Neonatal intensive care unit outcomes and resource use among extremely preterm survivors

Abstract

Survival outcomes and use of neonatal intensive care (NICU) were evaluated among extremely preterm (EPT) infants cared for in Australia and New Zealand NICUs. Retrospective analysis of prospectively collected data from the Australian and New Zealand Neonatal Network was conducted for infants born at 22–27 weeks of gestation and admitted and cared for in 29 NICUs between 1 January 2018 and 31 December 2022. Of the 5414 EPT infants, 83.1% survived and 63.7% without any major morbidities. Antenatal steroid use was low at 22–23 weeks of gestation, although there was an increase in survival from 40.2% in 2018 to 51.9% in 2022. Survival with major morbidities increased from 33.9% in 2018 to 39.1% in 2022 (p = 0.013), driven by significant increases in bronchopulmonary dysplasia (BPD) (17.4% to 21.2%) and retinopathy of prematurity (ROP) (14.5% to 17.7%). Survivors with major morbidities had significantly higher use of mechanical ventilation (median hours and IQR 347, 122–671 vs. 67, 19–198) and parenteral nutrition (488, 285–804 vs. 275, 196–420 h) than those without. Survival with major morbidities increased from 2018 to 2022, driven by increases in BPD and ROP. Infants with major morbidities required more intensive care across all gestation.