Faculty Collaboration Database

Variability of Care Practices for Extremely Early Deliveries. Pediatrics 2024 Sep 01;154(3)

Date

08/12/2024

Pubmed ID

39129496

Pubmed Central ID

PMC11350101

DOI

10.1542/peds.2023-065521

Scopus ID

2-s2.0-85202984223 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

OBJECTIVES: Assess temporal changes, intercenter variability, and birthing person (BP) factors relating to interventions for extremely early deliveries.

METHODS: Retrospective study of BPs and newborns delivered from 22-24 completed weeks at 13 US centers from 2011-2020. Rates of neonatology consultation, antenatal corticosteroids, cesarean delivery, live birth, attempted resuscitation (AR), and survival were assessed by epoch, center, and gestational age.

RESULTS: 2028 BPs delivering 2327 newborns were included. Rates increased in epoch 2-at 22 weeks: neonatology consultation (37.6 vs 64.3%, P < .001), corticosteroids (11.4 vs 29.5%, P < .001), live birth (66.2 vs 78.6%, P < .001), AR (20.1 vs 36.9%, P < .001), overall survival (3.0 vs 8.9%, P = .005); and at 23 weeks: neonatology consultation (73.0 vs 80.5%, P = .02), corticosteroids (63.7 vs 83.7%, P < .001), cesarean delivery (28.0 vs 44.7%, P < .001), live birth (88.1 vs 95.1%, P < .001), AR (67.7 vs 85.2%, P < .001), survival (28.8 vs 41.6%, P < .001). Over time, intercenter variability increased at 22 weeks for corticosteroids (interquartile range 18.0 vs 42.0, P = .014) and decreased at 23 for neonatology consultation (interquartile range 23.0 vs 5.2, P = .045). In BP-level multivariate analysis, AR was associated with increasing gestational age and birth weight, Black BP race, previous premature delivery, and delivery center.

CONCLUSIONS: Intervention rates for extremely early newborns increased and intercenter variability changed over time. In BP-level analysis, factors significantly associated with AR included Black BP race, previous premature delivery, and center.

Author List

LoRe D, Groden CM, Schuh AR, Holmes C, Ostilla L, Vogel MM, Murray PD, Yamasato K, Tonismae T, Anani UE, Henner N, Famuyide M, Leuthner SR, Laventhal N, Andrews BL, Tucker Edmonds BM, Brennan KG, Feltman DM, INVESTIGATING NEONATAL DECISIONS FOR EXTREMELY EARLY DELIVERIES (INDEED) STUDY GROUP

Author

Steven R. Leuthner MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenal Cortex Hormones
Cesarean Section
Female
Gestational Age
Humans
Infant, Extremely Premature
Infant, Newborn
Live Birth
Male
Neonatology
Practice Patterns, Physicians'
Pregnancy
Premature Birth
Referral and Consultation
Resuscitation
Retrospective Studies
United States