Geographic Variation in Active Perinatal Management and Outcomes for Extremely Preterm Infants in New South Wales: A Population‐Based Cohort Study
Nicholas Williams, Chenxi Li, Natasha Nassar, Adrienne GordonABSTRACT
Background
Perinatal management of infants born at 22–25 weeks' gestation varies internationally and may influence survival and long‐term outcomes. In New South Wales (NSW), no contemporary statewide guideline exists.
Aims
To evaluate rates of active delivery room management and associated survival and neurodevelopmental outcomes among infants born at 22–25 weeks' gestation in NSW.
Materials and Methods
Population‐based cohort study of all live births at 22 + 0–25 + 6 weeks in NSW (2011–2019) using linked administrative and clinical datasets. Active management was defined as provision of respiratory support or higher in the delivery room. Primary outcomes were survival to 1 year and moderate or severe neurodevelopmental impairment (NDI) at 2–3 years.
Results
Among 1285 live‐born infants, 69.0% received active management, increasing from 61.7% in 2011 to 74.5% in 2019 ( p < 0.001). Rates varied across local health districts (54.9%–83.5%). One‐year survival was 44.9% overall (64.4% among actively managed infants) and increased with gestational age. Of 577 children eligible for follow‐up, 440 (76.3%) underwent assessment at 2–3 years, of whom 18.4% had moderate or severe NDI. Maternal transfer to a tertiary centre was associated with a lower adjusted hazard of death (HR 0.79, 95% CI 0.63–0.98) but not with NDI.
Conclusions
Active management and survival increased over time; however, marked regional variation persists. Development of a statewide clinical practice guideline could support equitable, evidence‐based care for extremely preterm births.