Active treatment for increasingly premature babies

 Active treatment for increasingly premature babies

 Active treatment for increasingly premature babies

Babies born extremely preterm were more likely to receive active treatment in later years, but gaps in treatment remain among different racial and ethnic groups, according to a cross-sectional study.

From 2014 to 2020, the proportion of very preterm infants receiving active treatment increased nearly 4% per year (45.7% to 58.8%), with increases across all racial and ethnic groups, Karthik K. Venkatesh, MD , PhD, of the University College of Medicine in Columbus, Ohio, and colleagues report.

The frequency of active treatment increased across all gestational ages and was fastest among infants born at 22 weeks' gestation, increasing by an average of 14.4% per year over the study period (14.0% at 29, 7%), they said.

However, children born to white people had more medical experience than those born to Asian/Pacific Islander, black, or Hispanic people. The authors state that "in 2019, 66% of missing newborns were born to a mother who identified as non-Hispanic Black or Hispanic" and state that "changes in active treatment based on race and ethnicity may be a possible explanation for changes over time." Decomposition. Morbidity and Given the high probability of death and the uncertainty about the prognosis, doctors and families can make different decisions."

In an accompanying editorial, Henry Lee, MD, and Deirdre Lyell, of Stanford University School of Medicine in California, note that more data on the treatment's effectiveness and prognosis are needed. They add that the lack of data describing a child's individual risk of morbidity and mortality after active treatment makes effective counseling difficult, because the definition of active treatment is vague and depends on the region in which the patient receives care, the level of care in the hospital, and the individual family.

Unlike other interventions considered appropriate or optimal for larger populations, it is difficult to identify active treatment and its components as the 'appropriate' treatment for the very preterm population given the uncertainty of disease-free survival and survival. "They said. 'Quality care in this setting should be seen not simply as a matter of seeking active treatment, but as an optimal alignment of treatment, prognosis, and maternal and family values.'

Serial cross-sectional study, US population between 2014 and 2020. Live birth data. The National Vital Statistics System obtains data from birth files. Venkatesh's group collects data on all live births, defining a lost birth as a baby born between 22 and 25 weeks and 6 days. The pregnancy researchers excluded babies who were not residents of the United States. States and there were clinical There were inconsistencies.

They analyzed the proportion of newborns who received active treatment, including surfactant therapy, immediate assisted ventilation at birth, assisted ventilation for more than 6 hours, and antibiotic therapy during admission to the neonatal ICU. They were adjusted for mother's education, insurance status, year of delivery, age, parity, pre-pregnancy BMI, preterm delivery, gestational diabetes, baby's birth weight, and gender.

Of the estimated 27 million live births in the United States, approximately 62,000 extremely preterm infants were included in the final analysis. The average maternal age was 28 years and 54% of births were covered by Medicaid.

About 5% of the children in the study were Asian or Pacific Islander, 37% were black, 24% were Hispanic and 34% were white.

Of all the uncompensated deliveries, just over half received active treatment. About 45% of those who received active treatment received surfactant therapy, 96% received immediate assisted ventilation at birth, 60% received assisted ventilation for more than 6 hours, and 47% received antibiotic therapy.

Children born to whites were compared with those born to Asians or Pacific Islanders (adjusted hazard ratio [aRR] 0.82, 95% CI 0.79–0.86), blacks (aRR 0.90, CI 95% CI 0.89–0.92) or Hispanic (0.89 – 0.92), 95% CI: 0.81–0.85) individuals were less likely to receive active treatment. Babies born to people of color at 23, 24 and 25 weeks' gestation were significantly less likely to receive active treatment.

Study limitations include lack of assessment of neonatal morbidity and mortality. In addition, the researchers did not include stillbirths in the an