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Predictors of neonatal mortality in Iranian cases of preterm birth: a retrospective cohort study
Mohaddeseh Jahannia1, Seyyed Amir Yasin Ahmadi2,3, Narjes Khalili1
1Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Introduction:
Although the risk factors of neonatal mortality are currently known, it was necessary to know the risk factors of mortality in neonatal preterm birth. The present study was conducted to find and investigate the potential maternal, fetal and neonatal risk factors of neonatal mortality among the cases of preterm birth.
Methods:
A retrospective cohort study was conducted with a secondary analysis of existing data of a national registry. All premature infants born in Iran from March 21st 2019 to March 21st 2020 were included in the study using census. Mixed model logistic regression was used to identify the potential risk and protecting factors from a selected groups of the variables of the national registry with reporting odds ratio (OR) and 95% confidence interval (CI).
Results:
A total of 120,688 cases of preterm labor were studied with GA in the range of 22-36 weeks. A total of 5458 neonatal deaths (4.52% of total cases) were recorded. The most effective protecting factor was increased gestational age (GA) (adjusted OR = 0.664 per week, 95% CI: 0.658-0.669). The risk factors remained in the multivariable modeling were maternal hypertension, eclampsia / preeclampsia, addiction, placental abruption, meconium staining, impaired fetal heart rate, previous neonatal death, intrauterine growth restriction, lack of corticosteroid administration, rural and nomadic residency, cesarean delivery, malformation, public hospital (vs. private), and out-of-hospital delivery (P < 0.1). The protecting factors remained in the multivariable modeling were gestational diabetes mellitus, premature rupture of membrane for more than 18 h, female sex, GA, and mother age (P < 0.1).
Conclusion:
The present study showed that many maternal and neonatal related variables were potential risk and protecting factors of neonatal death among the preterm birth neonates. The main predictor of the outcome was GA, and using corticosteroid before birth was a modifiable protecting factor.
