1169: THE EPIDEMIOLOGY AND OUTCOMES OF NEONATAL IN-HOSPITAL CARDIAC ARREST IN THE US DURING 2000-2019

Abstract

Introduction: The primary objective was to evaluate the trend in the prevalence of in-hospital cardiac arrest (IHCA) and mortality among neonates in the U.S. between 2000 and 2019 using the Kids’ Inpatient Database (KID). Our secondary objective was to assess the influence of gestational age (GA). Methods: Neonates (< 29 days at the time of admission) in KID databases published in 2000, 2003, 2006, 2009, 2012, 2016, and 2019 were included in the study. Neonates who were transferred to another acute care hospital were excluded. IHCA was identified by ICD-9 or ICD-10 procedure codes for cardiopulmonary resuscitation. GA was grouped into extreme prematurity (EP; < 29 weeks), prematurity (P; 29-36 weeks), and term (T; >36 weeks). All analyses involving GA included neonates from 2003-2019. Linear trends were analyzed using the Extended Mantel-Haenszel test. The prevalence in each calendar year was adjusted for GA using binary regression analysis. For the national prevalence of IHCA, total yearly births in the U.S. were used. Results: The overall IHCA prevalence was 7.8 per 10,000 discharges and 6.62 per 10,000 live births in the U.S. The trend increased from 2000 to 2019 (p< 0.001). Most IHCA (72%) occurred on the day of admission. IHCA was more common in Black male infants, lower GA, urban teaching, and children’s hospitals (p< 0.05). Necrotizing enterocolitis and intraventricular hemorrhage were more often associated with IHCA (p< 0.001). The overall mortality rate for IHCA was 43.5%, and mortality increased from 34.7% in 2000 to 48% in 2019 (p< 0.001). In neonates with IHCA, extreme prematurity was present at 11% in 2003 and increased to 18.8% in 2019 (p< 0.001). The mortality rates for EP, P, and T neonates with IHCA were 72.8%, 39.6%, and 29.8%, respectively (p< 0.001). After adjusting for GA, the prevalence of IHCA was significantly higher from 2012 onwards (p< 0.05), and the mortality rate was higher in 2019 compared to 2003 (p=0.005). Conclusions: The prevalence of IHCA and associated mortality rate increased from 2000 to 2019 in neonates in the U.S. The increased prevalence of lower GA babies in IHCA may account for the increased mortality trend. A majority of IHCA occurring on the day of admission provides an opportunity for improvement in healthcare services in the delivery room.