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Objectives: Gestational age at birth is declining, probably because more deliveries are being induced. Gestational age is an important modifiable risk factor for neonatal mortality and morbidity. We aimed to investigate the association between gestational age and mortality in hospital for term-born neonates (≥ 37 wk') admitted to PICUs in Australia and New Zealand.Design: Observational multicenter cohort study.Setting: PICUs in Australia and New Zealand.Patients: Term-born neonates (≥ 37 wk') admitted to PICUs.Interventions: None MEASUREMENTS AND MAIN RESULTS:: We studied 5,073 infants born with a gestational age greater than or equal to 37 weeks and were less than 28 days old when admitted to a PICU in Australia or New Zealand between 2007 and 2016. The association between gestational age and mortality was estimated using a multivariable logistic regression model, adjusting for age, sex, indigenous status, Pediatric Index of Mortality version 2, and site. The median gestational age was 39.1 weeks (interquartile range, 38.2-40 wk) and mortality in hospital was 6.6%. Risk of mortality declined log-linearly with gestational age. The adjusted analysis showed a 20% (95% CI, 11-28%) relative reduction in mortality for each extra week of gestation beyond 37 weeks. The effect of gestation was stronger among those who received extracorporeal life support: each extra week of gestation was associated with a 44% (95% CI, 25-57%) relative reduction in mortality. Longer gestation was also associated with reduced length of stay in hospital: each week increase in gestation, the average length of stay decreased by 4% (95% CI, 2-6%).Conclusions: Among neonates born at "term" who are admitted to a PICU, increasing gestational age at birth is associated with a substantial reduction in the risk of dying in hospital. The maturational influence on outcome was more strongly noted in the sickest neonates, such as those requiring extracorporeal life support. This information is important in view of the increasing proportion of planned births in both high- and low-/middle-income countries. [ABSTRACT FROM AUTHOR]

On behalf of Australian and New Zealand Intensive Care Society Paediatric Study Group (ANZICS-PSG) & Australian and New Zealand Paediatric Intensive Care Registry (ANZPICR) Introduction: Population level data shows that the gestational age at birth is decreasing in various countries. Gestational age is an important and potentially modifiable risk factor and is particularly relevant in the neonate with congenital heart disease (CHD) where a high proportion of births occur before reaching full term. We studied the relationship between gestation & hospital mortality in a multi-center cohort of neonates undergoing cardiac surgery in Australia and New Zealand. Methods: A total of 2,267 neonates with CHD who underwent cardiac surgery during 2007 - 2016 were included. For the primary outcome of hospital mortality, we determined the best fitting first or second order fractional polynomial to describe its association with gestational age using multivariable logistic regression. The analysis was controlled for age, sex, indigenous status, centre and risk adjusted congenital heart surgery (RACHS-1) score. Results: The median (IQR) gestation at birth was 39 (37.6 - 40) weeks and hospital mortality following cardiac surgery was 7.4% (169 out of 2267). For each week increase in gestation, there was a 20% reduction in in-hospital mortality [adjusted odds ratio 0.80, 95%CI 0.74, 0.87, p<0.001]. On average, birth at 37 weeks was associated with mortality that was approximately 4 percentage points higher (80% increase) than those born at 40 weeks (figure). Among survivors, the mean intensive care length of stay decreased for each week increase in gestation [-4.7% per week, 95%CI -6.5%, -2.7%, p<0.001]. Conclusion: Increasing gestation, even within the ranges of term gestation, is associated with a considerable decrease in the risk of in-hospital mortality following neonatal cardiac surgery. This information is particularly relevant in the current context of a high number of planned births before reaching full term in the neonate with CHD, and underscores the urgent need for development of standard guidelines for timing of delivery. [ABSTRACT FROM AUTHOR]