 (1)

94 (99)

Health care insurance n, (%)

<0.0001

Public insurance

Commercial insurance

Uninsured

16 (34.7)

2 (4.3)

28 (61)

59 (59)

41 (41)

0

Conclusion:

Birth tourism and subsequently incidence of NICU admissions is increasing in our region. Significant social and financial burdens are created with unanticipated medical needs. Further studies are needed to better study these neonates, such work should include tools to define social and psychological stressors.

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