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Mortality and Morbidity in Premature Infants: An East and West Comparative Study
Monika Patil1,2, Venkateshwarlu Vardhelli3, Joseph L Hagan1
1Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Houston, Texas.
Insights
Preterm infant survival varies by country. This study found US infants had lower mortality but higher bronchopulmonary dysplasia (BPD) rates compared to Indian infants, highlighting differences in neonatal care practices.
Area of Science:
- Neonatal Medicine
- Global Health
- Pediatric Outcomes
Background:
- Survival rates for preterm infants significantly differ based on birthplace, with limited comparative data between low-middle-income and high-income countries.
- No prior studies have directly compared the outcomes of preterm infants between India and the United States.
Purpose of the Study:
- To evaluate differences in care practices, available resources, mortality, and morbidities among preterm infants (700-1,500g) between major neonatal centers in India and the United States.
- To identify factors contributing to disparate outcomes in preterm infant care across different economic settings.
Main Methods:
- A retrospective cohort study utilizing de-identified data from Fernandez Hospital (India) and Texas Children's Hospital (USA) for infants born between January 2016 and December 2018.
- Infants included had a birth weight between 700 and 1,500g. The primary outcome was in-hospital mortality.
Main Results:
- After adjusting for gestational age, small for gestational age status, and antenatal corticosteroid use, infants at Texas Children's Hospital (TCH) showed significantly lower mortality (aOR=0.28) but higher rates of bronchopulmonary dysplasia (BPD) (aOR=2.2) compared to Fernandez Hospital (FH).
- The composite outcomes of death or BPD, and death or any major morbidity (including severe intraventricular hemorrhage, periventricular leukomalacia, or retinopathy of prematurity requiring treatment) did not differ significantly between the two centers.
Conclusions:
- Infants born at a high-income country center (TCH) experienced decreased odds of death but increased odds of BPD compared to those in a low-middle-income country center (FH).
- These differences may be attributed to variations in neonatal intensive care unit (NICU) care practices and resource availability, potentially influencing survival-morbidity trade-offs.
Objective:
Survival of preterm infants differs dramatically depending on birthplace. No previous studies have compared outcomes of preterm infants between low middle-income and high-income countries such as India and the United States. The purpose of this study is to evaluate differences in care practices, resources, mortality, and morbidities in preterm infants with birth weight 700 to 1,500 g between two major neonatal centers in these countries.
Study Design:
This is a retrospective cohort study with de-identified data from Fernandez Hospital (FH) in Hyderabad, India, and Texas Children's Hospital (TCH) in Houston, TX, for infants born January 2016 to December 2018, and weighing 700 to 1,500 g at birth. The primary outcome was death before hospital discharge.
Results:
Of 1,195 infants, 736 were admitted to FH and 459 were admitted to TCH. After controlling for differences in gestational age, small for gestational age, and antenatal corticosteroid use, TCH patients had lower mortality before hospital discharge (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI]: 0.16-0.48, p < 0.001) and more bronchopulmonary dysplasia (BPD; aOR = 2.2, 95% CI: 1.51-3.21, p < 0.001). The composite outcome of death or BPD and death or any major morbidity (BPD or intraventricular hemorrhage grade II or more or periventricular leukomalacia grade II or more or retinopathy of prematurity requiring treatment) were not different.
Conclusion:
In this study, TCH infants had decreased odds of death before hospital discharge compared with FH but higher odds of BPD, which may be related to increased survival and differences in care practices.
Key Points:
· Few studies compared outcomes of premature infants between different high-income countries.. · There are no studies comparing preterm infants between low middle-income and high-income countries such as India and the United States.. · This study evaluated detailed comparison of care practices and infrastructure of NICUs in India and United states..
