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Does parity affect the neonatal outcome of very-low-birth-weight infants ?
1The Department of Neonatology, Mt. Scopus Hadassah University Hospital. 91240 Jerusalem, Israel.
Insights
Firstborn premature infants show a trend toward better survival. Advanced parity is linked to a higher risk of severe intraventricular hemorrhage in very-low-birth-weight infants.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Obstetrics
Background:
- Parity, the number of previous births, is a significant factor in maternal and infant health.
- Very-low-birth-weight (VLBW) infants face numerous neonatal complications.
- Understanding parity's influence on VLBW infant outcomes is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between parity and neonatal outcomes in VLBW infants.
- To analyze the impact of parity on survival, bronchopulmonary dysplasia, and severe intraventricular hemorrhage.
- To control for sociodemographic, obstetric, and perinatal variables in the analysis.
Main Methods:
- A cohort of 111 singleton VLBW infants (750-1250g) born between 1990-1994 was studied.
- Logistic regression was used to identify variables associated with neonatal outcomes.
- Analyses were conducted with and without respiratory distress syndrome (RDS) to assess its mediating role.
Main Results:
- Neonatal mortality showed a borderline significant increase in infants from parity group 2-11 compared to firstborns (OR=3.3, P=0.09), particularly when RDS was excluded.
- No association was found between parity and bronchopulmonary dysplasia.
- A higher risk of severe intraventricular hemorrhage was observed in offspring of multiparous women (OR=4.6-7.6, P=0.03-0.08).
- Respiratory distress syndrome significantly impacted all outcomes.
- Short pre-delivery hospitalization was linked to increased mortality and severe intraventricular hemorrhage.
Conclusions:
- A trend suggests improved survival for firstborn VLBW infants compared to those from subsequent deliveries.
- Advanced parity is associated with an increased risk of severe intraventricular hemorrhage in VLBW infants.
- Further research is needed to confirm these findings and their clinical implications.
Objective:
To evaluate the impact of parity on the neonatal outcome (survival, bronchopulmonary dysplasia and severe intraventricular hemorrhage) of very-low-birth-weight infants, accounting for sociodemographic, obstetric and perinatal variables.
Study Design:
One hundred and eleven singleton premature infants with birth weights of 750--1250 grams, delivered between 1990 and 1994 and treated in the Hadassah University Hospitals in Jerusalem, were evaluated. In the analyses, variables with statistically significant association with the outcome variables were identified and entered together with parity as explanatory variables in a logistic regression. The results were analyzed with and without the inclusion of respiratory distress syndrome, representing an index of initial illness severity, in the multivariate model.
Results:
Neonatal mortality was higher in the 2--11 parity group when compared with first born infants. This association was of borderline statistical significance (OR=3.3; P=0.09), and was evident only upon exclusion of respiratory distress syndrome from the equation. There was no association between parity and the development of bronchopulmonary dysplasia. The risk for developing severe intraventricular hemorrhage was higher in offsprings of multiparous women (OR=4.6; P=0,08 for parity 2-4, and OR=7.6; P=0.03 for parity 5--11). Respiratory distress syndrome was significantly associated with all the outcome variables and, to some extent, masked the relevance of pregnancy duration. A short hospitalization period before delivery was associated with increased mortality and with higher incidence of severe intraventricular hemorrhage. High initial Apgar scores appeared protective against severe intraventricular hemorrhage and bronchopulmonary dysplasia.
Conclusion:
Our results demonstrate a trend for increased survival of first born premature infants when compared with offsprings of subsequent deliveries, and an association between advanced parity and the development of severe intraventricular hemorrhage. Confirmation of these data by other studies is required before resultant implications are considered.
