763 - A Novel Care Model for Extremely Preterm Infants at Altitude: Early Outcomes from Program Implementation

Publication Number: 2744.763

Igor Shumskiy, University of Colorado School of Medicine, Denver, CO, United States; Laurie Sherlock, Children's Hospital Colorado, Aurora, CO, United States; Satya Houin, University of Colorado School of Medicine, Aurora, CO, United States; James s. Barry, University of Colorado School of Medicine, centennial, CO, United States; Emilee Carr, University of Colorado School of Medicine, Aurora, CO, United States; Allison Matti, University of colorado Anschutz Medical Campus, Arvada, CO, United States; Laura Marrs, University of Colorado School of Medicine, Aurora, CO, United States

Background: Care of extremely preterm infants (22-23 weeks' gestation, wga) varies nationally and by center. National data suggests survival to discharge/1-year of life is 30% at 22 wga and 55% at 23 wga with high morbidity among survivors. Despite this, some data suggests outcomes for 22-23 wga infants is not significantly different than those for 24-25 wga infants. High altitude is linked to lower birthweight and pulmonary vascular changes, which could impact extremely preterm outcomes, yet survival rates and morbidity outcomes for this cohort at altitude are not well described. A multidisciplinary team at University of Colorado Hospital implemented a standardized guideline for antenatal counseling, resuscitation practices, and neonatal care of neonates born < 24 wga. We describe NICU course and early outcomes for 22-23 wga neonates managed under this standardized approach at 5,280 feet.

Objective: To describe a formalized program for the care of 22-23 wga infants born at altitude and to report demographics and medical outcomes.

Design/Methods: Retrospective cohort of infants born at University of Colorado Hospital and cared for there and additionally at Children's Hospital Colorado including all liveborn infants 22 0/7-23 6/7, born February 2022 to November 2025, who received active resuscitation. Maternal and infant data abstracted from EMR. The study was deemed exempt by the Colorado Multiple Institutional Review Board.

Results: Among infants receiving active resuscitation, survival was 67% at 22 wga and 58% at 23 wga. Mean BW was 526 g at 22 wga, 594 g at 23 wga. Mean LOS was 162 days at 22 wga, 155 days at 23 wga. All survivors had BPD and rates of grade 3 BPD were 25% at 22 wga, 47% at 23 wga. Severe grade (3/4) IVH was 18% at 22 wga, 30% at 23 wga. Treatment ROP was 75% at 22 wga, 63% at 23 weeks. NEC (II or higher) was 7% at 22 wga, 25% at 23 wga. Rates of gastrostomy dependance were 42% at 22 wga and 27% at 23 wga.

Conclusion(s): At just over 5,000 feet (1,500m), a formal program for 22-23 wga neonates was associated with a survival rate of 58-67% and expected prematurity-related morbidity. To our knowledge, this is the first report on medical outcomes for 22-23 wga neonates receiving active resuscitation at altitude. Despite altitude-related risks, survival was comparable to or above national averages, though further investigation is necessary due to sample size limitation. Common complications included prolonged LOS, gastrostomy dependence, treatment ROP, and BPD. More research is needed on the care of extremely preterm infants to standardize approaches and improve survival without major co-morbidities.

Demographics and Medical Outcomes by Gestational Age


Mean Birthweight, Hospital LOS, and Day of Death (if applicable) by Gestational Age


Birth Weight Versus Gestational Age Scatter Plot of Survival
Individual cases reported as either survival to discharge (green dot), death before discharge (red X), and currently hospitalized (black dot).