Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Am J Perinatol. 2024 Jul;41(10):1379-1387. doi: 10.1055/a-2016-7568. Epub 2023 Jan 20.
Very preterm neonates have high rates of composite outcomes featuring mortality and major morbidities. If the modifiable risk factors could be identified, perhaps the rates could be decreased especially in resource-limited settings.
We performed a prospective study in a Thai neonatal intensive care unit to identify the risk factors of composite outcomes between 2014 and 2021. The inclusion criterion was neonates who were born in our hospital at a gestational age (GA) of less than 32 weeks. The exclusion criteria were neonates who died in the delivery room or had major congenital anomalies. The composite outcomes were analyzed by multivariable logistic regression with adjusted odds ratios (aORs) and a 95% confidence interval (CI).
Over the 8-year study period, 555 very preterm inborn neonates without major birth defects were delivered. The composite outcomes were 29.4% (163/555). The medians (interquartile ranges) of GA and birth weights of the neonates were 29 (27-31) weeks and 1,180 (860-1,475) grams, respectively. By multivariable analysis, GA (aOR: 0.65; 95% CI: 0.55-0.77), small for GA (aOR: 4.93; 95% CI: 1.79-13.58), multifetal gestation (aOR: 2.23; 95% CI: 1.12-4.46), intubation within 24 hours (aOR: 5.39; 95% CI: 1.35-21.64), and severe respiratory distress syndrome (aOR: 5.00; 95% CI: 1.05-23.89) were significantly associated with composite outcomes.
Very preterm infants who had a lower GA were small for GA, twins or more, respiratory failure on the first day of life, and severe respiratory distress syndrome were associated with mortality and/or major morbidities.
· In very preterm neonates, the composite outcomes and mortality rate were 29.4 and 12.3%.. · Composite outcomes were associated with lower GA, SGA, multifetal gestation, intubation, and severe RDS.. · Mortality was associated with lower GA or Apgar score at 5 minutes, SGA, and PPHN..
极早产儿的病死率和主要合并症发生率较高。如果能够确定可改变的危险因素，或许可以降低这些比率，尤其是在资源有限的环境中。
我们在泰国新生儿重症监护病房进行了一项前瞻性研究，以确定 2014 年至 2021 年期间复合结局的危险因素。纳入标准为胎龄（GA）＜32 周且在我院出生的新生儿。排除标准为在产房死亡或有重大先天畸形的新生儿。采用多变量逻辑回归分析复合结局，并用调整后的优势比（aOR）和 95%置信区间（CI）进行分析。
在 8 年的研究期间，共有 555 例无重大出生缺陷的极早产儿在我院出生。复合结局发生率为 29.4%（163/555）。新生儿的 GA 中位数（四分位间距）和出生体重中位数（四分位间距）分别为 29（27-31）周和 1180（860-1475）g。多变量分析显示，GA（aOR：0.65；95%CI：0.55-0.77）、小于胎龄儿（aOR：4.93；95%CI：1.79-13.58）、多胎妊娠（aOR：2.23；95%CI：1.12-4.46）、24 小时内插管（aOR：5.39；95%CI：1.35-21.64）和重度呼吸窘迫综合征（aOR：5.00；95%CI：1.05-23.89）与复合结局显著相关。
GA 较低、小于胎龄儿、双胎或多胎妊娠、生后第 1 天发生呼吸衰竭以及重度呼吸窘迫综合征的极早产儿，其病死率和/或主要合并症发生率较高。
· 在极早产儿中，复合结局和死亡率分别为 29.4%和 12.3%。· 复合结局与较低的 GA、小于胎龄儿、多胎妊娠、插管和重度呼吸窘迫综合征相关。· 死亡率与较低的 GA 或 5 分钟时的 Apgar 评分、小于胎龄儿和持续性肺动脉高压相关。
