758 - Resource Utilization and Survival between 22-24 weeks gestational age: A Focus on Perinatal Strategies for Improvement

Publication Number: 2739.758

Bree Andrews, University of Chicago, Chicago, IL, United States; Theiju Sebastian, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Hinsdale, IL, United States

Background: There is potential concern about the impact of resources used at the border of gestational viability due to lower survival rates for infants born and resuscitated at 22-25 weeks.

Objective: Analyze the influence of antenatal corticosteroids and cesarean delivery on NICU survival outcomes and resource use in infants born at 22-24 weeks’ gestation.

Design/Methods: Data from six tertiary care perinatal-centers were extracted from the Vermont Oxford Network Nightengale site based on both the IRB approval and VON administrative requirements. Outcomes and total length of stay were delineated based on mode of delivery and availability or treatment with antenatal corticosteroids. Mann–Whitney U, Kruskal–Wallis, Fisher’s Exact, and logistic regression via STATA were used to analyze results.

Results: A total of 1,172 infants were evaluated in this study born between 2015-2020. 83% of infants received antenatal corticosteroids and 69% were delivered. by cesarean section.. The survival rate amongst steroid exposed and unexposed infants at each GA is shown in Figure 1. The median total LOS for each group of survivors plus non survivors stratified by steroid administration is shown in Figure 2. Steroid-exposed infants were 3.26 times more likely to survive than non-steroid exposed infants. Cesarean delivery conferred a 2.25 times higher survival rate in an unadjusted model yet this improvement fell out in the logistic regression. Not surprisingly, gestational age and steroid use predict survival in the logistic regression.

Conclusion(s): Resource use for non-survivors at 22, 23, 24 weeks estimated gestational age is quite small making the relative contribution of resources used to resuscitate and treat 22 week infants in this population comparatively small . Accordingly, when total resource use is calculated by LOS for each GA group, 24 week infants use the most medical resources based on survival. Gestational age and steroid use are major predictors of improved survival while cesarean-section is not. The biggest gains in survival in this time period were amongst those who received steroids, a perinatal strategy that improves outcomes if parents chose resuscitation at the border of viability.

Figure 1: Survival based on Gestational Age and Steroid Administration from 22-25 wks Figure 2: Median LOS by GA and steroid administration for Survivors and Non-survivors.
figures1.pdf