105 - Surgery in Extremely Preterm Neonates Are Associated with Reduced Mortality

Publication Number: 2100.105

Lena S. Sun, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Ann Kim, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Neonates who undergo surgery have a greater risk of mortality compared with those who did not have any surgical procedures.1,2 Prematurity has been shown to increase the risk of mortality in neonatal surgical patients.. However, risks of mortality stratified by gestational age in the neonatal surgical population have not been well characterized.

Objective: The objective of this study is to examine mortality in the preterm infant surgical population based on their gestational age.

Design/Methods: This study was approved by Columbia University IRB. Data are NICU discharges from 2012 and 2023 in PHIS database. Preterm neonates (PRET) were grouped based on gestational age (GA): Extreme Preterm (EP): < 28 weeks GA, Very Preterm (VP): 28-31 weeks GA, and Late Preterm (LP): 32-36 weeks GA. Data were analyzed by ANOVA (continuous), Chi-square tests (categorical). Logistic regression analyses assessed GA groups and mortality as the outcome, adjusting for birthweight, sex and race. R was used for all analyses. P< 0.05 was deemed significant.

Results: A total 374,018 neonates (ALL) were included in the analysis, 185,293 (49.5%) were PRET and 188,725 (50.5 %) were full term (FT). Among PRET, 15.4% (n=28,537) was EP, 18.5% (n=34,191) was VP and 66.1% (n=188,725) was LP. There were 56,781 (15.2%) neonates who had one or more major operative procedures (Surg). 16.7% of PRET (n=30,877) and 13.7% of FT (n=25,904) had Surg. Among Surg, 54.4% were PRET and 45.6% were FT. Among PRET, 38.7% was EP, 17.3% was VP and 44.1% was LP. Within GA groups, 41.9% EP, 15.6% VP and 11.1% LP had Surg. Isolated PDA ligation was 5.7% and 8.4% of Surg in PRET and FT, respectively

Neonatal (ALL) mortality was 3.6% (n=13,412). PRET mortality (5.4%, n=9,949) was higher than FT (1.8%, n=3,463), p< 0.05. Among Surg, mortality was higher (ALL= 6.8%, FT=3.8%, PRET=9.3%, VP=10.7%, LP=6.9%) than those without procedures (non-Surg) (ALL=3.0%, FT=1.5%, PRET=4.6%, VP=4.0%, LP=2.0%), p< 0.05. Among EP, mortality was higher in non-Surg (22.8%) than Surg (11.5%), p< 0.05. PDA ligations did not significantly change mortality in any of the groups.

Conclusion(s): Mortality is gestational-age dependent in neonates, and PRET have a higher risk of mortality compared to FT. While surgery increases mortality in full term, but not in all groups of PRET neonates. In EP who underwent major operative procedures have lower mortality than those who had no procedures. These patterns remain the same if isolated PDA ligations were excluded as a major operative procedure. Thus, in EP, operative procedures may have a “protective” effect, and further investigations are needed.