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Resuscitation, survival and morbidity of extremely preterm infants in California 2011-2019
Brennan V Higgins1, Rebecca J Baer2,3, Martina A Steurer4,2,5
1Division of Neonatology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA. Brennan.higgins@ucsf.edu.
Insights
Resuscitation and survival rates for extremely preterm infants (born ≤28 weeks) have significantly improved over time. Morbidity has decreased, particularly for 28-week infants, offering better outcomes for periviable births.
Area of Science:
- Neonatal Medicine
- Perinatal Epidemiology
- Public Health
Background:
- Extremely preterm infants (born ≤28 weeks gestation) face significant survival and morbidity challenges.
- Understanding temporal trends in their care is crucial for improving outcomes.
Purpose of the Study:
- To analyze changes in resuscitation practices, survival rates, and morbidity among extremely preterm infants in California.
- To evaluate these trends across two distinct time periods (2011-2014 and 2015-2019).
Main Methods:
- Retrospective cohort study utilizing linked birth certificates and hospital discharge records.
- Inclusion criteria: infants born at or before 28 weeks gestation.
- Analysis of active resuscitation, survival to discharge, and major morbidity.
Main Results:
- Active resuscitation rates increased significantly over time for infants born at 22, 23, and 25 weeks gestation.
- Survival to discharge improved substantially with increasing gestational age, from 33.2% at 22 weeks to 96.1% at 28 weeks.
- Morbidity-free survival showed improvement over time, especially for infants born at 28 weeks gestation.
Conclusions:
- Resuscitation and survival rates for extremely preterm infants increase with gestational age, while morbidity decreases.
- Temporal analysis reveals increased active resuscitation for periviable infants and improved morbidity-free survival for 28-week infants.
- These findings provide valuable data for counseling families regarding the outcomes of extremely preterm birth.
Objective:
To describe changes over time in resuscitation, survival, and morbidity of extremely preterm infants in California.
Study Design:
This population-based, retrospective cohort study includes infants born ≤28 weeks. Linked birth certificates and hospital discharge records were used to evaluate active resuscitation, survival, and morbidity across two epochs (2011-2014, 2015-2019).
Results:
Of liveborn infants, 0.6% were born ≤28 weeks. Active resuscitation increased from 16.9% of 22-week infants to 98.1% of 25-week infants and increased over time in 22-, 23-, and 25-week infants (p-value ≤ 0.01). Among resuscitated infants, survival to discharge increased from 33.2% at 22 weeks to 96.1% at 28 weeks. Survival without major morbidity improved over time for 28-week infants (p-value < 0.01).
Conclusion:
Among infants ≤28 weeks, resuscitation and survival increased with gestational age and morbidity decreased. Over time, active resuscitation of periviable infants and morbidity-free survival of 28-week infants increased. These trends may inform counseling around extremely preterm birth.
