In-hospital cardiac arrest in neonates in the United States: a study of epidemiology, outcomes, and trends from 2003 to 2022.

Background: The incidence of in-hospital cardiac arrest (IHCA) in neonates varies with gestational age (GA) and carries high morbidity and mortality. The study aimed to explore incidence of and mortality after IHCA from time of birth to 28 days of life.

Methods: We retrospectively analyzed 7 one-year epochs from the Kids' Inpatient Database from 2003 to 2022. GA was divided into extremely preterm (EP; GA < 28 weeks), very preterm (VP; GA 28-31 weeks), moderately preterm (MP; GA 32-33 weeks), late preterm (LP; GA 34-36 weeks), and term (T; GA > 36 weeks). We analyzed the incidence and trend of IHCA per 1000 hospital discharges and 1000 US live births, including IHCA at birth or during hospitalization.

Results: Among 24,877,754 discharges, 30,117 neonates had IHCA with an incidence of 1.21 per 1000 discharges and 1.08 per 1000 US births. The incidence of IHCA increased (0.8-1.58 per 1000 discharges; p < 0.001), and the mortality during index admission decreased (46.3-40.8 %; p = 0.005). Odds of IHCA were higher in Black neonates and those at lower socioeconomic status.

Conclusion: The incidence of IHCA in neonates in the US has increased from 2003 to 2022, with a decrease in mortality during index admission. While the odds of IHCA is highest among EP and VP neonates, the majority of IHCA occurred in MP, LP, and T neonates. Mortality for EP, VP, and LP neonates has remained unchanged. These findings highlight the importance of GA-specific interventions and prevention strategies and addressing disparities related to race and socioeconomic status.