Related Experiment Video
Updated: Aug 10, 2025
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
Survival of infants born at periviable gestation: The US national database
Ibrahim Qattea1,2, Mohsen A A Farghaly1,3, Mohammad O Kattea4
1Cleveland Clinic Children's, Cleveland, OH, USA.
Insights
US survival rates for periviable infants (≤24 weeks gestational age) have increased. Higher birth weight (>500g) and public insurance are linked to better outcomes, while male sex is associated with lower survival.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Background:
- Infant resuscitation protocols vary for periviable gestations.
- Evaluating current survival data is crucial for prenatal counseling and setting realistic clinical expectations.
Purpose of the Study:
- To analyze national survival trends for infants born at gestational ages of 24 weeks or less in the United States.
Main Methods:
- Utilized de-identified data from the US Healthcare Cost and Utilization Project (HCUP) spanning 2007-2018.
- Included all infants with documented gestational age ≤24 weeks.
- Employed Cochran-Armitage tests for trend analysis and regression analyses for survival-associated variables.
Main Results:
- Over 124,000 infants born ≤24 weeks were analyzed; survival rates were 15.4% (<24 weeks) and 71.6% (completed 24 weeks).
- Survival rates showed a significant increasing trend over the study period.
- Higher birth weight (>500g), female sex, public insurance, and Black and Hispanic ethnicities were associated with increased survival compared to their counterparts.
Conclusions:
- National survival rates for periviable infants have demonstrably increased.
- Birth weight >500g is a strong predictor of significantly higher survival.
- Long-term outcomes for this vulnerable population remain unknown and require cautious interpretation of current findings.
Background:
Substantial differences exist in the approach to resuscitating infants born at periviable gestation. Evaluation of current survival may help guide prenatal counselling and provide accurate expectations of clinical outcomes. We aimed to assess the US national survival trends in periviable infants born at gestational age (GA) ≤24 weeks.
Methods:
We used de-identified patient data obtained from the US Healthcare Cost and Utilization Project (HCUP) from 2007 to 2018. All infants with documented GA ≤24 weeks were included. The Cochran-Armitage test was used for trend analyses. Regression analyses were conducted for variables associated with survival.
Findings:
A total of 44,628,827 infant records were identified with 124,345 (0.28%) infants born ≤24 weeks; of those, 77,050 infants <24 weeks and 47,295 infants had completed 24 weeks. Survival rates for infants <24 weeks and with completed 24 weeks were 15.4% and 71.6%, respectively, with higher survival over the years (Z = 9.438, P<0.001 & Z = 3.30, P<0.001, respectively). Survival was lower in males compared to females (aOR = 0.96, CI: 0.93-0.99 & aOR = 0.94, CI: 0.92-0.96, respectively) and with private insurance compared to public insurance (aOR = 0.74, CI: 0.71-0.77 & aOR = 0.67, CI: 0.65-0.69, respectively). Survival was higher when birth weight was >500 g compared to ≤500 g (aOR = 4.62, CI:3.23-5.02 & aOR = 5.44, CI: 4.59-5.84, respectively). Black (aOR = 1.33, CI: 1.31-1.36 & aOR = 1.24, CI: 1.20-1.32, respectively) and Hispanic (aOR = 1.29, CI: 1.27-1.32 & aOR = 1.27, CI: 1.22-1.30, respectively) had higher survival than White.
Interpretation:
There is a national increase in survival over the years in infants born at periviable GA. BW >500 is associated with >4 folds higher survival compared to ≤500 g. The results of this study should be cautiously interpreted as long-term outcomes are unknown.
Funding:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
