National Survival Rates among 22-Week Live Births in the United States: Associations with Active Treatment

This study aimed to evaluate the impact of Active Perinatal Treatment (AT) for 22-week live births on national 1-year survival trends to guide clinical decisions and counseling.

We utilized U.S. natality data (2019-2022) to identify a cohort of non-anomalous, singleton live births at 22 weeks' gestation. The cohort was divided into two groups: AT and Non-Active Perinatal Treatment (Non-AT). AT was defined as receiving more than one of the following: Antenatal corticosteroids, cesarean delivery, neonatal intensive care unit (NICU) admission, neonatal antibiotics, surfactant, or mechanical ventilation (immediate or for >6 hours). Maternal and neonatal outcomes were compared between the two groups, and a Cox proportional hazards model adjusted for maternal age, race, education, prepregnancy medical history, and birth weight was used to assess adjusted hazard ratios (aHRs) for mortality within the first year of life. A subanalysis was performed to compare the neonatal and postneonatal survival rates among the two groups and over time.

Of the 4,994 live births at 22 weeks, 2,769 (55.4%) received AT, and 2,225 (44.6%) were in the Non-AT group. One-year survival rate for the AT group was estimated at 34% compared with 8.6% in the Non-AT group. AT reduced the mortality hazard by 63% during the first year of life (aHR = 0.37; 95% CI: 0.34-0.39, p < 0.001). From 2019 to 2022, AT use increased from 49.8% to 63.9%, paralleled by improved survival (p < 0.003). Neonatal and postneonatal survival rates were higher with AT compared with the Non-AT for each year (p < 0.001).

Active treatment at 22 weeks significantly improves the 1-year survival. Its rising national use reflects growing clinical acceptance and highlights a potential shift in the threshold of viability in U.S. neonatal care.

· U.S. national data were used to evaluate one-year survival rates among infants born at the threshold of viability who received proactive care.. · One-year survival was significantly higher for 22-week live births that received active perinatal treatment.. · Active treatment was associated with a 63% reduction in the risk of one-year mortality among live births at 22 weeks of gestation.. · The study observed an increase in the utilization of active treatment for 22-week live births in the U.S. between 2019 and 2022..