Subscribe to RSS
National Trends in Survival and Short-Term Outcomes of Periviable Births ≤24 Weeks Gestation in the United States, 2009 to 2018Funding 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.
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 (https://www.hcup-us.ahrq.gov)
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.
Received: 09 January 2022
Accepted: 29 April 2022
Accepted Manuscript online:
06 May 2022
Article published online:
12 June 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Raju TNK, Mercer BM, Burchfield DJ, Joseph Jr GF. Periviable birth. Obstet Gynecol 2014; 123 (05) 1083-1096
- 2 Hayman WR, Leuthner SR, Laventhal NT, Brousseau DC, Lagatta JM. Cost comparison of mechanically ventilated patients across the age span. J Perinatol 2015; 35 (12) 1020-1026
- 3 Allen KM, Smith B, Iliev I, Evans J, Werthammer J. Short term cost of care for the surviving periviable neonate. J Neonatal Perinatal Med 2017; 10 (02) 191-194
- 4 Younge N, Goldstein RF, Bann CM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Survival and neurodevelopmental outcomes among periviable infants. N Engl J Med 2017; 376 (07) 617-628
- 5 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314 (10) 1039-1051
- 6 Kono Y, Yonemoto N, Nakanishi H, Kusuda S, Fujimura M. Changes in survival and neurodevelopmental outcomes of infants born at <25 weeks' gestation: a retrospective observational study in tertiary centres in Japan. BMJ Paediatr Open 2018; 2 (01) e000211
- 7 Norman M, Hallberg B, Abrahamsson T. et al. Association between year of birth and 1-year survival among extremely preterm infants in Sweden during 2004-2007 and 2014-2016. JAMA 2019; 321 (12) 1188-1199
- 8 Rysavy MA, Li L, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015; 372 (19) 1801-1811
- 9 Boghossian NS, Geraci M, Edwards EM, Ehret DEY, Saade GR, Horbar JD. Regional and racial-ethnic differences in perinatal interventions among periviable births. Obstet Gynecol 2020; 135 (04) 885-895
- 10 Barfield WD, Papile LA, Baley JE. et al; American Academy of Pediatrics Committee on Fetus And Newborn. Levels of neonatal care. Pediatrics 2012; 130 (03) 587-597
- 11 Levels of Maternal Care | ACOG.. Accessed March 26, 2022 at: https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2019/08/levels-of-maternal-care
- 12 Meuli RL, Cohen LJ. Regionalization of perinatal care. West J Med 1984; 141 (05) 695-697
- 13 Hein HA. Regionalized perinatal care in North America. Semin Neonatol 2004; 9 (02) 111-116
- 14 Hein HA. Regionalization of perinatal health care: a lesson learned but lost. J Perinatol 1999; 19 (8 Pt 1): 584-588
- 15 The Regionalized Perinatal Care Program - RWJF. Accessed October 14, 2021 at: https://www.rwjf.org/en/library/research/2001/01/to-improve-health-and-health-care-2001/the-regionalized-perinatal-care-program.html
- 16 The Dartmouth Atlas of Neonatal Intensive Care. Accessed December 10, 2021 at: https://www.dartmouthatlas.org/Neonatal_Atlas_090419.pdf
- 17 Gould JB, Marks AR, Chavez G. Expansion of community-based perinatal care in California. J Perinatol 2002; 22 (08) 630-640
- 18 Haberland CA, Phibbs CS, Baker LC. Effect of opening midlevel neonatal intensive care units on the location of low birth weight births in California. Pediatrics 2006; 118 (06) e1667-e1679
- 19 HCUP-US NIS Overview. Accessed January 12, 2020 at: https://www.hcup-us.ahrq.gov/nisoverview.jsp
- 20 HCUP NIS Trend Weights.. Healthcare Cost and Utilization Project (HCUP). Published 2015. Accessed January 12, 2019 at: https://www.hcup-us.ahrq.gov/db/nation/nis/trendwghts.jsp
- 21 Kourtis AP, Bansil P, Posner SF, Johnson C, Jamieson DJ. Trends in hospitalizations of HIV-infected children and adolescents in the United States: analysis of data from the 1994-2003 Nationwide Inpatient Sample. Pediatrics 2007; 120 (02) e236-e243
- 22 Zickafoose JS, Benneyworth BD, Riebschleger MP, Espinosa CM, Davis MM. Hospitalizations for intussusception before and after the reintroduction of rotavirus vaccine in the United States. Arch Pediatr Adolesc Med 2012; 166 (04) 350-355
