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Multivariate risks among extremely premature infants
M E Msall1, G M Buck, B T Rogers
1Department of Pediatrics, Robert Warner Rehabilitation Center, Buffalo, NY 14209.
Insights
Extremely premature infants face significant mortality and morbidity risks. Key factors include low birth weight, severe brain bleeds, low Apgar scores, male sex, and lack of surfactant therapy.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Public Health
Background:
- The surfactant era has improved outcomes for premature infants, but mortality and morbidity remain significant concerns.
- Identifying specific risk factors is crucial for developing targeted interventions to improve long-term outcomes for extremely premature infants.
Purpose of the Study:
- To identify significant risk factors associated with mortality and major impairments in extremely premature infants born during the surfactant era.
- To provide data that can inform the development of strategies aimed at optimizing the long-term health and development of this vulnerable population.
Main Methods:
- A cohort of 194 infants born at < 29 weeks' gestation between 1983 and 1986 was studied.
- Mortality data were collected, and survivors underwent blinded neurodevelopmental assessments at a mean age of 52 months.
- Logistic regression analysis was used to identify significant risk factors for mortality and major impairments.
Main Results:
- Five significant risk factors for mortality were identified: grade III/IV intraventricular hemorrhage, birth weight < 800 gm, 5-minute Apgar score ≤ 3, male sex, and absence of surfactant therapy.
- Significant risk factors for major impairment included sepsis, male sex, and nonwhite race.
- Hydrocephalus requiring shunting was a strong predictor of cerebral palsy and neonatal retardation. Nonwhite race, sepsis, and male sex were also significant risk factors for mental retardation.
Conclusions:
- Specific factors such as intraventricular hemorrhage, low birth weight, and Apgar scores are critical predictors of mortality in extremely premature infants.
- Sepsis, male sex, and nonwhite race are significant risk factors for major neurodevelopmental impairments, including mental retardation and cerebral palsy.
- Understanding these risk factors is essential for developing targeted interventions to improve survival and long-term outcomes for extremely premature infants.
Abstract:
This study was designed to identify risk factors for mortality and morbidity of extremely premature infants born in the surfactant era. The study cohort included 194 infants born at < 29 weeks' gestation at one regional tertiary center between 1983 and 1986. Forty-one infants died. Blinded neurodevelopmental assessments were performed on 149 of 153 (97%) survivors at a mean age of 52 months. Thirty-one (21%) survivors had major impairments: 15 had mental retardation, 8 had multiple impairments, 7 had cerebral palsy, and 1 was blind. Logistic regression analysis identifies five significant risk factors for mortality: grade III or IV intraventricular hemorrhage, birth weight < 800 gm, 5-minute Apgar score < or = 3, male sex, and absence of surfactant therapy. Significant risk factors for any major impairment included sepsis (relative risks [RR] = 6.4), male sex (RR = 3.1), and nonwhite race (RR = 2.8). Hydrocephalus requiring shunting was a significant risk factor for cerebral palsy (RR = 16.4) and neonatal retardation (RR = 16.0). Nonwhite race (RR = 7.3), sepsis (RR = 6.8), and male sex (RR = 3.7) also were significant risk factors for mental retardation. Confirmation of these risk factors should facilitate development of targeted interventions for optimizing long-term outcome.