High costs in infancy reported for preterm birth

A nationwide Swedish register study published in Acta Paediatrica quantified the long-term medical and societal costs associated with children born before 24 weeks’ gestation, finding that expenses are heavily concentrated in infancy and that nonmedical costs surpass health care spending in later childhood.¹

The findings provide rare longitudinal economic data on one of the most vulnerable neonatal populations surviving beyond the first year of life. The analysis is clinically relevant as survival among infants born at the threshold of viability has improved in high-income countries, including Sweden, where active resuscitation at 22 weeks is now practiced in some settings.¹

“We see that costs are highest during the first year of life, averaging around SEK 1.7 million per child. At the same time, there are large differences between children. Those who experience severe complications early in life often have more long-term and extensive support needs,” said Hanna Gyllensten, PhD, senior lecturer at the Sahlgrenska Academy.²

Register-based cohort captures national births below 24 weeks

Investigators conducted a population-based cohort study including all infants born before 24 weeks’ gestation in Sweden between 2007 and 2018 who survived at least 1 year. The final cohort included 344 children with a mean gestational age of 23.3 weeks and mean birth weight of 567 g.

Slightly more than half were male, and neonatal morbidity was common, including bronchopulmonary dysplasia in 85.1%, treated retinopathy of prematurity in 42.4%, and severe intraventricular hemorrhage in 16.9%.¹

Data were derived from linked national health and social registers, including the Swedish Medical Birth Register, National Patient Register, Prescribed Drug Register, Cause of Death Register, and the Swedish Social Insurance Agency. Costs were evaluated from a societal payer perspective and included inpatient and outpatient health care, pharmaceuticals, and nonmedical costs such as parental income loss and government transfer payments.¹

Early hospitalization drives costs, while social costs persist into childhood

Total costs were greatest during the first year of life, when mean total expenditure reached approximately 1,676,000 Swedish Krona per child, with medical costs accounting for the vast majority of spending. More than 80% of total health care expenditure occurred during infancy, primarily driven by specialized inpatient neonatal care.¹

By year 1, mean total costs dropped substantially to approximately 274,000 Swedish Krona and continued to decline across childhood. Inpatient care costs decreased over time, while outpatient care and social insurance expenditures became more prominent.¹

A key finding was the shifting balance between medical and nonmedical costs. Although medical costs dominated early life, nonmedical costs, including parental benefits, care allowances, and income replacement, increased with age and exceeded medical costs beginning at approximately 4 years of age.¹

Subgroup analyses suggested that children born at 21 to 22 weeks’ gestation experienced more sustained nonmedical costs into later childhood compared with those born at 23 weeks. Cost patterns were broadly similar by sex and mode of delivery, while higher long-term societal costs were observed among children with major neonatal morbidities.¹

Clinical and policy implications for extreme prematurity

The findings underscore that the economic impact of extreme prematurity extends far beyond the neonatal intensive care unit. While early survival gains are associated with intensive and costly inpatient care, long-term expenditures shift toward social systems and family support structures.¹

For clinicians, the results highlight the importance of anticipating prolonged multidisciplinary follow-up needs in this population, particularly among survivors with bronchopulmonary dysplasia or severe neurologic injury. The authors note that prior cost studies often grouped extremely preterm infants with more mature cohorts, potentially underestimating the financial burden specific to those born below 24 weeks.¹

These data may inform counseling for families during periviability discussions, as well as health system planning for long-term pediatric disability services. However, the findings should be interpreted within the context of Sweden’s tax-funded universal health care and social insurance systems, which may limit generalizability to other settings.¹

“After a few years, we see a clear shift: Health care no longer accounts for the largest share of costs; instead, societal support for the family becomes the largest component. These are long-term support measures that follow the child through childhood and reflect needs that remain long after acute care has ended,” said Chatarina Löfqvist, PhD, professor at the Sahlgrenska Academy.²

References

1. Löfqvist C, Hallberg B, Sjöbom U, et al. Long-term societal costs after births before 24 weeks of gestation in Sweden. Acta Paediatr. Published online March 31, 2026. doi:10.1111/apa.70527
2. High societal costs linked to extremely preterm birth. News release. University of Gothenberg. April 9, 2026. Accessed April 10, 2026. https://www.eurekalert.org/news-releases/1123440