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Am J Perinatol
DOI: 10.1055/a-2016-7568
Original Article

Risk Factors for Mortality or Major Morbidities of Very Preterm Infants: A Study from Thailand

Anucha Thatrimontrichai 
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Manapat Phatigomet
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Gunlawadee Maneenil 
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Supaporn Dissaneevate
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Waricha Janjindamai
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Abstract

Objective Very preterm neonates have high rates of composite outcomes featuring mortality and major morbidities. If the modifiable risk factors could be identified, perhaps the rates could be decreased especially in resource-limited settings.

Study Design We performed a prospective study in a Thai neonatal intensive care unit to identify the risk factors of composite outcomes between 2014 and 2021. The inclusion criterion was neonates who were born in our hospital at a gestational age (GA) of less than 32 weeks. The exclusion criteria were neonates who died in the delivery room or had major congenital anomalies. The composite outcomes were analyzed by multivariable logistic regression with adjusted odds ratios (aORs) and a 95% confidence interval (CI).

Results Over the 8-year study period, 555 very preterm inborn neonates without major birth defects were delivered. The composite outcomes were 29.4% (163/555). The medians (interquartile ranges) of GA and birth weights of the neonates were 29 (27–31) weeks and 1,180 (860–1,475) grams, respectively. By multivariable analysis, GA (aOR: 0.65; 95% CI: 0.55–0.77), small for GA (aOR: 4.93; 95% CI: 1.79–13.58), multifetal gestation (aOR: 2.23; 95% CI: 1.12–4.46), intubation within 24 hours (aOR: 5.39; 95% CI: 1.35–21.64), and severe respiratory distress syndrome (aOR: 5.00; 95% CI: 1.05–23.89) were significantly associated with composite outcomes.

Conclusion Very preterm infants who had a lower GA were small for GA, twins or more, respiratory failure on the first day of life, and severe respiratory distress syndrome were associated with mortality and/or major morbidities.

Key Points

  • In very preterm neonates, the composite outcomes and mortality rate were 29.4 and 12.3%.

  • Composite outcomes were associated with lower GA, SGA, multifetal gestation, intubation, and severe RDS.

  • Mortality was associated with lower GA or Apgar score at 5minutes, SGA, and PPHN.

Keywords

birth asphyxia - persistent pulmonary hypertension of the newborn - premature infants - SGA


Publication History

Received: 03 October 2022

Accepted: 17 January 2023

Accepted Manuscript online:
20 January 2023

Article published online:
21 February 2023

© 2023. Thieme. All rights reserved.

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