Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Does active treatment in infants born at 22–23 weeks correlate with outcomes of more mature infants at the same hospital? An analysis of California NICU data, 2015–2019

Journal of Perinatology volume 42, pages 1301–1305 (2022)Cite this article

Subjects

Abstract

Objective

To investigate whether hospital rates of active treatment for infants born at 22–23 weeks is associated with survival of infants born at 24–27 weeks.

Study design

We included all liveborn infants 22–27 weeks of gestation delivered at California Perinatal Quality Care Collaborative hospitals from 2015 to 2019. We assessed (1) the correlation of active treatment (e.g., endotracheal intubation, epinephrine) in 22–23 week infants and survival until discharge for 24–27 week infants and (2) the association of active treatment with survival using multilevel models.

Result

The 22–23 week active treatment rate was associated with infant outcomes at 22–23 weeks but not 24–27 weeks. A 10% increase in active treatment did not relate to 24–25 week (adjusted OR: 1.00 [95% CI: 0.95–1.05]), or 26–27 week survival (aOR: 1.02 [0.95–1.09]).

Conclusion

The hospital rate of active treatment for infants born at 22–23 weeks was not associated with improved survival for 24–27 week infants.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Cohort selection process, CPQCC 2015–2019.
Fig. 2: Comparison of hospital rates of 22-23 week infant active treatment and outcomes of interest by gestational age, CPQCC 2015–2019 (N = 88)a.

Data availability

Data are available upon request and completion of requirements from CPQCC. Code is also available upon request.

References

  1. United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics. Natality public-use data 2016-2019, on CDC WONDER Online Database, October 2020. Accessed July 8, 2021. https://wonder.cdc.gov/controller/datarequest/D149;jsessionid=87F7F0097232707320A45E0DC8F2

  2. Macdorman MF, Mathews TJ, Zeitlin J National Vital Statistics Report (Volume 63, Number 5 - September 24, 2014)—International Comparisons of Infant Mortality and Related Factors: United States and Europe, 2010. Vol 63.; 2014. Accessed August 14, 2020. http://www.oecd.org.

  3. Raju TNK, Mercer BM, Burchfield DJ, Joseph GF. Periviable birth: Executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. Obstet Gynecol. 2014;123:1083–96. https://doi.org/10.1097/AOG.0000000000000243

    Article  PubMed  Google Scholar 

  4. Ecker JL, Kaimal A, Mercer BM, Blackwell SC, DeRegnier RAO, Farrell RM, et al. Periviable birth. Obstet Gynecol. 2017;130:e187–e199. https://doi.org/10.1097/AOG.0000000000002352

    Article  Google Scholar 

  5. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Periviable Birth. Obstet Care Consens. 2017;130.

  6. Hajdu SA, Rossi RM, DeFranco EA. Factors associated with maternal and neonatal interventions at the threshold of viability. Obstet Gynecol. 2020;135:1398–408. https://doi.org/10.1097/AOG.0000000000003875

    Article  PubMed  Google Scholar 

  7. Rysavy MA, Li L, Bell EF, Das A, Hintz SR, Stoll BJ, et al. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med. 2015;372:1801–11. https://doi.org/10.1056/NEJMoa1410689

    Article  PubMed  PubMed Central  Google Scholar 

  8. Smith PB, Ambalavanan N, Li L, Cotten CM, Laughon M, Walsh MC, et al. Approach to infants born at 22 to 24 weeks’ gestation: Relationship to outcomes of more-mature infants. Pediatrics. 2012;129. https://doi.org/10.1542/peds.2011-2216

  9. Morgan AS, Khoshnood B, Diguisto C, Foix L’Helias L, Marchand-Martin L, Kaminski M, et al. Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: Evidence from the EPIPAGE-2 cohort study. BMC Pediatr. 2020;20. https://doi.org/10.1186/s12887-019-1856-1

  10. Gould JB. The role of regional collaboratives: The California perinatal quality care collaborative model. Clin Perinatol. 2010;37:71–86. https://doi.org/10.1016/j.clp.2010.01.004

    Article  PubMed  Google Scholar 

  11. Shih Z, Lee HC. Improving outcomes for preterm infants in the California Perinatal Quality Care Collaborative. Pediatr Med. 2019;2:54–54. https://doi.org/10.21037/pm.2019.10.03

    Article  Google Scholar 

  12. California Perinatal Quality Care Collaborative. NICU Data Manual of Definitions. Accessed November 30, 2021. https://www.cpqcc.org/sites/default/files/2021 NICU Data Manual.pdf

