Am J Perinatol
DOI: 10.1055/a-1845-2526
Original Article

National Trends in Survival and Short-Term Outcomes of Periviable Births ≤24 Weeks Gestation in the United States, 2009 to 2018

Harshit Doshi
1   Neonatal Intensive Care Unit, Golisano Children's Hospital of Southwest Florida, Florida
Samarth Shukla
2   University of Florida College of Medicine, Jacksonville, Florida
Shalinkumar Patel
2   University of Florida College of Medicine, Jacksonville, Florida
Grace Annan Cudjoe
3   University of Ghana School of Medicine and Dentistry, Accra, Ghana
Wendy Boakye
4   National Institute of Health, Bethesda, Maryland
Narendrasinh Parmar
5   Department of Pediatrics Brookdale University Hospital and Medical Center, Brooklyn, New York
Parth Bhatt
6   Department of Pediatrics, United Hospital Center, Bridgeport, West Virginia
7   Neonatal Intensive Care Unit, Valley Children's Hospital, Madera, California
Keyur Donda
8   Department of Pediatrics/Division of Neonatology University of South Florida, Tampa, Florida
› Author Affiliations
Funding None.


Objective Data from the academic medical centers in the United States showing improvements in survival of periviable infants born at 22 to 24 weeks GA may not be nationally representative since a substantial proportion of preterm infants are cared for in community hospital-based neonatal intensive care units. Our objective was to examine the national trends in survival and other short-term outcomes among preterm infants born at ≤24 weeks gestational age (GA) in the United States from 2009 to 2018.

Study Design This was a retrospective, repeated cross-sectional analysis of the National Inpatient Sample for preterm infants ≤24 weeks GA. The primary outcome was the trends in survival to discharge. Secondary outcomes were the trends in the composite outcome of death or one or more major morbidity (bronchopulmonary dysplasia, necrotizing enterocolitis stage ≥2, periventricular leukomalacia, severe intraventricular hemorrhage, and severe retinopathy of prematurity). The Cochran–Armitage trend test was used for trend analysis. p-Value <0.05 was considered significant.

Results Among 71,854 infants born at ≤24 weeks GA, 34,251 (47.6%) survived less than 1 day and were excluded. Almost 93% of those who survived <1 day were of ≤23 weeks GA. Among the 37,603 infants included in the study cohort, 48.1% were born at 24 weeks GA. Survival to discharge at GA ≤ 23 weeks increased from 29.6% in 2009 to 41.7% in 2018 (p < 0.001), while survival to discharge at GA 24 weeks increased from 58.3 to 65.9% (p < 0.001). There was a significant decline in the secondary outcomes among all the periviable infants who survived ≥1 day of life.

Conclusion Survival to discharge among preterm infants ≤24 weeks GA significantly increased, while death or major morbidities significantly decreased from 2009 to 2018. The postdischarge survival, health care resource use, and long neurodevelopmental outcomes of these infants need further investigation.

Key Points

  • Survival increased significantly in infants ≤24 weeks GA in the United States from 2009 to 2018.

  • Death or major morbidity in infants ≤24 weeks GA decreased significantly from 2009 to 2018.

  • Death or surgical procedures including tracheostomy, VP shunt placement, and PDA surgical closure in infants <=24 weeks GA decreased significantly from 2009 to 2018.

Prior Presentation of Abstract or Poster

An abstract of this study was accepted for oral presentation at the 2021 American Academy of Pediatrics National Conference and Exhibition Meeting.

Data Sharing Statement

Deidentified individual participant data will not be made available. The raw data were obtained from the Agency for Healthcare Research and Quality (

Contributors' Statement

G.A.C., W.B., and N.P. designed the data collection instruments, collected data, performed the initial analyses, and reviewed and revised the manuscript. S.S. and P.B. conceptualized and designed the study, performed the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. K.D., H.D., and F.D.-S. conceptualized and designed the study, coordinated, and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Supplementary Material

Publication History

Received: 09 January 2022

Accepted: 29 April 2022

Accepted Manuscript online:
06 May 2022

Article published online:
12 June 2022

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