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Abstract
Objective Perinatal epidemiological studies and outcomes are often reported on gestational week thresholds. This study aims to quantify and investigate the association of each gestational day at birth on antenatal management, mortality and respiratory outcomes of extremely preterm infants.
Design Retrospective cohort study using National Neonatal Research Database.
Setting England and Wales.
Patients 26 098 infants born <28 weeks of gestational age (GA) and admitted to neonatal units from 2010 to 2020.
Interventions Antenatal care and outcome measures for each gestational day were described with 95% CI determined using Agresti-Coull method. χ2 test for trend assessed the trends across gestational day. Analysis of means assessed if outcome on each gestational day differed from the overall outcome for that gestational week.
Main outcome measures Mortality and respiratory disease.
Results Neonatal admissions peaked at the start of each gestational week. Caesarean section was the most common birth mode from 26+1 to 26+4 weeks GA. Mortality and severe respiratory morbidity decreased with each day of gestation within the gestational week threshold (p<0.01). Mortality at the beginning and end of each gestational week differed from the overall mortality for that gestational week (p=0.03 to <0.001) in infants <27+0 weeks GA. Mortality was higher in infants <26+0 weeks GA born to mothers without complete antenatal corticosteroid course or born in centres without neonatal intensive care units.
Conclusions Each day of gestation is important for extremely preterm infant outcomes. Perinatal decision-making, counselling and reporting should avoid broad gestational weeks and include day of gestation.
- Neonatology
- Respiratory Medicine
- Epidemiology
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
X @tngchang, @DrDonSharkey
Contributors TCK designed the study, carried out the analysis, interpreted the results, drafted the initial manuscript and critically reviewed and revised the manuscript for important intellectual content. MF interpreted the result, drafted the initial manuscript and critically reviewed and revised the manuscript for important intellectual content. NJ and KW designed the study, interpreted the results and critically reviewed and revised the manuscript for important intellectual content. DS conceptualised and designed the study, interpreted the results, drafted the initial manuscript and critically reviewed and revised the manuscript for important intellectual content. DS is the guarantor of the study. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This work was supported by the Action Medical Research training fellowship (grant number GN2941) and the Albert Gubay Foundation.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer-reviewed.
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