Does active treatment in infants born at 22–23 weeks correlate with outcomes of more mature infants at the same hospital? An analysis of California NICU data, 2015–2019

OBJECTIVE: To investigate whether hospital rates of active treatment for infants born at 22–23 weeks is associated with survival of infants born at 24–27 weeks. STUDY DESIGN: We included all liveborn infants 22–27 weeks of gestation delivered at California Perinatal Quality Care Collaborative hospitals from 2015–2019. We assessed (1) the correlation of active treatment (e.g., endotracheal intubation, epinephrine) in 22–23 week infants and survival until discharge for 24–27 week infants and (2) the association of active treatment with survival using multilevel models. RESULT: The 22–23 week active treatment rate was associated with infant outcomes at 22–23 weeks but not 24–27 weeks. A 10% increase in active treatment did not relate to 24–25 week (adjusted OR: 1.00 [95% CI: 0.95–1.05]), or 26–27 week survival (aOR: 1.02 [0.95–1.09]). CONCLUSION: The hospital rate of active treatment for infants born at 22–23 weeks was not associated with improved survival for 24–27 week infants.