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Risk factors of early mortality within 72 hours of birth in neonates born at 22 23 weeks' gestation
Tomonori Kurimoto1, Takuya Tokuhisa2, Asataro Yara2
1Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, 37-1 Uearata, Kagoshima, Japan. maron.n.tomo.o@gmail.com.
Insights
Neonatal death within 72 hours in extremely preterm infants (22-23 weeks gestation) is linked to fetal bradycardia, low 5-minute Apgar scores, and tension pneumothorax. Improving prenatal care and resuscitation may enhance survival rates.
Area of Science:
- Neonatalogy
- Perinatology
- Critical Care Medicine
Background:
- Survival rates for neonates vary significantly by gestational age and internationally.
- Neonates born at 22-23 weeks gestation have high mortality rates despite advancements in neonatal care.
- Factors influencing mortality in extremely preterm infants remain unclear.
Purpose of the Study:
- To compare the risk of death within 72 hours in neonates born at 22 and 23 weeks' gestation.
- To identify risk factors associated with early mortality in this vulnerable population.
Main Methods:
- Retrospective analysis of 185 neonatal intensive care unit patients (2006-2023).
- Comparison of maternal, placental, and neonatal data between survivors and non-survivors within 72 hours.
- Logistic regression model to identify predictors of early mortality, including fetal bradycardia, 5-minute Apgar score, umbilical arterial pH, and tension pneumothorax.
Main Results:
- Fetal bradycardia, low 1-minute and 5-minute Apgar scores, low umbilical arterial pH, and tension pneumothorax were observed more frequently in neonates who died within 72 hours.
- Logistic regression identified fetal bradycardia (OR 7.89), 5-minute Apgar score (OR 1.43), and tension pneumothorax (OR 8.79) as significant risk factors for early mortality.
Conclusions:
- Early death in neonates born at 22-23 weeks gestation is associated with fetal bradycardia, low 5-minute Apgar scores, and tension pneumothorax.
- Optimizing prenatal care, resuscitation, and neonatal management strategies is crucial for improving survival outcomes in extremely preterm infants.
Background:
The survival rates of neonates are significantly influenced by gestational age, with further differences observed internationally. Survival rates for live births at 22 and 23 weeks of gestation range from 3.7% to 56.7% and from 20.0% to 79.3%, respectively. Despite advancements in neonatal care, the mortality rate in these preterm infants remains high, and the factors influencing mortality remain unclear. In this study, we conducted a comparative analysis of the risk of death within 72 h of birth in neonates born at 22 and 23 weeks' gestation.
Methods:
This single-center, retrospective study analyzed 185 patients admitted to the neonatal intensive care unit between January 2006 and December 2023. Maternal information, placental pathology, out-of-hospital births, and neonatal information were compared between patients who did and did not succumb to mortality within 72 h. A logistic regression model was created with death within 72 h as the outcome variable, and fetal bradycardia, 5-min Apgar score, Umbilical arterial pH (UA pH), and tension pneumothorax as explanatory variables. Parameter estimation was performed using the likelihood method.
Results:
In the death within 72 h after birth group, differences were observed in the mode of delivery determined by fetal bradycardia (4/15 cases, 26.7%), 1-min Apgar score (1, 95% confidence interval [CI]: 1-3 points), 5-min Apgar score (5, 95% CI: 2-6 points), UA pH (7.24, 95% CI: 7.11-7.32), and tension pneumothorax (7/15 cases, 46.7%). In the logistic regression model estimating risk factors of death within 72 h, the expected values of the regression coefficients and 95% CI were as follows: fetal bradycardia (7.89, 95% CI: 1.31-48.40), 5-min Apgar score (1.43, 95% CI: 1.04-2.03), UA pH (6.10, 95% CI: 0.09-300.93), and tension pneumothorax (8.79, 95% CI: 2.35-35.46).
Conclusion:
Death within 72 h of birth in neonates born at 22-23 weeks gestation is associated with fetal bradycardia, low 5-min Apgar scores, and tension pneumothorax. Optimizing prenatal care, timely resuscitation, and neonatal management strategies may improve survival outcomes.
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