A national analysis of surgical outcomes in extremely preterm neonates using the NSQIP-P database

The aim of this study was to compare outcomes of neonates born at 22-24 weeks of gestational age (GA) to those born at 25-26 weeks GA after emergent surgeries to determine the association between GA and post-operative mortality and morbidity.

This study was conducted using Pediatric National Surgical Quality Improvement Project (NSQIP-P) data from 2012 to 2024 and included infants born GA 22-26 weeks who had emergent surgery within the first 60-days of life. Thirty-day post-operative outcomes of morbidity and mortality were compared between those born GA 22-24 and 25-26. Logistic regression models assessed the association between GA and postoperative mortality and morbidity among those who had an emergent exploratory laparotomy.

Of 2998 extremely preterm infants, 46.7% (n = 1399) patients were born at a GA 22-24 weeks and 53.3% (n = 1599) at 25-26 weeks. Infants of GA 22-24 weeks had a 25.0% post-operative mortality rate and 42.2% post-operative complications rate, compared to infants of GA 25-26 weeks, who had a 19.7% post-operative mortality rate and 35.3% post-operative complication rate. Multivariable regression models indicated 1.23 times higher odds of post-operative mortality after exploratory laparotomy for GA 22-24 weeks than GA 25-26 weeks, and 1.30 times higher odds of post-operative complications among those born GA 22-24.

Neonates born at GA 22-24 had a higher likelihood of death or complications after emergent operations compared to those born at 25-26 weeks. With more patients being born at younger GA, new research is required to improve outcomes in this unique population.