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Outcomes and resource usage of infants born at ≤ 25 weeks gestation in Canada
Amy Shafey1, Rani Ameena Bashir2, Prakesh Shah1,3
1Department of Pediatrics, University of Toronto, Toronto, Ontario.
Insights
Infants born at 24 weeks gestational age or earlier face significantly worse health outcomes and higher resource needs compared to those born at 25 weeks. This includes increased medical complications and neurodevelopmental impairments.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Perinatal Epidemiology
Background:
- Infants born extremely preterm (≤ 25 weeks gestational age) represent a vulnerable population with significant healthcare needs.
- Understanding the specific outcomes and resource utilization based on gestational age is crucial for optimizing care and resource allocation.
Purpose of the Study:
- To compare short-term morbidities, neurodevelopmental outcomes, and resource utilization between infants born at ≤ 24 weeks gestational age and those born at 25 weeks gestational age.
- To identify specific factors contributing to adverse outcomes in extremely preterm infants.
Main Methods:
- Retrospective study of infants born ≤ 25 weeks gestational age across Canadian neonatal intensive care units (April 2009 - September 2011).
- Comparison of outcomes (morbidities, neurodevelopmental impairment) and resource utilization (length of stay, respiratory support, etc.) between infants born ≤ 24 weeks and 25 weeks GA.
- Follow-up assessments at 18-24 months corrected age.
Main Results:
- Infants born ≤ 24 weeks GA had higher rates of C-section, lower birth weight, and less antenatal steroid exposure.
- Significantly increased incidences of ductus arteriosus ligation, severe intracranial hemorrhage, and retinopathy of prematurity were observed in the ≤ 24 weeks GA group.
- Neurodevelopmental impairment rates were substantially higher in infants born ≤ 23 weeks (68.9%) and 24 weeks (64.5%) compared to 25 weeks (55.6%) GA.
Conclusions:
- Adverse outcomes, including severe morbidities and neurodevelopmental impairments, are significantly higher for infants born at ≤ 24 weeks gestational age compared to those born at 25 weeks.
- Resource utilization, such as length of hospital stay and need for respiratory support, was also markedly greater in the extremely preterm group (≤ 24 weeks GA).
- These findings underscore the critical impact of gestational age on infant health and healthcare resource demands in the neonatal period.
Objectives:
To determine the outcomes and resource usage of infants born at ≤ 25 weeks gestational age (GA).
Methods:
Retrospective study of infants born between April 2009 and September 2011 at ≤ 25 weeks' GA in all neonatal intensive care units in Canada with follow-up in the neonatal follow-up clinics. Short-term morbidities, neurodevelopmental impairment, significant neurodevelopmental impairment, and resource utilization of infants born at ≤ 24 weeks were compared with neonates born at 25 weeks.
Results:
Of 803 neonates discharged alive, 636 (80.4%) infants born at ≤ 25 weeks' GA were assessed at 18 to 24 months. Caesarean delivery, lower birth weight, and less antenatal steroid exposure were more common in infants born ≤ 24 weeks as compared with 25 weeks. They had significantly higher incidences of ductus arteriosus ligation, severe intracranial hemorrhage, retinopathy of prematurity as well as longer length of stay, central line days, days on respiratory support, days on total parenteral nutrition, days on antibiotics, and need for postnatal steroids. Neurodevelopmental impairment rates were 68.9, 64.5, and 55.6% (P=0.01) and significant neurodevelopmental impairment rates were 39.3, 29.6, and 20.9% (P<0.01) for infants ≤ 23, 24, and 25 weeks GA, respectively. Postdischarge service referrals were higher for those ≤ 23 weeks. Nonsurviving infants born at 25 weeks GA had higher resource utilization during admission than infants born less than 25 weeks.
Conclusions:
Adverse outcomes and resource usage were significantly higher among infants born ≤ 24 weeks GA as compared with 25 weeks GA.
