Survival, Resuscitation and Morbidities in Extremely Preterm Infant – A Retrospective Cohort Study [23C

Abstract

INTRODUCTION: This study aims to evaluate survival to discharge, resuscitation, predictors of survival and short-term morbidities of preterm babies born at less than 24 weeks. METHODS: We conducted a retrospective cohort study using the Nationwide Inpatient Sample-Healthcare Cost and Utilization Project database. We evaluated the neonatal outcomes of all live birth admissions of less than 24 weeks from 2003-2011, excluding newborns with known congenital malformation. We used multivariate logistic regression to estimate the predictors of survival and intact survival in (1) all resuscitated newborn less than 24 weeks and in (2) resuscitated and survived infants. RESULTS: There were 9,644 live births that met study criteria, of which 76% were not resuscitated and 24% were resuscitated. The survival rate among resuscitated infants was 42.86%, while the overall survival rate to discharge among non-resuscitated infants was 10.27%. Mortality was highest in the first 2 days of life. The incidence of intraventricular hemorrhage was 13.62%, respiratory distress syndrome was 65.79%, and necrotizing enterocolitis was 0.91%. The rate of intact survival was 31.89 % in resuscitated newborn less than 24 weeks of gestation. Birth weight greater than 500g and urban non-teaching hospitals were positive predictors of survival, with an adjusted OR of 1.46 (95% CI 1.12-1.90) and OR of 1.71(95% CI 1.43-2.06), respectively. CONCLUSION: Mortality and morbidity of extremely preterm infants born at less than 24 weeks of gestation is high. However, selected extremely preterm newborns can be viable without major short-term morbidity. Providing patient counseling requires up-to-date estimates of the health outcomes in extremely preterm births.