Active Treatment of Infants Born at 22-25 Weeks of Gestation in California, 2011-2018

Abstract

To determine the rate and trend of active treatment in a population-based cohort of infants born at 22-25weeks of gestation and to examine factors associated with active treatment. This observational study evaluated 8247 infants born at 22-25weeks of gestation at hospitals in the California Perinatal Quality Care Collaborative between 2011 and 2018. Multivariable logistic regression was used to relate maternal demographic and prenatal factors, fetal characteristics, and hospital level of care to the primary outcome of active treatment. Active treatment was provided to 6657 infants. The rate at 22weeks was 19.4% and increased with each advancing week, and was significantly higher for infants born between days 4 and 6 at 22 or 23weeks of gestation compared with those born between days 0 and 3 (26.2% and 78.3%, respectively, vs 14.1% and 65.9%, respectively; P<.001). The rate of active treatment at 23weeks increased from 2011 to 2018 (from 64.9% to 83.4%; P<.0001) but did not change significantly at 22weeks. Factors associated with increased odds of active treatment included maternal Hispanic ethnicity and Black race, preterm premature rupture of membranes, obstetrical bleeding, antenatal steroids, and cesarean delivery. Factors associated with decreased odds included lower gestational age and small for gestational age birth weight. In California, active treatment rates at 23weeks of gestation increased between 2011 and2018, but rates at 22weeks did not. At 22 and 23weeks, rates increased during the latter part of the week. Several maternal and infant factors were associated with the likelihood of active treatment.