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Q&A

Prematurity

Poster Session 3

(731) Nationwide Trends in Periviable Preterm Birth Interventions

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Ernesto Licon, MD

    Maternal-Fetal Medicine Fellow
    University of California Irvine
    Pasadena, CA, United States

    • Coauthor(s)

  • MC

    Melissa Chambers, MD

    University of California Irvine
    Whitter, CA, United States

  • JC

    Jenny Chang, MPH

    University of California Irvine School of Medicine
    Irvine, CA, United States

  • FB

    Fayez Bany-Mohammed, MD

    Clinical Professor, Division of Neonatology, Pediatrics School of Medicine
    University of California Irvine
    Irvine, CA, United States

  • Afshan B. Hameed, MD

    Professor Maternal Fetal Medicine & Cardiology
    UCI
    Orange, CA, United States

  • Judith H. Chung, PhD,MD,PhD

    Professor of Clinical Obstetrics and Gynecology
    UC Irvine Health
    Orange, CA, United States

Objective:

To examine differences in periviable preterm birth interventions in neonates born in 2021 compared to 2016 in the United States after implementation of the Obstetrics Care Consensus guidelines (introduced in 2015 with most recent revisions made in 2017).

Study Design:

This study is a retrospective analysis of the National Vitals Statistics Database, comparing obstetric (corticosteroids and cesarean delivery) and neonatal interventions (ventilation, surfactant use, NICU admission) for periviable preterm births (22 to 25 weeks’ gestation)  in the years 2016 and 2021. Adjusted odds ratios and 95% confidence intervals were calculated for the outcomes of interest, using the year 2016 as the reference group.

Results:

Table 1 presents a comparison of birth characteristics for the years 2016 and 2021. In 2016, preterm births accounted for 11.4% (450,225 cases). Among the preterm births, 15,668 (447/1000 births) were categorized as periviable births (between 22 to 25 weeks gestation). In 2021, preterm births slightly increased to 12.3% (450,318). Periviable births numbered 13,689 (425/1000 births), showing a small decrease compared to 2016. Table 2 provides the adjusted odds ratios for various outcomes in the year 2021 when compared to 2016 (reference group). Use of Corticosteroids for Fetal Lung Maturity showed an odds ratio of 1.51 (CI: 1.42-1.60) in 2021 and the odds of Cesarean Section rose to 1.20 (CI: 1.13-1.27) in 2021 compared to the reference year 2016. Additionally, the odds of Immediate-Assisted Ventilation were 1.35 times higher in 2021 compared to 2016, with a 95% CI of (1.27-1.43). Furthermore, the odds of Assisted ventilation exceeding 6 hours increased to 1.30 (CI: 1.22-1.38), NICU Admission to 1.31 (CI: 1.23-1.40), and Surfactant Use to 1.18 (CI: 1.10-1.27) in 2021.

Conclusion:

These findings suggest that neonatal care interventions and medical practices for periviable preterm births have undergone substantial changes between 2016 and 2021. Further study is warranted to understand how current management of periviable preterm births impacts long term maternal and neonatal health outcomes.