Disparities in antepartum and neonatal resuscitation of periviable infants

The decision to provide resuscitation to periviable infants involves obstetric and neonatal counseling based on medical factors leading to and present at birth, as well as parental preference. This study reviews the patterns in the resuscitation of periviable infants at gestational ages 22 through 25 to examine whether there are racial or insurance-based disparities in the receipt of interventions. A retrospective cohort study was conducted on periviable live births at 22 through 25 weeks of gestation that occurred during the years 2016-2020 utilizing U.S. national vital statistics data (N=59,102). An infant was recorded as receiving an intervention if they received one of the following: steroids, antibiotics, assisted ventilation immediately or greater than 6 hours after birth, surfactant, and/or antibiotics. The percentage of live births occurring at each gestational age remained consistent from 2016-2020. Approximately 44.0% of infants delivered at 22 weeks were administered interventions compared with a greater percentage at 23 weeks (74.2%), 24 weeks (78.8%), and 25 weeks (79.0%). When looking at the administration of interventions by race, at 22 weeks, infants born to Black, Non-Hispanic mothers had a higher percentage of interventions as shown in Table 1. At subsequent gestational ages, infants born to White, Non-Hispanic mothers had the highest percentage (Table 1). There was no difference in the percentages of infants who received interventions when the cohort was divided by type of insurance (Table 2). While there were no differences in rates of interventions by type of insurance, some differences exist in the number of infants provided interventions by race, particularly at 22 weeks gestational age, the lower end of viability. The decision-making process for live-births at these periviable gestational ages becomes more complex due to the paucity of tested guidelines and therefore may be subject to biases introduced during counseling or other patient-specific factors.View Large Image Figure ViewerDownload Hi-res image Download (PPT)