356 - Intensive Care of Infants Born at 22-24 Weeks Gestation who Die During Initial Hospitalization in the US, 2008-2022

Publication Number: 356.5216

Mir A. Basir, Medical College of Wisconsin, Wauwatosa, WI, United States; Siobhan M. McDonnell, Medical College of Wisconsin, Milwaukee, WI, United States; Dinushan Kaluarachchi, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Scott A.. McDonald, RTI International, Raleigh, NC, United States; Ravi M. Patel, Emory University & Children's Healthcare of Atlanta, Atlanta, GA, United States; Colm P. Travers, University of Alabama at Birmingham, Birmingham, AL, United States; Noelle Younge, Duke University School of Medicine, Durham, NC, United States; Abhik Das, RTI International, North Potomac, MD, United States; Matthew Rysavy, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; NICHD Neonatal Research Network, National Institute of Child Health and Human Development, Bethesda, MD, United States

Background: Intensive care (IC) for infants born at 22-24 weeks gestation has increased.

Objective: We hypothesize that 22-24 week infants who receive IC: (1) now undergo more surgeries prior to dying than in the past, and (2) now survive longer prior to dying than in the past. Understanding these IC trends may inform medical decisions.

Design/Methods: We analyzed prospectively collected data from 2008-2022 for inborn infants at 21 academic centers in the Neonatal Research Network (NRN). Infants with congenital anomalies or transfers were excluded. Among infants receiving IC who died, we compared the number of surgeries per 100 infants and median days of survival over time using Poisson regression and median regression, respectively. Regressions were adjusted for center, prenatal care, infant sex, plurality, gestational age, small for gestational age, and maternal age, diabetes, and hypertension. Sensitivity analysis was conducted with only the continuously participating hospitals.

Results: Of 7,537 infants inborn from 2008-2022, 6,057 (80%) received IC and 2,573 died with IC. Figure 1 presents rates of death with and without IC, and survival with IC. Of infants who died with IC, 665 (26%) died within 12 hours, with no surgery data collected. Among the 1,908 infants who died after 12 hours, 396 (21%) had surgery. Figure 2 presents data on the use of IC, survival, and surgery for all 7,537 infants. The number of surgeries among infants who received IC and died increased from 35/100 infants in 2008-2012 to 47/100 in 2018-2022 (RR 1.41; 95% CI: 1.06, 1.86), with parallel increases in surviving infants, Table 1. Most surgeries (78%) were for necrotizing enterocolitis or spontaneous intestinal perforation. Median (IQR) postnatal age in days of first surgery for infants who died decreased from 21 (10-40) in 2008-2012 to 14 (8-28) in 2013-2017 to 12 (7-26) in 2018-2022. Median (IQR) days of survival for infants who died with IC decreased from 11 (4-16) in 2008-2012 to 10 (3-22) in 2018-2022, adjusted median difference -2.0; 95% CI (-3.55, -0.45). These infants spent 93% of their hospitalization on mechanical ventilation and 87% on parenteral nutrition. Results were consistent among the continuously participating hospitals.

Conclusion(s): Surgeries among 22-24 week infants receiving IC who died increased significantly from 2008-2022, with surgery for necrotizing enterocolitis and spontaneous intestinal perforation accounting for most surgeries. Days of survival decreased over time in infants who died with IC. Information on the processes and outcomes of IC among infants who die is needed to make informed decisions.

Figure 1.
Figure 1_10.23.2024.pdfRates of infant intensive care and survival by gestational age and epoch

Figure 2.
Figure 2_10.23.2024.pdfUse of intensive care, infant survival, and surgery among 22-24 week gestational age infants inborn at NRN centers from 2008-2022.

Table 1.
Table 1_10.23.2024.pdfNumber of surgeries by type, survival status, and epoch