Skip to content
DraconiticResearch
Search Sources API
203,203 studies31 sourcesUpdated 38 min ago
Peer-reviewedCC BY 4.0The Australian & New Zealand Journal of Obstetrics & Gynaecology

Geographic Variation in Active Perinatal Management and Outcomes for Extremely Preterm Infants in New South Wales: A Population‐Based Cohort Study

  • Nicholas Williams1,2,3
  • Chenxi Li4,5
  • Natasha Nassar4,5,6
  • Adrienne Gordon1,2,6
6 affiliations
  1. 1RPA Newborn Care Royal Prince Alfred Hospital Sydney Australia
  2. 2Reproduction and Perinatal Centre, Faculty of Medicine and Health The University of Sydney Sydney Australia
  3. 3Implementation Science Academy Sydney Health Partners Sydney Australia
  4. 4Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health The University of Sydney Sydney Australia
  5. 5Leeder Centre for Health Policy, Economics and Data, Faculty of Medicine and Health The University of Sydney Sydney Australia
  6. 6Charles Perkins Centre The University of Sydney Sydney Australia
Read full textPDFDOICite

Abstract

Background: Perinatal management of infants born at 22–25 weeks' gestation varies internationally and may influence survival and long‐term outcomes. In New South Wales (NSW), no contemporary statewide guideline exists.

Aims: To evaluate rates of active delivery room management and associated survival and neurodevelopmental outcomes among infants born at 22–25 weeks' gestation in NSW.

Materials and Methods: Population‐based cohort study of all live births at 22 + 0–25 + 6 weeks in NSW (2011–2019) using linked administrative and clinical datasets. Active management was defined as provision of respiratory support or higher in the delivery room. Primary outcomes were survival to 1 year and moderate or severe neurodevelopmental impairment (NDI) at 2–3 years.

Results: Among 1285 live‐born infants, 69.0% received active management, increasing from 61.7% in 2011 to 74.5% in 2019 (p < 0.001). Rates varied across local health districts (54.9%–83.5%). One‐year survival was 44.9% overall (64.4% among actively managed infants) and increased with gestational age. Of 577 children eligible for follow‐up, 440 (76.3%) underwent assessment at 2–3 years, of whom 18.4% had moderate or severe NDI. Maternal transfer to a tertiary centre was associated with a lower adjusted hazard of death (HR 0.79, 95% CI 0.63–0.98) but not with NDI.

Conclusions: Active management and survival increased over time; however, marked regional variation persists. Development of a statewide clinical practice guideline could support equitable, evidence‐based care for extremely preterm births.

Related

  1. Significant Geographic Variation in the Epidemiology and Management of Pediatric Osteochondritis Dissecans Exists Between the Asia‐Pacific and North America
    Joshua Rui Yen Wong, Yun Xiu Lam, Si Heng Sharon Tan +2
    Arthroscopy, sports medicine, and rehabilitationPeer-reviewedCC BYFull textSurgery & anaesthesiaEurope PMCPMC
  2. Evaluation of Perinatal Prevalence, Geographic Disparities, and Survival of Neural Tube Defects — China, 2006–2024
    Wenli Xu, Wenyan Li, Jufen Liu +7
    China CDC weeklyPeer-reviewedCC BY-NCFull textGeneral medicineEurope PMC
  3. High Prevalence and Limited Perinatal Prediction of Kidney Dysfunction in Adolescents Born Extremely Preterm.
    Keia R Sanderson, Jesus E Vazquez, Jennifer E Flythe +8
    Kidney international reportsPeer-reviewedCC BY-NC-NDFull textObstetrics, gynaecology & paediatricsEurope PMC
  4. Center Geography or Center Practice? Decomposing Geographic Variation in Access to Kidney Transplantation Before vs. After Circles
    Luckmini N. Liyanage, Darren E. Stewart, Tanveen Ishaque +4
    Clinical transplantationPeer-reviewedLicence not statedFull text1 citedEpidemiology & public healthPMC
  5. Geographic variation in proportions meeting the waist circumference criterion and having elevated hemoglobin A1c among Specific Health Checkup examinees in Japan: an ecological analysis of the 10th NDB Open Data
    Hirotaka Nakashima, Takahiro Kamihara, Takuya Omura
    Environmental Health and Preventive MedicinePeer-reviewedCC BY 4.0Full textEndocrinology & metabolismJ-STAGE

Cite

BibTeXRIS
BibTeX
@article{williams2026geographic,
  title = {{Geographic Variation in Active Perinatal Management and Outcomes for Extremely Preterm Infants in New South Wales: A Population‐Based Cohort Study}},
  author = {Nicholas Williams and Chenxi Li and Natasha Nassar and Adrienne Gordon},
  journal = {The Australian \& New Zealand Journal of Obstetrics \& Gynaecology},
  year = {2026},
  month = nov,
  doi = {10.1111/ajo.70196},
  url = {https://doi.org/10.1111/ajo.70196},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Geographic Variation in Active Perinatal Management and Outcomes for Extremely Preterm Infants in New South Wales: A Population‐Based Cohort Study
AU  - Nicholas Williams
AU  - Chenxi Li
AU  - Natasha Nassar
AU  - Adrienne Gordon
PY  - 2026
DA  - 2026/11/04
JO  - The Australian & New Zealand Journal of Obstetrics & Gynaecology
DO  - 10.1111/ajo.70196
UR  - https://doi.org/10.1111/ajo.70196
AB  - Background: Perinatal management of infants born at 22–25 weeks' gestation varies internationally and may influence survival and long‐term outcomes. In New South Wales (NSW), no contemporary statewide guideline exists.  Aims: To evaluate rates of active delivery room management and associated survival and neurodevelopmental outcomes among infants born at 22–25 weeks' gestation in NSW.  Materials and Methods: Population‐based cohort study of all live births at 22 + 0–25 + 6 weeks in NSW (2011–2019) using linked administrative and clinical datasets. Active management was defined as provision of respiratory support or higher in the delivery room. Primary outcomes were survival to 1 year and moderate or severe neurodevelopmental impairment (NDI) at 2–3 years.  Results: Among 1285 live‐born infants, 69.0% received active management, increasing from 61.7% in 2011 to 74.5% in 2019 (p < 0.001). Rates varied across local health districts (54.9%–83.5%). One‐year survival was 44.9% overall (64.4% among actively managed infants) and increased with gestational age. Of 577 children eligible for follow‐up, 440 (76.3%) underwent assessment at 2–3 years, of whom 18.4% had moderate or severe NDI. Maternal transfer to a tertiary centre was associated with a lower adjusted hazard of death (HR 0.79, 95% CI 0.63–0.98) but not with NDI.  Conclusions: Active management and survival increased over time; however, marked regional variation persists. Development of a statewide clinical practice guideline could support equitable, evidence‐based care for extremely preterm births.
SN  - 0004-8666
SN  - 1479-828X
ER  -