Survival of infants born at periviable gestation: The US national database

Summary: Background: Substantial differences exist in the approach to resuscitating infants born at periviable gestation. Evaluation of current survival may help guide prenatal counselling and provide accurate expectations of clinical outcomes. We aimed to assess the US national survival trends in periviable infants born at gestational age (GA) ≤24 weeks. Methods: We used de-identified patient data obtained from the US Healthcare Cost and Utilization Project (HCUP) from 2007 to 2018. All infants with documented GA ≤24 weeks were included. The Cochran-Armitage test was used for trend analyses. Regression analyses were conducted for variables associated with survival. Findings: A total of 44,628,827 infant records were identified with 124,345 (0.28%) infants born ≤24 weeks; of those, 77,050 infants 500 g compared to ≤500 g (aOR = 4.62, CI:3.23–5.02 & aOR = 5.44, CI: 4.59–5.84, respectively). Black (aOR = 1.33, CI: 1.31–1.36 & aOR = 1.24, CI: 1.20–1.32, respectively) and Hispanic (aOR = 1.29, CI: 1.27–1.32 & aOR = 1.27, CI: 1.22–1.30, respectively) had higher survival than White. Interpretation: There is a national increase in survival over the years in infants born at periviable GA. BW >500 is associated with >4 folds higher survival compared to ≤500 g. The results of this study should be cautiously interpreted as long-term outcomes are unknown Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.