Variability of Care Practices for Extremely Early Deliveries

Area of Science:

• Perinatology and Neonatal Medicine
• Reproductive Health Outcomes
• Public Health and Epidemiology

Background:

• Extremely early deliveries (22-24 weeks gestation) represent a high-risk obstetric and neonatal challenge.
• Understanding temporal trends and factors influencing interventions is crucial for improving outcomes.
• Intercenter variability in care practices may impact survival rates for extremely preterm neonates.

Purpose of the Study:

• To evaluate changes over time in interventions for extremely early deliveries (22-24 weeks gestation).
• To assess variability in care practices across different US centers.
• To identify birthing person (BP) factors associated with interventions, specifically attempted resuscitation (AR).

Main Methods:

• Retrospective analysis of 2028 birthing persons and 2327 newborns delivered between 22-24 weeks gestation.
• Data collected from 13 US centers spanning the years 2011-2020, divided into two epochs.
• Assessment of rates for neonatology consultation, antenatal corticosteroids, cesarean delivery, live birth, attempted resuscitation (AR), and survival, analyzed by epoch, center, and gestational age.

Main Results:

• Significant increases in interventions and live birth rates were observed between epochs for 22- and 23-week gestations.
• At 22 weeks, AR rates rose from 20.1% to 36.9%, and survival from 3.0% to 8.9%.
• Multivariate analysis identified Black BP race, previous premature delivery, and delivery center as significant factors associated with attempted resuscitation (AR).

Conclusions:

• Intervention rates for extremely preterm newborns have increased, alongside changes in intercenter variability.
• Temporal trends show improved outcomes, but disparities persist.
• Birthing person race (Black), history of premature delivery, and delivery center are key factors influencing resuscitation efforts for extremely early births.