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Pattern of Independent Factors Influencing Preterm Infants' Chance of Survival to Discharge Without Any Significant
1Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.
Insights
Extreme prematurity, mechanical ventilation, and thrombocytopenia are key factors influencing infant survival without major morbidities like bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Critical Care
Background:
- Understanding factors contributing to significant morbidity in preterm infants is crucial for clinical management and parental counseling.
- Limited current knowledge necessitates further investigation into predictors of major neonatal complications.
Purpose of the Study:
- To identify predictors of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP) in surviving preterm infants.
- To differentiate factors associated with survival without these morbidities versus survival with one or more complications.
Main Methods:
- Retrospective single-center study of 443 infants born between 22 and 32 weeks gestation.
- Group comparisons of 33 maternal, intrapartum, and neonatal factors to identify 15 potential predictors.
- Regression models used to determine predictors of survival with and without specific morbidities.
Main Results:
- Infants born at 22-27 weeks gestation, requiring mechanical ventilation, or with thrombocytopenia, sepsis, or necrotizing enterocolitis (NEC) had decreased likelihood of survival without BPD, IVH, and ROP.
- Maternal pre-eclampsia was associated with an increased likelihood of survival without these morbidities.
- Gestational age (22-27 weeks), mechanical ventilation, and thrombocytopenia predicted multiple morbidities.
Conclusions:
- Extreme prematurity, mechanical ventilation, and thrombocytopenia are significant factors distinguishing infants with multiple morbidities from those surviving without major complications.
- These findings may aid in clinical decision-making and parental counseling for high-risk preterm infants.
- Further validation is required for clinical application.
Abstract:
Background Recognizing the factors that contribute to significant morbidity in preterm infants is essential for effective clinical management and parental counseling. However, current knowledge in this area remains limited. Methods This retrospective single-center study aimed to identify the predictors of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP) in surviving infants born between 22 and 32 weeks of gestation. Of the 443 infants studied, 269 did not have any of these conditions, while 174 had at least one. Among the latter group, 110 infants had one, and 64 had more than one disease. We conducted group-based comparisons of 33 maternal, intrapartum, and neonatal factors, which helped identify 15 potentially significant predictors. These were included in regression models to identify those that predicted survival without BPD, IVH, and ROP, as well as survival with one or more of these morbidities. The models presented odds ratios (ORs) along with 95% confidence intervals (CIs). A p-value of less than 0.05 was considered statistically significant. Results The likelihood of survival without BPD, IVH, and ROP was decreased in infants born with a gestational age of 22-27 weeks (OR 0.68, 95% CI 0.48, 0.97), who were mechanically ventilated (OR 0.48, 95% CI 0.35, 0.98), or diagnosed with thrombocytopenia (OR 0.52, 95% CI 0.35, 0.79), sepsis (OR 0.74, 95% CI 0.56, 0.97), or necrotizing enterocolitis (NEC; OR 0.28, 95% CI 0.22, 0.91), but was increased in the presence of maternal pre-eclampsia (OR 1.44, 95% CI 1.05, 1.97). The presence of intrapartum antibiotics, mechanical ventilation, thrombocytopenia, and NEC predicted the finding of a single morbidity, whereas a gestational age of 22-27 weeks, mechanical ventilation, and thrombocytopenia predicted more than one morbidity in these infants. Conclusion Extreme prematurity, mechanical ventilation, and thrombocytopenia are important factors, and their presence or absence can help distinguish infants who will survive without BPD, IVH, and ROP from those who will have two or three morbidities. Further validation of these findings is necessary before their application in clinical practice.
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