Red Cell Distribution Width as a Predictor of Mortality in Neonates With Very Low Birth Weight: A Retrospective...

Red cell distribution width (RDW) is recognised as a prognostic biomarker for predicting mortality in neonatal sepsis. However, its utility in forecasting 28-day mortality amongst very low birth weight (VLBW) neonates remains uncertain.

We conducted a retrospective, observational, single-centre study involving neonates with a birth weight of less than 1500 g. The primary endpoint was 28-day mortality. RDW and the Score for Neonatal Acute Physiology-Perinatal Extension II (SNAPPE-II) were measured on Days 1 and 3 following admission to evaluate their predictive value for mortality. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were used to assess the association between RDW and 28-day mortality, and to compare the predictive performance of RDW with SNAPPE-II.

RDW levels were significantly higher in the non-survivor group (n = 35) compared to the survivor group (n = 70) on both Day 1 and 3 post-admission (p < 0.01 for both). Additionally, RDW was positively correlated with SNAPPE-II scores (r = 0.63 and 0.61, p < 0.01). ROC analysis revealed that RDW measured on Day 3 had a strong predictive value for 28-day mortality (AUC = 0.89, p < 0.01), which was significantly greater than the AUC for RDW on Day 1 (AUC = 0.73).

These findings suggest that dynamic RDW changes (on post-admission Day 1-3) are a reliable prognostic biomarker for 28-day mortality in VLBW neonates, with predictive performance comparable to SNAPPE-II. It can serve as a low-cost, easily accessible tool for risk stratification in resource-limited settings.

China Clinical Trial Registration Center Registration No.: ChiCTR2100043217.