WIP 12 - Mortality and morbidity of neonates born at 22 and 23 weeks gestation at a single center

Publication Number: WIP 12.7549

Ashlee N. Smith-Patel, Baylor College of Medicine, Houston, TX, United States; Shweta Parmekar, Baylor College of Medicine, Houston, TX, United States; George Mandy, Baylor College of Medicine, Houston, TX, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Nathan C.. Sundgren, Baylor College of Medicine, Houston, TX, United States; Monika Patil, Baylor College of Medicine, Houston, TX, United States

Background: With advances in neonatal care, the survival of extremely preterm infants has been steadily improving over the last few decades. While extremely preterm births constitute a small proportion of all births worldwide, they contribute to a large portion of perinatal death and morbidity. Currently, there is a paucity of evidence on the optimal care practices for preterm infants born at 22 and 0/7 to 23 and 6/7 weeks gestation (referred to as “ultra-low gestational age newborns” [ULGANs] in this study), and thus there is high variability on outcomes of these patients across centers worldwide. This institutional variability in ULGAN care practices and outcomes highlights the need for additional evidence.

Objective: The objective of this study is to evaluate the mortality and major morbidities of ULGANs before and after implementation of institution-specific novel care guidelines at a single quaternary center in January 2023. We hypothesize that the novel care guidelines have improved mortality and morbidity in ULGAN patients since January 2023.

Design/Methods: This is a retrospective analysis of ULGANs admitted to a single newborn center from January 1, 2021 – December 31, 2024. Institutional review board approval was obtained. Data collection is currently ongoing. Exclusion criteria includes infants with major congenital anomalies, outborn infants, and infants born in 2023 and 2024 who were still admitted to the NICU at time of analysis. The primary outcome will be mortality before hospital discharge in ULGANs who were actively resuscitated. Secondary outcomes will include major morbidities including bronchopulmonary dysplasia, necrotizing enterocolitis, severe intraventricular hemorrhage (grade 3-4), periventricular leukomalacia, retinopathy of prematurity, oxygen requirement at discharge, need for conventional ventilation at discharge, and length of initial hospital stay. Fisher’s exact test and Wilcoxon rank sum test will be utilized for analysis.