764 - Impact of improved survival of treated infants born less than 24 weeks gestational age on length of hospitalization and daily NICU bed occupancy over a six-year period (2019-2024)

Publication Number: 2745.764

Toni P. Iurcotta, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Sinead Brady, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Rakesh Sahni, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Care of periviable infants remains an ongoing challenge despite recent reports of improving survival for infants born at 22 to 24 weeks gestational age (GA). The impact of treatment at periviable birth and subsequent survival of these infants on neonatal intensive care unit (NICU) operations management has not been examined.

Objective: To evaluate the effect of changing patterns in the resuscitation, treatment, and survival of infants born at < 24 weeks GA on the length of hospitalization (LoH) for very low birth (VLBW) infants and percent daily bed occupancy (PDBO) in the NICU since offering NICU care to infants born at 22 weeks GA beginning in 2022.

Design/Methods: A retrospective review of data on all infants born < 24 weeks GA admitted to the level IV NICU at Columbia University Irving Medical Center between 2019 and 2024 was performed. In addition, data on annual LoH for VLBW infants and PDBO during the study period was extracted. These data were collected as part of NICU QI and Vermont Oxford Network registry submission, and thus the study was IRB-exempt. The effect of increasing treatment and survival following periviable birth over time on NICU logistics was evaluated using regression analysis.

Results: Over this six-year study period, no infants born < 20 weeks GA were admitted. Four infants born at 21 weeks GA were treated with palliative care. From 2022 to 2024, ten infants were born at 22 weeks GA, six of whom received intensive care. The % survival of these infants was 50% in 2022 and 67% in 2024. Of the infants born at 23 weeks GA who were treated with intensive care, % survival has ranged from 28.6% in 2019 to 100% in 2022 and 2023 (Table 1). The number of infants born < 24 weeks GA who were treated and survived increased significantly during the study period (r2=0.74, p=0.02). Within the same time frame, the LoH for VLBW infants increased from 50 days to 64 days (r2=0.96, p< 0.0001), and the PDBO in the NICU increased from 97 to 111% (r2=0.75, p=0.02) (Figure 2).

Conclusion(s): Following the integration of newer periviable birth management guidelines, the number and % survival of infants born at < 24 weeks GA who were treated with intensive care and survived significantly increased with each passing year. This was mirrored by significant increases in VLBW infant LoH and PDBO in each successive year. Though these relationships are correlative and not causative, recognizing these shifts in NICU logistics and census metrics can help inform the efficient coordination of NICU resource utilization for improving day-to-day operations.

Table 1
The number of infants born between 2019 and 2024 at 21-, 22-, and 23-weeks gestational age (GA), treated with palliative care ("comf care"), treated with intensive care and died, treated with intensive care and survived, and the percent survival of those treated with intensive care.

Figure 1
Annual trends in infants born <24 weeks from 2019 to 2024.

Figure 2
For 2019 to 2024, (a) the number of infants born at <24 weeks gestational age who were treated and survived; (b) the length of hospitalization (LoH, in days) of very low birth weight (VLBW) infants; (c) the neonatal intensive care unit (NICU) daily bed occupancy (in %).