Xuxin Chen1, Tianyao Lu2, Jeffrey Gould2, Susan R Hintz2, Deirdre J Lyell3, Xiao Xu4, Lillian Sie2, Matthew Rysavy5, Alexis S Davis2, Henry C Lee2. 1. Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA. Electronic address: chenx13@stanford.edu. 2. Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA. 3. Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA. 4. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT. 5. Division of Neonatology, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA; Division of Neonatology, Department of Pediatrics, University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX.
Abstract
OBJECTIVE: To determine the rate and trend of active treatment in a population-based cohort of infants born at 22-25 weeks of gestation and to examine factors associated with active treatment. STUDY DESIGN: This observational study evaluated 8247 infants born at 22-25 weeks 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. RESULTS: Active treatment was provided to 6657 infants. The rate at 22 weeks was 19.4% and increased with each advancing week, and was significantly higher for infants born between days 4 and 6 at 22 or 23 weeks 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 23 weeks increased from 2011 to 2018 (from 64.9% to 83.4%; P < .0001) but did not change significantly at 22 weeks. 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. CONCLUSIONS: In California, active treatment rates at 23 weeks of gestation increased between 2011 and 2018, but rates at 22 weeks did not. At 22 and 23 weeks, rates increased during the latter part of the week. Several maternal and infant factors were associated with the likelihood of active treatment.
OBJECTIVE: To determine the rate and trend of active treatment in a population-based cohort of infants born at 22-25 weeks of gestation and to examine factors associated with active treatment. STUDY DESIGN: This observational study evaluated 8247 infants born at 22-25 weeks 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. RESULTS: Active treatment was provided to 6657 infants. The rate at 22 weeks was 19.4% and increased with each advancing week, and was significantly higher for infants born between days 4 and 6 at 22 or 23 weeks 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 23 weeks increased from 2011 to 2018 (from 64.9% to 83.4%; P < .0001) but did not change significantly at 22 weeks. 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. CONCLUSIONS: In California, active treatment rates at 23 weeks of gestation increased between 2011 and 2018, but rates at 22 weeks did not. At 22 and 23 weeks, rates increased during the latter part of the week. Several maternal and infant factors were associated with the likelihood of active treatment.
Authors: Joseph W Kaempf; Mark Tomlinson; Cindy Arduza; Shelly Anderson; Betty Campbell; Linda A Ferguson; Mara Zabari; Valerie T Stewart Journal: Pediatrics Date: 2006-01 Impact factor: 7.124
Authors: Brownsyne Tucker Edmonds; Teresa A Savage; Robert E Kimura; Sarah J Kilpatrick; Miriam Kuppermann; William Grobman; Karen Kavanaugh Journal: J Matern Fetal Neonatal Med Date: 2017-11-05
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