Trends in gestational age and short-term neonatal outcomes in the United States

To evaluate the association between shifts in gestational age (GA) at birth and the trends in assisted ventilation, neonatal intensive care unit (NICU) admissions, and neonatal antibiotic exposure in the United States (US).

We conducted a retrospective cross-sectional analysis of national livebirth data from the US Centers for Disease Control from 2016 through 2023. The outcomes were the rate (per 1,000 live births) of NICU admissions, assisted ventilation, surfactant administration, and neonatal exposure to antibiotics. We used linear regression for trend analysis.

Between 2016 and 2023, the average GA at birth and BW decreased from 38.5 to 38.3 (p<0.01) and from 3,267 to 3,240 gm (p<0.001), respectively. NICU admission rates increased from 87 to 98 (p<0.001). Assisted ventilation >6 h increased from 13.7 to 20.9 (p<0.001) but the change in surfactant administration was not significant (4.83-5.04; p=0.19). Neonatal exposure to antibiotics for suspected sepsis declined from 23 to 19 (p<0.001; R=0.95) despite an increase in maternal chorioamnionitis from 15.3 to 17.6 per 1,000 (p=0.02).

Between 2016 and 2023, GA and BW declined significantly, alongside increases in NICU admissions and respiratory morbidity. However, antibiotic exposure for neonatal sepsis declined significantly. The drivers behind these trends require further study.