Neonatal-Perinatal Fellow Indiana University School of Medicine Indiana University School of Medicine Indianapolis, Indiana, United States
Background: Practice variability remains in managing newborns born between 22 and 24 completed weeks’ gestation. The INDEED (Investigating Neonatal Decisions for Extremely Early Deliveries) group is expanding its retrospective study to include 10 years and 15 centers. We present here early findings of two centers over a 6-year period.
Objective: To understand how perinatal, medical, and sociodemographic factors vary between mothers whose newborns do or do not receive delivery room resuscitation.
Design/Methods: We reviewed extremely early deliveries at two centers from 2011-2016. Mothers admitted with living fetuses and threatened preterm delivery who delivered between 22 0/7 and 24 0/7 weeks were eligible. Those whose fetuses had severe congenital or genetic anomalies were excluded. Demographic and social characteristics, obstetric management, neonatal consultation, and clinical courses data were collected. Federal census-related geocoding data (2015 American Community Survey 5 year estimates) were extracted using mothers’ residential zip codes at delivery. Mothers were grouped based on whether live newborns received “attempted resuscitation (AR)” (positive pressure ventilation or NICU admission) vs “comfort care (CC).” Odds ratios were generated for categorical characteristics between groups (OR, 95th confidence interval, p value); continuous factors were analyzed using Mann-Whitney U or Chi-square tests as appropriate.
Results: Of the 195 mothers (227 newborns) included, 139 mothers (156 newborns) received AR. Prior obstetric history, assisted reproduction, race, ethnicity, insurance status, and geocoding factors of home zip codes did not differ between AR and CC mothers. CC group mothers were older, admitted at lower gestational ages, less likely to be carrying singletons (0.372, 0.158-0.875, 0.038), less likely to receive neonatal consultation (0.329, 0.147-0.735, 0.011), and more likely to have cervical insufficiency (2.76, 1.28-5.96, 0.015). Their newborns were smaller and more premature. Comfort care occurred 16 times more often at 22 vs. 23-24 weeks (16.2, 6.26-42.1, <0.001) and 7 times more often at 23 vs. 24 weeks (7.30, 1.96-27.2, 0.002). Conclusion(s): While previous studies have suggested that psychosocial and sociodemographic factors affect decisions for extremely early newborns, our findings did not confirm this. Rather, newborn size and age were most predictive of treatment decision. Data from the entire cohort of 10 years and 15 centers will test the generalizability of these preliminary findings.
Authors/Institutions: Catherine Groden, Indiana University School of Medicine, Indianapolis, Indiana, United States; Tiffany Tonismae, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, United States; Christine Carlos, University of Chicago, Chicago, Illinois, United States; Allison Schuh, University of Chicago, Chicago, Illinois, United States; Jasmine Soo, Indiana University School of Medicine, Indianapolis, Indiana, United States; Vanessa Villalobos, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana, United States; Brownsyne Tucker Edmonds, Indiana University School of Medicine, Indianapolis, Indiana, United States; Bree Andrews, The University of Chicago, Chicago, Illinois, United States; Dalia M. Feltman, NorthShore University HealthSystem, Evanston, Illinois, United States