A National Analysis of Surgical Outcomes in Extremely Preterm Neonates Using the NSQIP-P Database

Area of Science:

• Neonatal surgery
• Perinatal outcomes
• Pediatric critical care

Background:

• Emergent surgeries in extremely preterm neonates pose significant risks.
• Gestational age (GA) is a critical factor influencing surgical outcomes in neonates.
• Understanding the impact of early GA on post-operative results is vital for clinical practice.

Purpose of the Study:

• To compare post-operative mortality and morbidity in neonates born at 22-24 weeks GA versus 25-26 weeks GA after emergent surgery.
• To determine the association between gestational age and adverse post-operative outcomes.
• To inform strategies for improving surgical care in extremely preterm infants.

Main Methods:

• Utilized the Pediatric National Surgical Quality Improvement Project (NSQIP-P) database (2012-2024).
• Included infants born between 22-26 weeks GA undergoing emergent surgery within 60 days of life.
• Employed logistic regression to analyze 30-day post-operative outcomes and the association with GA.

Main Results:

• Infants born at 22-24 weeks GA (46.7%) had higher mortality (25.0%) and complication rates (42.2%) than those born at 25-26 weeks GA (19.7% mortality, 35.3% complications).
• Multivariable analysis revealed 1.23 times higher odds of mortality and 1.30 times higher odds of complications for the 22-24 weeks GA group after exploratory laparotomy.
• A total of 2,998 extremely preterm infants were included in the analysis.

Conclusions:

• Neonates born at 22-24 weeks GA have a significantly increased likelihood of death and post-operative complications following emergent operations compared to those born at 25-26 weeks GA.
• The rising incidence of births at younger gestational ages necessitates novel research to enhance outcomes for this vulnerable population.
• These findings underscore the need for specialized care protocols for extremely preterm infants undergoing surgery.