Recent advances in neonatology have led to increased survival rates of neonates, especially very and extremely preterm infants. This has also led to increased morbidities and mortality in these infants.
Methods
A retrospective observational study was conducted in a level III neonatal intensive care unit (NICU) between January 2020 and December 2021 in preterm infants <32 weeks gestation to analyse the antenatal, natal and postnatal risk factors associated with preterm births. We aimed to study the clinical outcomes related to prematurity in these infants.
Results
233 preterm infants of <32 weeks’ gestation were analysed. Mortality was noted in 87 preterm infants (37%). Respiratory distress syndrome (RDS) was seen in 195 cases (84%). Grade 2 RDS was significantly more in infants of 24-28 weeks gestation when compared to infants of 28-32 weeks gestation (42% vs. 9.4%, P = .0001). Sepsis was reported in 188 cases (80.68%), of which early-onset sepsis was seen in 159 cases (84.6%) and late-onset sepsis in 29 cases (15.4%). These outcomes were significantly more prevalent in infants of 24-28 weeks’ gestation compared to those of 28-32 weeks’ gestation (100% vs. 78%, P = .0001 and 87% vs. 67%, P = .02, respectively). Haemodynamically significant ductus was seen in 52% of infants, and it was significantly more in infants of 24-28 weeks gestation versus 28-32 weeks (80% vs. 48%, P = .0008). Incidence of bronchopulmonary dysplasia was seen in 4.7% of infants and was significantly higher in 24-28 weeks versus 28-32 weeks (13% vs. 3.4%, P = .04). Preterm low birth weight status showed an association with mortality in preterm infants.
Conclusion
This audit suggests strengthening antenatal and neonatal interventions for preterm infants in resource-poor settings.
BlencoweH, CousensS, OestergaardMZ, . National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832): 2162–2172.
2.
ChawanpaiboonS, VogelJP, MollerAB, . Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019;7(1):e37–e46.
3.
McGoldrickE, StewartF, ParkerR, DalzielSR.Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2020;12(12):CD004454.
4.
WolfHT, HuusomLD, HenriksenTB, HegaardHK, BrokJ, PinborgA.Magnesium sulphate for fetal neuroprotection at imminent risk for preterm delivery: a systematic review with meta-analysis and trial sequential analysis. BJOG. 2020;127(10): 1180–1188.
5.
RabeH, GyteGM, Díaz-RosselloJL, DuleyL.Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev. 2019;9(9):Cd003248.
6.
RamaswamyVV, AbiramalathaT, BandyopadhyayT, . Delivery room CPAP in improving outcomes of preterm neonates in low-and middle-income countries: a systematic review and network meta-analysis. Resuscitation. 2022;170:250–263.
7.
BahadueFL, SollR.Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2012;11(11):CD001456.
8.
SchmidtB, RobertsRS, DavisP, . Caffeine therapy for apnea of prematurity. N Engl J Med. 2006;354(20):2112–2121.
9.
SharifS, MeaderN, OddieSJ, Rojas-ReyesMX, McGuireW.Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants. Cochrane Database Syst Rev. 2023;7(7):CD005496.
10.
StrobelNA, AdamsC, McAullayDR, EdmondKM.Mother’s own milk compared with formula milk for feeding preterm or low birth weight infants: systematic review and meta-analysis. Pediatrics. 2022;150(Suppl. 1).
11.
QuigleyM, EmbletonND, McGuireW.Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2019;7(7):CD002971.
12.
ThanigainathanS, AbiramalathaT.Early fortification of human milk versus late fortification to promote growth in preterm infants. Cochrane Database Syst Rev. 2020;7(7):CD013392.
13.
WardRM, BeachyJC.Neonatal complications following preterm birth. BJOG. 2003;110(Suppl. 20):8–16.
14.
KatzJ, LeeAC, KozukiN, . Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet. 2013;382(9890):417–425.
15.
SmidMC, StringerEM, StringerJS.A worldwide epidemic: the problem and challenges of preterm birth in low- and middle-income countries. Am J Perinatol. 2016;33(3):276–289.
16.
GladstoneM, OliverC, Van den BroekN.Survival, morbidity, growth and developmental delay for babies born preterm in low and middle income countries—a systematic review of outcomes measured. PLoS One. 2015;10(3):e0120566.
17.
