Trends in the Mortality and Death of Periviable Preterm Infants in the United States, 2011 to 2020

Jenil Patel; Omobola Oluwafemi; Tiffany Tang; Angel Sunny; Narendrasinh Parmar; Harshit Doshi; Parth Bhatt; Keyur Donda; Sarah E. Messiah; Fredrick Dapaah-Siakwan

doi:10.1055/a-2435-0908

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(07): 854-861
DOI: 10.1055/a-2435-0908

Original Article

Trends in the Mortality and Death of Periviable Preterm Infants in the United States, 2011 to 2020

Jenil Patel

¹Department of Epidemiology, Human Genetics and Environmental Sciences, UT Health Houston School of Public Health, Dallas, Texas

,

Omobola Oluwafemi

²Department of Epidemiology, Human Genetics and Environmental Sciences, UT Health Houston School of Public Health, Houston, Texas

,

Tiffany Tang

³School of Natural Sciences, Rice University, Houston, Texas

,

Angel Sunny

⁴Department of Pediatrics, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York

,

Narendrasinh Parmar

⁵Section of Emergency Medicine, East Tennessee Children's Hospital, Knoxville, Tennessee

,

Harshit Doshi

⁶Division of Neonatology, Golisano Children's Hospital of Southwest Florida, Fort Myers, Florida

,

Parth Bhatt

⁷Division of Neonatology, Cincinnati Children's Medical Center, Cincinnati, Ohio

,

Keyur Donda

⁸Division of Neonatology, Department of Pediatrics, University of South Florida, Tampa, Florida

,

Sarah E. Messiah

¹Department of Epidemiology, Human Genetics and Environmental Sciences, UT Health Houston School of Public Health, Dallas, Texas

,

Fredrick Dapaah-Siakwan

⁹Departments of Neonatology and Graduate Medical Education, Valley Children's Hospital, Madera, California

› Author Affiliations

Abstract

Objective

This study aimed to examine the trends in the infant mortality rate (IMR) and the trends in the timing of death among periviable preterm infants at 22 to 24 weeks' gestational age (GA) in the United States from 2011 to 2020.

Study Design

Retrospective, serial cross-sectional analysis of periviable preterm infants born in the United States at 22 to 24 weeks' GA using the linked birth/infant death records from the Centers for Disease Control and Prevention. Data were analyzed from 2011 to 2020. The exposure was the year of death, and the outcome was the changes over time in the IMR and the timing of death. Further, we evaluated racial differences in the timing of death. We used nonparametric trend analysis to evaluate changes in mortality rate across the study period.

Results

The IMR was inversely related to GA, and for each GA and race/ethnicity, the IMR significantly declined during the study period. The IMR rate was highest in the first 7 days of life for all GAs and races/ethnicities. While Non-Hispanic White infants had a higher infant neonatal mortality rate than non-Hispanic Black infants, non-Hispanic Black infants had a higher postneonatal mortality rate.

Conclusion

The IMR among periviable infants born at 22 to 24 weeks' GA improved for all GAs and races in the United States between 2011 and 2020. However, significant racial differences in the timing of death exist.

Key Points

As expected, the IMR was inversely related to gestational age at 22 to 24 weeks.
At each gestational age and for each racial/ethnic group, the overall IMR decreased during the study period.
Non-Hispanic White infants had a higher neonatal mortality rate, whereas non-Hispanic Black infants had a higher postneonatal mortality rate.

Keywords

neonatology - periviable newborn - racial/ethnic disparities - mortality - periviable births - trends

Full Text

References

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