Importance Birth in the periviable period between 22 weeks 0 days and 25 weeks 6 days' gestation is a major source of neonatal morbidity and mortality, and the decision to initiate active life-saving treatment is challenging. Objective To assess whether the frequency of active treatment among live-born neonates in the periviable period has changed over time and whether active treatment differed by gestational age at birth and race and ethnicity. Design, Setting, and Participants Serial cross-sectional descriptive study using National Center for Health Statistics natality data from 2014 to 2020 for 61 908 singleton live births without clinical anomalies between 22 weeks 0 days and 25 weeks 6 days in the US. Exposures Year of delivery, gestational age at birth, and race and ethnicity of the pregnant individual, stratified as non-Hispanic Asian/Pacific Islander, non-Hispanic Black, Hispanic/Latina, and non-Hispanic White. Main Outcomes and Measures Active treatment, determined by whether there was an attempt to treat the neonate and defined as a composite of surfactant therapy, immediate assisted ventilation at birth, assisted ventilation more than 6 hours in duration, and/or antibiotic therapy. Frequencies, mean annual percent change (APC), and adjusted risk ratios (aRRs) were estimated. Results Of 26 986 716 live births, 61 908 (0.2%) were periviable live births included in this study: 5% were Asian/Pacific Islander, 37% Black, 24% Hispanic, and 34% White; and 14% were born at 22 weeks, 21% at 23 weeks, 30% at 24 weeks, and 34% at 25 weeks. Fifty-two percent of neonates received active treatment. From 2014 to 2020, the overall frequency (mean APC per year) of active treatment increased significantly (3.9% [95% CI, 3.0% to 4.9%]), as well as among all racial and ethnic subgroups (Asian/Pacific Islander: 3.4% [95% CI, 0.8% to 6.0%]); Black: 4.7% [95% CI, 3.4% to 5.9%]; Hispanic: 4.7% [95% CI, 3.4% to 5.9%]; and White: 3.1% [95% CI, 1.1% to 4.4%]) and among each gestational age range (22 weeks: 14.4% [95% CI, 11.1% to 17.7%] and 25 weeks: 2.9% [95% CI, 1.5% to 4.2%]). Compared with neonates born to White individuals (57.0%), neonates born to Asian/Pacific Islander (46.2%; risk difference [RD], -10.81 [95% CI, -12.75 to -8.88]; aRR, 0.82 [95% CI, [0.79-0.86]), Black (51.6%; RD, -5.42 [95% CI, -6.36 to -4.50]; aRR, 0.90 [95% CI, 0.89 to 0.92]), and Hispanic (48.0%; RD, -9.03 [95% CI, -10.07 to -7.99]; aRR, 0.83 [95% CI, 0.81 to 0.85]) individuals were significantly less likely to receive active treatment. Conclusions and Relevance From 2014 to 2020 in the US, the frequency of active treatment among neonates born alive between 22 weeks 0 days and 25 weeks 6 days significantly increased, and there were differences in rates of active treatment by race and ethnicity.

中文翻译：

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2014 年至 2020 年美国孕龄和孕产妇种族和民族对 22 周 0 天至 25 周 6 天活产新生儿积极治疗的趋势。

重要性 在妊娠 22 周 0 天和 25 周 6 天之间的可存活期出生是新生儿发病率和死亡率的主要来源，启动积极的挽救生命治疗的决定具有挑战性。目的 评估活产新生儿在活产期间接受积极治疗的频率是否随时间发生变化，以及积极治疗是否因出生胎龄、种族和民族而异。设计、设置和参与者 使用国家卫生统计中心 2014 年至 2020 年的出生数据对美国 22 周 0 天至 25 周 6 天之间的 61 908 名无临床异常的单胎活产进行系列横断面描述性研究。暴露 分娩年份、出生时的胎龄以及怀孕个体的种族和民族，分层为非西班牙裔亚裔/太平洋岛民、非西班牙裔黑人、西班牙裔/拉丁裔和非西班牙裔白人。主要结局和措施 积极治疗，由是否尝试治疗新生儿决定，定义为表面活性剂治疗、出生时立即辅助通气、持续时间超过 6 小时的辅助通气和/或抗生素治疗的组合。估计了频率、平均年百分比变化 (APC) 和调整后的风险比 (aRR)。结果 在 26 986 716 名活产婴儿中，61 908 名 (0.2%) 为本研究纳入的适龄活产婴儿：5% 为亚裔/太平洋岛民，37% 为黑人，24% 为西班牙裔，34% 为白人；14% 在 22 周出生，21% 在 23 周出生，30% 在 24 周出生，34% 在 25 周出生。52% 的新生儿接受了积极治疗。从2014年到2020年，积极治疗的总体频率（每年平均 APC）显着增加（3.9% [95% CI，3.0% 至 4.9%]），以及所有种族和民族亚群（亚洲/太平洋岛民：3.4% [95%置信区间，0.8% 至 6.0%])；黑色：4.7% [95% CI，3.4% 至 5.9%]；西班牙裔：4.7% [95% CI，3.4% 至 5.9%]；和白人：3.1% [95% CI，1.1% 至 4.4%]）和每个胎龄范围（22 周：14.4% [95% CI，11.1% 至 17.7%] 和 25 周：2.9% [95% CI , 1.5% 至 4.2%])。与白人 (57.0%) 所生新生儿相比，亚裔/太平洋岛民所生新生儿 (46.2%；风险差 [RD]，-10.81 [95% CI，-12.75 至 -8.88]；aRR，0.82 [95% CI , [0.79-0.86]），黑人（51.6%；RD，-5.42 [95% CI，-6.36 至 -4.50]；aRR，0.90 [95% CI，0.89 至 0.92]）和西班牙裔（48.0%；RD ，-9.03 [95% CI，-10.07 至 -7.99]；aRR，0.83 [95% CI，0.81 至 0。85]) 个体接受积极治疗的可能性显着降低。结论与意义 2014年至2020年美国22周0天至25周6天活产新生儿积极治疗频率显着增加，且积极治疗率存在种族和民族差异。