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Outcomes of outborn very-low-birth-weight infants in Japan
Katsuya Hirata1, Takeshi Kimura2, Shinya Hirano2
1Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan khirata0513@gmail.com.
Insights
Outborn very-low-birth-weight infants (VLBWIs) face a higher risk of severe intraventricular hemorrhage (IVH). This study found no significant differences in other major morbidities or mortality between outborn and inborn VLBWIs.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Background:
- Outcomes for outborn very-low-birth-weight infants (VLBWIs) are not well-established.
- Understanding differences between outborn and inborn VLBWIs is crucial for improving neonatal care.
Purpose of the Study:
- To compare morbidity and mortality rates between outborn and inborn VLBWIs.
- To identify specific risks associated with outborn VLBWI delivery.
Main Methods:
- An observational cohort study was conducted using data from the Neonatal Research Network of Japan (2012-2016).
- Inverse-probability-of-treatment weighting (IPTW) was employed to adjust for prenatal covariate imbalances.
- Singleton VLBWIs without major anomalies admitted to NICU were included.
Main Results:
- The study included 15,842 VLBWIs, with 668 classified as outborn.
- Outborn VLBWIs exhibited a significantly higher incidence of severe intraventricular hemorrhage (IVH) (8.2% vs. 4.1%) and pulmonary hemorrhage.
- No significant differences were observed in overall mortality, necrotizing enterocolitis, sepsis, or chronic lung disease.
Conclusions:
- Outborn delivery is associated with an increased risk of severe IVH in very-low-birth-weight infants.
- While severe IVH is a concern, other major neonatal outcomes do not significantly differ between outborn and inborn VLBWIs.
Background:
Outcomes of prenatal covariate-adjusted outborn very-low-birth-weight infants (VLBWIs) (≤1500 g) remain uncertain.
Objective:
To compare morbidity and mortality between outborn and inborn VLBWIs.
Design:
Observational cohort study using inverse-probability-of-treatment weighting.
Setting:
Neonatal Research Network of Japan.
Patients:
Singleton VLBWIs with no major anomalies admitted to a neonatal intensive care unit from 2012 to 2016.
Methods:
Inverse-probability-of-treatment weighting with propensity scores was used to reduce imbalances in prenatal covariates (gestational age (GA), birth weight, small for GA, sex, maternal age, premature rupture of membranes, chorioamnionitis, preeclampsia, maternal diabetes mellitus, antenatal steroids and caesarean section). The primary outcome was severe intraventricular haemorrhage (IVH). The secondary outcomes were outcomes at resuscitation, other neonatal morbidities and mortality.
Results:
The full cohort comprised 15 842 VLBWIs (668 outborns). The median (IQR) GA and birth weight were 28.9 (26.4-31.0) weeks and 1128 (862-1351) g for outborns and 28.7 (26.3-30.9) weeks and 1042 (758-1295) g for inborns. Outborn VLBWIs had a higher incidence of severe IVH (8.2% vs 4.1%; OR, 3.45; 95% CI 1.16 to 10.3) and pulmonary haemorrhage (3.7% vs 2.8%; OR, 5.21; 95% CI 1.41 to 19.2). There were no significant differences in Apgar scores, oxygen rates at delivery, intubation ratio at delivery, persistent pulmonary hypertension of the newborn, IVH of any grade, periventricular leukomalacia, chronic lung disease, oxygen at discharge, patent ductus arteriosus, retinopathy of prematurity, necrotising enterocolitis, sepsis or mortality.
Conclusion:
Outborn delivery of VLBWIs was associated with an increased risk of severe IVH.
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