463 - Neonatal Outcomes of infants born at 24-31 weeks’ gestation in relation with inborn/outborn birth status in China

Poster Number: 463
Publication Number: 463.130

lei xia, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (People's Republic); Xinyue Gu, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Jingyun Shi, GANSU PROVINCIAL MATERNAL AND CHILD HOSPITAL, Lanzhou, Gansu, China (People's Republic); Jiahua Pan, Anhui Provincial Hospital, Hefei, Anhui, China (People's Republic); Siyuan Jiang, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Yun Cao, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Jianhua Sun, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, China (People's Republic); Falin Xu, Zhengzhou University, Zhengzhou, Henan, China (People's Republic)

Background: Newborns transferred of the NICU ward, including infants from the delivery room or operating room and outside hospitals. Regionalization of high-risk perinatal care has been advocated because intensive care for newborns who were sick and need treatment may beard lower mortality and morbidity.

Objective: To describe the rates of inborn and outborn status for very preterm infants (VPI) admitted to tertiary Neonatal Intensive Care Units (NICUs) participating in the Chinese Neonatal Network (CHNN); to identify factors associated with inborn/outborn status; to compare neonatal outcomes of inborn and outborn infants.

Design/Methods: This is a hospital-based retrospective cohort study VPI born at 24–31+6 weeks’ gestation and admitted to CHNN NICUs in 2019. All infants were followed until death or discharge from hospital. Demographic information for mothers and infants were compared between inborn and outborn group. Association between inborn/outborn status and neonatal outcomes were analyzed by multivariable logistic regression.

Results: Among 9422 VPIs, 3417 (36.3%) were outborn. The mothers of outborn infants had lower maternal age, proportion of primigravida and the rates of complications during pregnancy, compared with the mothers of inborn infants (P < 0.01). The outborn infants were less likely to be multiple birth, small for gestational age, and have high TRIPS score, lower incidence of early-onset sepsis. Outborn status was associated with higher odds of composite adverse outcome (necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), cystic periventricular leukomalacia (cPVL), severe retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD)) (aOR 1.55, 95%CI 1.39, 1.73), NEC (aOR 1.67, 95%CI 1.38, 2.03), any grade IVH (aOR 1.29, 95%CI 1.17, 1.43), severe IVH (aOR 1.56, 95%CI 1.31, 1.87), cPVL (aOR 1.77, 95%CI 1.43, 2.20), severe ROP (aOR 2.19, 95%CI 1.71, 2.81) and BPD (aOR 1.64, 95%CI 1.48, 1.82) Outborn infants who were transferred to a tertiary NICU > 24 hours had higher odds of adverse outcomes compared to those transferred ≤ 24 hours.Conclusion(s): The rate of outborn infants at 24–31 weeks’ gestation in CHNN was high in 2019 Outborn infants had higher risk of mortality or morbidity compared with inborn infants.
Mortality and morbidities of inborn and outborn infants with 24-31 weeks’ gestationTable1 .jpeg+ Inborn group as reference.
* Comprised of overall death, NEC, IVH, cPVL, late-onset sepsis, severe ROP and BPD at 36 week’s corrected GA or discharge.
** In-hospital death is calculated within infants received complete care during hospitalization.
# Adjusted for GA, SGA, sex, multiple birth, TRIPS score, primigravida, maternal age, maternal hypertension, maternal diabetes.
Table 2 Mortality and morbidities of outborn infants at 24-31 weeks’ gestation, admitted at different postnatal age (≤ 24hr vs > 24hr)Table2.jpeg+ Inborn group as reference.
* Comprised of overall death, NEC, IVH, cPVL, late-onset sepsis, severe ROP and BPD at 36 week’s corrected GA or discharge.
** In-hospital death is calculated within infants received complete care during hospitalization.
# Adjusted for GA, SGA, sex, multiple birth, TRIPS score, primigravida, maternal age, maternal hypertension, maternal diabetes.
12 infants were excluded from this table, due to missing value of their birth date so that we cannot calculate their age at admission.