Resident Sidney Kimmel Medical College at Thomas Jefferson University Wilmington, Delaware, United States
Background: Wide practice variation, selection bias, and limitations of outcomes data impact decision making for deliveries at 22 and 23 weeks’ gestational age (GA). Evidence-based clinical guidelines for women with threatened extremely premature delivery may improve care and outcomes. In 2015, a multidisciplinary group at ChristianaCare developed guidelines for the care of 22-25 weeks’ GA pregnancies and infants, including the consideration of resuscitation and NICU care on an individual basis at 22 weeks’ GA. Objective: To assess the outcomes of deliveries between 22 0/7 and 23 6/7 weeks’ GA at a single high-risk delivery center before and after the implementation of obstetrical and neonatal periviability medical guidelines. Design/Methods: A retrospective, cohort analysis of all infants delivered at 22 0/7- 23 6/7 weeks’ GA between Jan. 1, 2004- Dec. 31, 2022 at ChristianaCare, Newark Campus was completed. Data collection included aspects of antenatal maternal care, delivery method and outcome, parental preference of interventions, resuscitation interventions, neonatology and perinatal palliative care team consult, length of hospital stay, neonatal morbidities, and final disposition. Exclusion criteria included potential life limiting fetal diagnoses aside from prematurity. Continuous variables were compared using the Student’s t-test and ANOVA. Discrete variables were compared using chi-square or Fisher’s exact test. A p-value of < 0.05 was considered significant. Regression models were used to determine associations between variables.
