Association of gestational day with antenatal management and the mortality and respiratory outcomes of extremely preterm infants

Kwok, T'ng Chang; Fiolna, Magdalena; Jones, Nia; Walker, Kate; Sharkey, Don

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.

Citation

Kwok, T. C., Fiolna, M., Jones, N., Walker, K., & Sharkey, D. (2025). Association of gestational day with antenatal management and the mortality and respiratory outcomes of extremely preterm infants. Archives of Disease in Childhood. Fetal and Neonatal Edition, 110(4), 415-421. https://doi.org/10.1136/archdischild-2024-328066

• Journal Article Type: Article
• Acceptance Date: Nov 30, 2024
• Online Publication Date: Jan 16, 2025
• Publication Date: 2025-07
• Deposit Date: Jan 18, 2025
• Publicly Available Date: Jan 20, 2025
• Journal: Archives of Disease in Childhood - Fetal and Neonatal Edition
• Electronic ISSN: 1468-2052
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 110
• Issue: 4
• Pages: 415-421
• DOI: https://doi.org/10.1136/archdischild-2024-328066
• Public URL: https://nottingham-repository.worktribe.com/output/44234162
• Publisher URL: https://fn.bmj.com/content/110/4/415