Effect of pregestational maternal, obstetric and perinatal factors on neonatal outcome in extreme prematurity

Abstract

PurposeTo investigate the effect of pregestational maternal, obstetric and perinatal factors on neonatal outcome in extreme preterm deliveries.MethodsRetrospective study of deliveries in a Norwegian tertiary teaching hospital. All women with live births at 24+0– 27+6 weeks of gestation between 2004 and 2007 were included. Major morbidity is defined as intraventricular haemorrhage grade 3–4, periventricular leukomalacia, bronchopulmonary dysplasia or necrotizing enterocolitis. Pregestational maternal, obstetric and perinatal variables were initially compared for mortality and survival with major morbidity at 24-h, 7- or 28-day postpartum/discharge in univariate analysis. Then, a multivariate analysis was conducted in order to determine independent factors associated with mortality and survival with major morbidity.ResultsA total of 109 babies were delivered alive in 92 women, representing 1.6% of total births. The survival rates were 93.6, 84.4 and 80.7%, with a prevalence of major morbidity among survivors of 40.4, 32.1 and 39.4% at 24-h, 7- and 30-day postpartum/discharge, respectively. After adjustment using multiple logistic regression, only a 5-min Apgar score ≤3 and babies with at least one major morbidity had significantly independent effects on neonatal survival. Multiple pregnancy and gestational age <26 weeks were the only two independent risk factors for survival with major morbidity.ConclusionsNeonatal survival was significantly predicted by a 5-min Apgar score and neonatal morbidity, independent of pregestational maternal disease, obstetric complications, method of delivery, gestational age and birth weight in extreme preterm deliveries. The excess morbidity rate was confined among multiples and babies who were delivered before 26 weeks of gestation.

The influence of mode of birth on neonatal survival and maternal outcomes at extreme prematurity: A retrospective cohort study

“…Other publications have demonstrated GA at birth, birthweight <1.5 kg, gender, multiple gestation, indigenous status and MA (<20 years or >35 years) to significantly influence survival . In this study, indigenous ethnicity in the total cohort, and MA >35 years in the multiple pregnancy sub‐group were associated with survival.…”

“…The significance of gestational age (GA) on the chance of survival is well documented . Consensus statements guiding the clinical decision to perform neonatal resuscitation at extreme prematurity have been published .…”

Avaliação da qualidade da atenção pré-natal dentre gestantes com e sem história de prematuridade no Sistema Único de Saúde no Rio de Janeiro, Brasil

“…12,13 A maioria dos estudos sobre este tema abordou os determinantes e os efeitos sobre o recém-nascido prematuro, como hemorragia intraventricular, leucomalacia periventricular, displasia broncopulmonar, enterocolite necrotizante e deficiências cognitivas e motoras ao longo da vida. 14,15 Porém, poucos estudos avaliaram a historia de prematuridade e fatores relacionados a ela.…”