Bozhbanbayeva Nishankul, An Olga, Sairankyzy Saltanat, Suleimenova Indira, Bazarbayeva Aigul, Adilbekova Indira
Department of Neonatology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
Department of Propaedeutics of Childhood Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
Int J Pediatr. 2025 Aug 23;2025:8678975. doi: 10.1155/ijpe/8678975. eCollection 2025.
This study is aimed at evaluating the cumulative effect of postnatal risk factors on the survival of preterm neonates by examining key clinical parameters and complications across various gestational ages. A retrospective cohort study was conducted using data from 1109 neonates admitted to neonatal intensive care units at two tertiary regional hospitals in Kazakhstan between 2021 and 2024. Patients were classified into three groups based on gestational age: extremely preterm (< 28 weeks, = 223), very preterm (28-31 weeks, = 384), and moderate to late preterm (32-36 weeks, = 502). Initially, to identify significant risk factors, categorical variables were analyzed using the test or Fisher's exact test with the Bonferroni correction, depending on whether the expected counts were ≥ 5 or < 5, while continuous variables were examined with the Kruskal-Wallis and Mann-Whitney tests. Subsequently, multivariate logistic regression was applied to develop a prognostic model for each study group based on previously identified statistically significant risk factors for neonatal mortality. The predictive performance of these factors was further evaluated through ROC curve analysis with AUC. Finally, the Kaplan-Meier method was used to reflect overall mortality outcomes, illustrating their association with gestational age and the distribution of fatal cases over time in days. The results of this study reveal significant differences in survival rates among preterm neonates based on gestational age, with mortality being most pronounced in infants born at less than 28 weeks of gestation. As gestational age increased among preterm infants, there was a marked reduction in the number of statistically significant independent risk factors identified in logistic models that influence survival. Disseminated intravascular coagulation consistently emerged as a significant predictor across all three logistic models. Neonatal depression, hyperbilirubinemia, and necrotizing enterocolitis were significant in both extremely preterm infants (less than 28 weeks) and very preterm infants (28-31 weeks). However, patent ductus arteriosus and bronchopulmonary dysplasia were statistically significant only in the extremely preterm group (less than 28 weeks). In a cohort of preterm neonates in Kazakhstan, the cumulative impact of various risk factors plays a critical role in determining survival outcomes, with increasing gestational age significantly enhancing the likelihood of survival. Further research is required to refine prognostic models and identify factors specific to different sociogeographical populations.
本研究旨在通过检查不同胎龄的关键临床参数和并发症，评估产后危险因素对早产儿生存的累积影响。采用哈萨克斯坦两家三级区域医院2021年至2024年新生儿重症监护病房收治的1109例新生儿的数据进行回顾性队列研究。根据胎龄将患者分为三组：极早产儿（<28周，n = 223）、极早早产儿（28 - 31周，n = 384）和中度至晚期早产儿（32 - 36周，n = 502）。最初，为了确定显著的危险因素，分类变量根据预期频数是否≥5或<5，使用卡方检验或经Bonferroni校正的Fisher精确检验进行分析，而连续变量则用Kruskal - Wallis检验和Mann - Whitney检验进行检查。随后，应用多因素逻辑回归，根据先前确定的新生儿死亡的统计学显著危险因素，为每个研究组建立预后模型。通过受试者工作特征（ROC）曲线分析及曲线下面积（AUC）进一步评估这些因素的预测性能。最后，采用Kaplan - Meier方法反映总体死亡结局，说明其与胎龄的关联以及致命病例随时间（以天为单位）的分布情况。本研究结果显示，基于胎龄的早产儿生存率存在显著差异，胎龄小于28周的婴儿死亡率最高。随着早产儿胎龄增加，在影响生存的逻辑模型中确定的统计学显著独立危险因素数量显著减少。弥散性血管内凝血在所有三个逻辑模型中始终是一个显著的预测因素。新生儿窒息、高胆红素血症和坏死性小肠结肠炎在极早产儿（小于28周）和极早早产儿（28 - 31周）中均具有显著性。然而，动脉导管未闭和支气管肺发育不良仅在极早产儿组（小于28周）中具有统计学显著性。在哈萨克斯坦的一组早产儿中，各种危险因素的累积影响在决定生存结局方面起着关键作用，胎龄增加显著提高了生存可能性。需要进一步研究以完善预后模型并确定不同社会地理人群特有的因素。