- 23 Hirai AH, Ko JY, Owens PL, Stocks C, Patrick SW. Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017. JAMA 2021; 325 (02) 146-155
- 24 Donda K, Vijayakanthi N, Dapaah-Siakwan F, Bhatt P, Rastogi D, Rastogi S. Trends in epidemiology and outcomes of respiratory distress syndrome in the United States. Pediatr Pulmonol 2019; 54 (04) 405-414
- 25 Donda K, Sharma M, Amponsah JK. et al. Trends in the incidence, mortality, and cost of neonatal herpes simplex virus hospitalizations in the United States from 2003 to 2014. J Perinatol 2019; 39 (05) 697-707
- 26 Shankaran S, Fanaroff AA, Wright LL. et al. Risk factors for early death among extremely low-birth-weight infants. Am J Obstet Gynecol 2002; 186 (04) 796-802
- 27 Bhatt P, Lekshminarayanan A, Donda K. et al. National trends in neonatal extracorporeal membrane oxygenation in the United States. J Perinatol 2018; 38 (08) 1106-1113
- 28 Jiang S, Huang X, Zhang L. et al; Reduction of Infection in Neonatal Intensive Care Units Using the Evidence-Based Practice for Improving Quality (REIN-EPIQ) Study Group. Estimated survival and major comorbidities of very preterm infants discharged against medical advice vs treated with intensive care in China. JAMA Netw Open 2021; 4 (06) e2113197-e2113197
- 29 Anderson JG, Baer RJ, Partridge JC. et al. Survival and major morbidity of extremely preterm infants: a population-based study. Pediatrics 2016; 138 (01) e20154434
- 30 Zhu Z, Yuan L, Wang J. et al. Mortality and morbidity of infants born extremely preterm at tertiary medical centers in China from 2010 to 2019. JAMA Netw Open 2021; 4 (05) e219382-e219382
- 31 Edstedt Bonamy AK, Zeitlin J, Piedvache A. et al; Epice Research Group. Wide variation in severe neonatal morbidity among very preterm infants in European regions. Arch Dis Child Fetal Neonatal Ed 2019; 104 (01) F36-F45
- 32 Shafey A, Bashir RA, Shah P, Synnes A, Yang J, Kelly EN. Canadian Neonatal Network and Canadian Neonatal Follow-Up Network Investigators. Outcomes and resource usage of infants born at ≤ 25 weeks gestation in Canada. Paediatr Child Health 2020; 25 (04) 207-215
- 33 Lui K, Lee SK, Kusuda S. et al; International Network for Evaluation of Outcomes (iNeo) of neonates Investigators. Trends in outcomes for neonates born very preterm and very low birth weight in 11 high-income countries. J Pediatr 2019; 215: 32-40.e14
- 34 Ancel PY, Goffinet F, Kuhn P. et al; EPIPAGE-2 Writing Group. Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr 2015; 169 (03) 230-238
- 35 Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ 2012; 345 (7886): e7976
- 36 Bonet M, Cuttini M, Piedvache A. et al; MOSAIC and EPICE research groups. Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population-based studies in ten European regions. BJOG 2017; 124 (10) 1595-1604
- 37 Maier RF, Blondel B, Piedvache A. et al; MOSAIC and EPICE Research Groups. Duration and time trends in hospital stay for very preterm infants differ across European regions. Pediatr Crit Care Med 2018; 19 (12) 1153-1161
- 38 Rysavy MA, Tyson JE, Stoll BJ. Changing outcomes, changing policies for periviable births. BJOG 2017; 124 (10) 1605-1605
- 39 Korst LM, Feldman DS, Bollman DL. et al. Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals. Am J Obstet Gynecol 2015; 213 (04) 523.e1-523.e8
- 40 Hatch LD, Scott TA, Walsh WF, Goldin AB, Blakely ML, Patrick SW. National and regional trends in gastrostomy in very low birth weight infants in the USA: 2000-2012. J Perinatol 2018; 38 (09) 1270-1276
- 41 Boakye W, Biney B, Preko E, Poku AF, Anim-Koranteng C, Donda K, Nkrumah-Ababio N, Dapaah-Siakwan F. Inpatient burden and resource use in preterm infants with bronchopulmonary dysplasia undergoing gastrostomy tube placement. The American Journal of Gastroenterology 2021; 116: S590-S591
- 42 Mori R, Kusuda S, Fujimura M. Neonatal Research Network Japan. Antenatal corticosteroids promote survival of extremely preterm infants born at 22 to 23 weeks of gestation. J Pediatr 2011; 159 (01) 110-114.e1
- 43 Rossi RM, DeFranco EA, Hall ES. Association of antenatal corticosteroid exposure and infant survival at 22 and 23 Weeks. Am J Perinatol 2021; (November): DOI: 10.1055/S-0041-1740062.