  13. Rysavy MA, Horbar JD, Bell EF, Li L, Greenberg LT, Tyson JE, et al. Assessment of an Updated Neonatal Research Network Extremely Preterm Birth Outcome Model in the Vermont Oxford Network. JAMA Pediatr. 2020;174. https://doi.org/10.1001/jamapediatrics.2019.6294

  14. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92:529–34. https://doi.org/10.1016/S0022-3476(78)80282-0

    Article  CAS  PubMed  Google Scholar 

  15. Lee HC, Liu J, Profit J, Hintz SR, Gould JB Survival Without Major Morbidity Among Very Low Birth Weight Infants in California. Pediatrics. 2020;146. https://doi.org/10.1542/PEDS.2019-3865

  16. Alexander G, Himes J, Kaufman R, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol. 1996;87:163–8. https://doi.org/10.1016/0029-7844(95)00386-X

    Article  CAS  PubMed  Google Scholar 

  17. CCS Approved Hospitals. Accessed November 19, 2021. https://www.dhcs.ca.gov/services/ccs/scc/Pages/SCCName.aspx

  18. Rysavy MA, Mehler K, Oberthür A, Ågren J, Kusuda S, McNamara PJ, et al. An Immature Science: Intensive Care for Infants Born at ≤23 Weeks of Gestation. J Pediatr. 2021;233:16–25.e1. https://doi.org/10.1016/J.JPEDS.2021.03.006

    Article  PubMed  PubMed Central  Google Scholar 

  19. Phibbs CS, Bronstein JM, Buxton E, Phibbs RH. the effects of patient volume and level of care at the hospital of birth on neonatal mortality. JAMA. 1996;276:1054–9. https://doi.org/10.1001/JAMA.1996.03540130052029

    Article  CAS  PubMed  Google Scholar 

  20. Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med. 2007;356:2165–75. https://doi.org/10.1056/NEJMSA065029/SUPPL_FILE/NEJM_PHIBBS_2165SA1.PDF

    Article  CAS  PubMed  Google Scholar 

  21. Our Publications | California Perinatal Quality Care Collaborative. Accessed November 19, 2021. https://www.cpqcc.org/analysis/our-publications

  22. Hagadorn JI, Bennett MV, Brownell EA, Payton KSE, Benitz WE, Lee HC. Covariation of neonatal intensive care unit-level patent ductus arteriosus management and in-neonatal intensive care unit outcomes following preterm birth. J Pediatr. 2018;203:225–233.e1. https://doi.org/10.1016/J.JPEDS.2018.07.025

    Article  PubMed  Google Scholar 

  23. Lee HC, Powers RJ, Bennett MV, Finer NN, Halamek LP, Nisbet C, et al. Implementation methods for delivery room management: a quality improvement comparison study. Pediatrics. 2014;134:e1378–e1386. https://doi.org/10.1542/PEDS.2014-0863

    Article  PubMed  PubMed Central  Google Scholar 

  24. Handley SC, Steinhorn RH, Hopper AO, Govindaswami B, Bhatt DR, Van Meurs KP, et al. Inhaled nitric oxide use in preterm infants in California neonatal intensive care units. J Perinatol. 2016;36:635–9. https://doi.org/10.1038/JP.2016.49

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Research reported in this manuscript was supported by the National Institutes of Health under award number R01HD098287. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, 94306, USA

    Shalmali Bane

  2. Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, TX, 77030, USA

    Matthew A. Rysavy

  3. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA

    Suzan L. Carmichael, Tianyao Lu, Mihoko Bennett & Henry C. Lee

  4. Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, 94306, USA

    Suzan L. Carmichael

  5. California Perinatal Quality Care Collaborative, Stanford, CA, 94306, USA

    Tianyao Lu, Mihoko Bennett & Henry C. Lee

Authors
  1. Shalmali Bane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew A. Rysavy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suzan L. Carmichael
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tianyao Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mihoko Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Henry C. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SB and HCL conceived and designed this work and drafted the manuscript. SB conducted the study analysis with input from all other co-authors (HL, MAR, SLC, TL, MB). All authors provided critical feedback on study design and interpretation of results and approved the final version of the manuscript.

Corresponding author

Correspondence to Shalmali Bane.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bane, S., Rysavy, M.A., Carmichael, S.L. et al. Does active treatment in infants born at 22–23 weeks correlate with outcomes of more mature infants at the same hospital? An analysis of California NICU data, 2015–2019. J Perinatol 42, 1301–1305 (2022). https://doi.org/10.1038/s41372-022-01381-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-022-01381-x

Search

Advanced search

Quick links