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Neonatology

Poster Session 2

(585) Association of Hospital Volume with Mode of Delivery and Neonatal Outcome Among Periviable Births

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Delivery of a pregnancy in the periviable period should ideally occur at a center with a level III-IV neonatal intensive care unit, level III-IV maternal care designation, or both. Transfer before delivery has been associated with improved neonatal outcomes compared to postnatal transport1; however, antenatal transport is not always feasible depending on the clinical scenario. The purpose of this study is to determine the association between hospital delivery volume and neonatal outcomes with periviable deliveries.

Study Design: Retrospective cohort study using a maternal-infant linked database of live births in the state of Florida from 2006 to 2019. Singleton deliveries of infants born at 22w0d to 25w6d in which neonatal resuscitation was attempted were included. We compared neonatal mortality and morbidity between deliveries occurring at lower-volume hospitals (defined as less than 2,000 deliveries per year) and higher-volume hospitals (greater than or equal to 2,000 deliveries per year).

Results: We identified a total of 6,958 periviable live births who had resuscitation during the study period. As expected, the majority of periviable deliveries occured at higher-volume delivery hospitals (n=5,585, 84.2%). Infants born during the periviable period at lower-volume hospitals had higher mortality rates, with 13.5%, 26.9%, 35.7%, and 42.2% mortality at 24-hour, 7-day, 28-day, and 1-year of life respectively. Higher-volume hospitals exhibited mortality of 8.6%, 19.6%, 29.3%, and 36.7% at the same time intervals. Overall, neonatal morbidity outcomes were clinically similar between the two groups (Table 1).

Conclusion: The majority of periviable deliveries occur at higher-volume hospitals, with lower rates of neonatal mortality across multiple time points when compared to lower-volume hospitals. Further research is needed to optimize support for neonates born in the periviable period at lower-volume centers when antenatal transfer is logistically challenging.