Publication Date

10-2023

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Abstract

Introduction There has been significant innovation and technological advancement in prenatal diagnosis, fetal therapeutic intervention, and establishment of fetal health centers (FHC) at children’s hospitals with dedicated delivery services for high-risk neonates and expedited access to level IV neonatal intensive care units (NICU). Morality trends have been examined on individual bases and within diagnostic groups, but there have been few studies that examine overall modes of mortality in the NICU population across diagnoses after the implementation of a dedicated FHC. This study aims to compare modes of death at a level IV children’s hospital NICU between infants born at the fetal health center (inborn) and those transferred from referral centers (outborn). Study Design/Methods Patients who died at the Children’s Mercy Hospital NICU from January 2012-December 2022 were identified. FHC deliveries started in 2011. Via retrospective chart review, data were collected on place of birth and mode of death (CPR within six hours of death, withholding of potential interventions, or withdrawal of existing interventions). Results were evaluated with a 2-tailed z test. Further analysis will be undertaken. Results Over the 10-year study period, there were 10,862 admissions and 563 (5.2%) deaths. Of the deaths, 35.6% were inborn and 64.5% outborn. Of total admissions, 1,857 (17%) were inborn with 200 (10.7%) deaths. Outborn infants accounted for 9,005 admissions with 363 (4%) deaths. Data were available for 561 deaths, including all inborn deaths. Figures 1 (inborn) and 2 (outborn) show modes of death by year as a percentage. Modes of death were compared based on place of birth in Figure 3. Differences for withdrawal and withholding of interventions between outborn and inborn infants were significant with p=<0.00001 while the difference for receiving CPR approached but did not reach significance with p=0.073. Discussion The data demonstrate a significant difference in the percentage of withdrawal of intervention and withholding of intervention as the primary mode of death between inborn and outborn infants. This could be secondary to initial stabilization at outside hospitals prior to transport or indicate differences in the underlying diagnoses. This could also be secondary to inborn births receiving extensive prenatal counselling at the FHC with a do not resuscitate (DNR) at birth or limited intervention plan already in place. Further analyses based on diagnoses and type of birth plan will be undertaken. The presence of immediate post-natal withholding of care will be further evaluated with multivariate analysis based on age of death. Year-by-year data also demonstrates a trend of increased rates of CPR prior to death in the outborn group. FHC programs focus on congenital abnormalities that are amenable to prenatal diagnosis which may lead to an overrepresentation of devastating congenital abnormalities in this group. Further multivariate analysis will be undertaken to assess if this or other variables may be responsible for the differences in modes of death between populations. Conclusion Inborn newborns born at a fetal health center had a higher mortality compared to outborn infants and were more likely than outborn infants to have interventions held.

Disciplines

Pediatrics

Notes

Presented at the 2023 Children's Hospital Neonatal Consortium Annual Symposium; Denver, CO; Oct 11-13, 2023.

Impact of Fetal Health Center on Mode of Neonatal Death

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Pediatrics Commons

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