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The Landscape of Resource Utilization After Resuscitation of 22-, 23-, and 24-Weeks' Gestation Infants

Cassandra C Daisy1, Camille Fonseca2, Allison Schuh2

  • 1The University of Chicago Pritzker School of Medicine, Chicago, IL.

The Journal of Pediatrics
|March 29, 2024
PubMed

Insights

Infants born at 22 weeks gestation do not require disproportionately more hospital resources than 23- and 24-week infants. These findings support resuscitation for 22-week infants, regardless of resource concerns.

Area of Science:

  • Neonatal Medicine
  • Perinatology
  • Pediatric Critical Care

Background:

  • Infants born at the threshold of viability (22-24 weeks gestation) present unique challenges in resource allocation.
  • Previous assumptions about high resource utilization for extremely preterm infants may influence clinical decisions regarding resuscitation.

Purpose of the Study:

  • To compare the estimated healthcare resources required for infants born at 22, 23, and 24 weeks gestation.
  • To inform resuscitation guidelines for extremely preterm infants by evaluating resource utilization.

Main Methods:

  • A multicenter, retrospective cohort study of 1505 infants (22-24 weeks gestation) from 2011-2020.
  • Neonatal intensive care unit (NICU) length of stay (LOS) served as a proxy for hospital resource utilization.
  • Comorbidities and medical technology use estimated future care needs.

Main Results:

  • Twenty-two-week infants had shorter median LOS than 23- and 24-week infants, primarily due to lower survival rates.
  • Surviving 22-week infants showed no significant difference in LOS compared to surviving 23-week infants.
  • Proportions of comorbidities and medical technology use were similar between surviving 22- and 23-week infants.

Conclusions:

  • Twenty-two-week infants do not consume a disproportionate amount of hospital resources compared to 23- and 24-week infants.
  • Resuscitation decisions for 22-week infants should not be based on concerns about increased hospital care or technology requirements.
  • Further research is needed to evaluate evolving resource needs as resuscitation and survival rates for 22-week infants improve.
Abstract

Keywords:
border of viabilitylength of staymorbiditiesneonatology

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