SpeerCP.Neonatal respiratory distress syndrome: an inflammatory disease?Neonatology. 2011;99(4):316–319.
18.
El-KhuffashA, LevyPT, GorenfloM, FrantzID3rd.The definition of a hemodynamically significant ductus arteriosus. Pediatr Res. 2019;85(6):740–741.
Valdez SandovalP, Hernández RosalesP, Quiñones HernándezDG, Chavana NaranjoEA, García NavarroV.Intraventricular hemorrhage and posthemorrhagic hydrocephalus in preterm infants: diagnosis, classification, and treatment options. Child Nerv Syst. 2019;35:917–927.
27.
SilversteinFS, JensenFE.Neonatal seizures. Ann Neurol. 2007;62(2):112–120.
28.
GilfillanM, BhandariA, BhandariV.Diagnosis and management of bronchopulmonary dysplasia. BMJ. 2021;375.
29.
CfD Control Prevention. Criteria for defining nosocomial pneumonia. 2009.
30.
GurungA, WrammertJ, SunnyAK, . Incidence, risk factors and consequences of preterm birth—findings from a multi-centric observational study for 14 months in Nepal. Arch Public Health. 2020;78:64.
31.
PervinJ, RahmanSM, RahmanM, AktarS, RahmanA.Association between antenatal care visit and preterm birth: a cohort study in rural Bangladesh. BMJ Open. 2020;10(7): e036699.
32.
BeeckmanK, LouckxF, DowneS, PutmanK.The relationship between antenatal care and preterm birth: the importance of content of care. Eur J Public Health. 2013;23(3):366–371.
33.
BerruetaM, Hemingway-FodayJ, ThorstenVR, . Use of antenatal corticosteroids at health facilities and communities in low- and-middle income countries. Reprod Health. 2016;13(1):1–6.
34.
UmaS, NishaS, ShikhaS.A prospective analysis of etiology and outcome of preterm labor. J Obstetr Gynecol India. 2007;57(1):48–52.
35.
JamalS, SrivastavaR.A retrospective analytical study of the epidemiology and causes of preterm birth. Int J Reprod Contracept Obstet Gynecol. 2017;6(12):5453–5457.
36.
MagannEF, DohertyDA, LutgendorfMA, MagannMI, ChauhanSP, MorrisonJC.Peripartum outcomes of high-risk pregnancies complicated by oligo-and polyhydramnios: a prospective longitudinal study. J Obstetr Gynaecol Res. 2010;36(2): 268–277.
37.
TsujimotoY, KataokaY, BannoM, . Association of low birthweight and premature birth with hypertensive disorders in pregnancy: a systematic review and meta-analysis. J Hypertens. 2022;40(2):205–212.
38.
PolinRA, CarloWA.Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics. 2014;133(1):156–163.
39.
SweetDG, CarnielliVP, GreisenG, . European consensus guidelines on the management of respiratory distress syndrome: 2022 update. Neonatology. 2023;120(1):3–23.
40.
MorleyCJ, DavisPG, DoyleLW, BrionLP, HascoetJM, CarlinJB.Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008;358(7):700–708.
41.
FinerNN, CarloWA, WalshMC, . Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010;362(21):1970–1979.
42.
DunnMS, KaempfJ, de KlerkA, . Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics. 2011;128(5):e1069–e1076.
43.
MurthyS, GodinhoMA, GuddattuV, LewisLES, NairNS.Risk factors of neonatal sepsis in India: A systematic review and meta-analysis. PLoS One. 2019;14(4):e0215683.
44.
VanhaesebrouckP, AllegaertK, BottuJ, . The EPIBEL study: outcomes to discharge from hospital for extremely preterm infants in Belgium. Pediatrics. 2004;114(3):663–675.
45.
ZinA, GoleGA.Retinopathy of prematurity-incidence today. Clin Perinatol. 2013;40(2):185–200.
46.
ChevallierM, DebillonT, PierratV, . Leading causes of preterm delivery as risk factors for intraventricular hemorrhage in very preterm infants: results of the EPIPAGE 2 cohort study. Am J Obstetr Gynecol. 2017;216(5):518. e1–518.e12.
47.
ShahPS, LuiK, SjörsGset al. Neonatal outcomes of very low birth weight and very preterm neonates: an international comparison. J Pediatr. 2016;177:144–152.e6.
