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Updated: Aug 7, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Improving perinatal regionalization by predicting neonatal intensive care requirements of preterm infants: an
Rachel Vieux1, Jeanne Fresson, Jean-Michel Hascoet
1Department of Neonatalogy, Maternite Regionale Universitaire, Nancy, France. r.vieux@maternite.chu-nancy.fr
Insights
Gestational age and antenatal factors predict neonatal intensive care needs in preterm infants. Infants under 31 weeks gestation require level III care, while some older infants can be managed at level IIb facilities.
Area of Science:
- Neonatalogy
- Perinatal care
- Obstetrics
Background:
- Perinatal regionalization stratifies care based on infant pathology.
- Current guidelines recommend level III facility referral for all very preterm infants.
- Not all very preterm neonates necessitate intensive care, prompting a need for refined referral criteria.
Purpose of the Study:
- To identify antenatal factors predicting neonatal intensive care unit (NICU) admission in preterm infants.
- To correlate gestational age with the need for intensive care.
- To optimize the matching of birth weight and required care level within perinatal networks.
Main Methods:
- Analysis of a cohort of 1262 preterm infants born in 1997 across nine French regions.
- Definition of neonatal intensive care requirement: specialized management (e.g., mechanical ventilation >48 hours, high-frequency oscillation, inhaled nitric oxide) or poor outcome (transfer to level III within 2 days, early neonatal death).
- Exclusion criteria: triplet pregnancies, fetal malformations, maternal pre-delivery intensive care needs.
Main Results:
- For infants at 30, 31, and 32 weeks gestation, NICU admission rates were 42.8%, 33.2%, and 22.8%, respectively.
- Multivariate analysis identified twin pregnancies, maternal hypertension, antepartum hemorrhage, infection, and male gender as risk factors for intensive care.
- Antenatal steroid therapy and premature rupture of membranes demonstrated protective effects against intensive care requirement.
Conclusions:
- Infants born at less than 31 weeks gestation should be referred to level III facilities.
- From 31 weeks gestation, select infants may be safely managed in level IIb facilities.
- Long-term follow-up is crucial for a comprehensive assessment of perinatal regionalization quality.
Objective:
Perinatal regionalization has been organized into 3 ascending levels of care, fitting increasing degrees of pathology. Current recommendations specify that very premature infants be referred prenatally to level III facilities, yet not all very preterm neonates require level III intensive care. The objective of our study was to determine the antenatal factors that, in association with gestational age, predict the need for neonatal intensive care in preterm infants, to match the size of birth with the level of care required.
Methods:
Data were analyzed from a cohort of very preterm infants born in nine French regions in 1997. We defined the need for neonatal intensive care as follows: (1) the requirement for specialized management (mechanical ventilation for >48 hours, high frequency oscillation, or inhaled nitric oxide) or (2) poor outcome (transfer to a level III facility within the first 2 days of life or early neonatal death). Triplet pregnancies and pregnancies marked by fetal malformations or intensive care requirements for the mother before delivery were excluded.
Results:
We focused our study on 1262 neonates aged 30, 31 and 32 weeks' gestation, where the need for intensive care was 42.8%, 33.2%, and 22.8%, respectively. Multivariate analysis showed that the risk factors for intensive care requirement with low gestational age were twin pregnancies, maternal hypertension, antepartum hemorrhage, infection, and male gender. Antenatal steroid therapy and premature rupture of membranes were protective factors against intensive care requirement.
Conclusion:
Infants <31 weeks' gestation should be referred to level III facilities. From 31 weeks' gestation, some infants can be safely handled in level IIb facilities. However, the quality of perinatal regionalization may only be fully assessed by long-term follow-up.
