Year: 2024
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: Assess temporal changes, intercenter variability, and birthing person (BP) factors relating to interventions for extremely early deliveries. METHODS: Retrospective study of BPs and newborns delivered from 22-24 completed weeks at 13 US centers from 2011-2020. Rates of neonatology consultation, antenatal corticosteroids, cesarean delivery, live birth, attempted resuscitation (AR), and survival were assessed by epoch, center, and gestational age. RESULTS: 2028 BPs delivering 2327 newborns were included. Rates increased in epoch 2-at 22 weeks: neonatology consultation (37.6 vs 64.3%, P < .001), corticosteroids (11.4 vs 29.5%, P < .001), live birth (66.2 vs 78.6%, P < .001), AR (20.1 vs 36.9%, P < .001), overall survival (3.0 vs 8.9%, P = .005); and at 23 weeks: neonatology consultation (73.0 vs 80.5%, P = .02), corticosteroids (63.7 vs 83.7%, P < .001), cesarean delivery (28.0 vs 44.7%, P < .001), live birth (88.1 vs 95.1%, P < .001), AR (67.7 vs 85.2%, P < .001), survival (28.8 vs 41.6%, P < .001). Over time, intercenter variability increased at 22 weeks for corticosteroids (interquartile range 18.0 vs 42.0, P = .014) and decreased at 23 for neonatology consultation (interquartile range 23.0 vs 5.2, P = .045). In BP-level multivariate analysis, AR was associated with increasing gestational age and birth weight, Black BP race, previous premature delivery, and delivery center. CONCLUSIONS: Intervention rates for extremely early newborns increased and intercenter variability changed over time. In BP-level analysis, factors significantly associated with AR included Black BP race, previous premature delivery, and center.
Source: PEDIATRICS
Authors: Danielle LoRe, Catherine M. Groden, Allison R. Schuh, Chondraah Holmes, Lorena Ostilla, Maggie M. Vogel, Peter D. Murray, Kelly Yamasato, Tiffany Tonismae, Uchenna E. Anani, Natalia Henner, Mobolaji Famuyide, Steven R. Leuthner, Naomi Laventhal, Bree Landis Andrews, Brownsyne M. Tucker Edmonds, Kathleen G. Brennan, Dalia M. Feltman, INVESTIGATING NEONATAL DECISIONS FOR EXTREMELY EARLY DELIVERIES (INDEED) STUDY GROUP
Institutions: Columbia University, University of Chicago, Children's Hospital of Wisconsin, Lurie Children's Hospital, Advocate Christ Medical Center, University of Virginia, University of Hawaiʻi at Mānoa, University of Hawaii System, Vanderbilt University, University of Mississippi Medical Center, University of Michigan, Indiana University Indianapolis, Endeavor Health, Evanston Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G2615776415, G9000054231, G95160140
OpenAlex ID: W4401519787