Hospital factors associated with survival of infants born at periviable gestation: The USA National Database

Abstract

Abstract Background Reports on survival of infants born at periviable gestation (GA ≤ 24 weeks and birth weight < 500gm) vary significantly. We aimed to determine hospital factors associated with their survival and to assess the trend for the timing of postnatal mortality in these periviable infants.Methods We utilized the de-identified National Inpatient Sample (NIS) dataset from the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality (AHRQ). National data were analyzed for the years 2010–2018. Hospitals were categorized according to delivery volume, USA regions, and teaching status.Results We identified 33,998,014 infants born during the study period; 76,231 infants were ≤ 24 weeks. Survival was greatest in urban teaching hospitals in infants < 24 weeks and completed 24 weeks, respectively. The Northeast region has the lowest survival rate. There was a significant delay in the postnatal day of mortality in periviable infants.Conclusions Hospital factors are associated with increased survival rates. Improved survival in large teaching hospitals supports the need for regionalization of care in infants born at the limits of viability. There was a significant delay in the postnatal mortality day.