Analysis of risk factors for death of premature infants in hospital_West China Medical Journal

Authors：

XIONG Xiaoyun ¹ ,  CHEN Juan ¹ , LIN Zhicheng ² , YANG Lei ³

1. Department of Neonatology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Maternal and Child-Related Diseases, Ministry of Education, Chengdu, Sichuan 610041, P. R. China;
2. School of Computer Science, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Out-patient Department, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Maternal and Child-Related Diseases, Ministry of Education, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Juan, Email: chenjuan2000@163.com

Keywords：

Premature infants; mortality rate; cause of death; risk factor

DOI：

10.7507/1002-0179.202308036

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Objective To explore the risk factors of premature infants death. Methods The medical records of hospitalized premature infants admitted to West China Second University Hospital of Sichuan University between January 2015 and December 2022 were collected. Premature infants were divided into the death group and the non-death group (control group) based on discharge diagnosis of death. Parturient and premature infants related information were collected, and the disease classification and diagnosis of premature infants were analyzed. Results A total of 13 739 premature infants were included, with 53 deaths and a mortality rate of 3.85‰ (53/13 739). The ages of death were 1-49 days, and the median age of death was (9.68±9.35) days. According to the matching method, 212 premature infants were ultimately included. Among them, there were 53 premature infants in the death group and 159 premature infants in the control group. Compared with the control group, premature infants in the death group had lower gestational age, birth weight, lower 1-minute Apgar scores, lower 5-minute Apgar scores and shorter hospital stay (P<0.05), and received more delivery interventions (P<0.05). There was no statistically significant difference in other indicators between the two groups of premature infants (P>0.05). A total of 212 parturient were included. Among them, there were 53 parturients in the death group and 159 parturients in the control group. The use rate of prenatal corticosteroids in the control group was higher than that in the death group (55.35% vs. 54.72%). There was no statistically significant difference in other related factors between the two groups of parturient (P>0.05). The results of logistic regression analysis showed that longer hospital stay [odds ratio (OR)=0.891, 95% confidence interval (CI) (0.842, 0.943), P<0.001], prenatal use of corticosteroids [OR=0.255, 95%CI (0.104, 0.628), P=0.003] reduced the risk of premature infant death. However, tracheal intubation [OR=10.738, 95%CI (2.893, 39.833), P<0.001] increased the risk of premature infant death. Conclusions Clinicians should pay attention to prenatal examination of newborns and pay attention to evaluation of newborn status. Obstetricians and neonatologists should make joint plans for women with high risk factors for preterm delivery. During the hospitalization, after the diagnosis is clear, standardized treatment should be carried out in strict accordance with the guidelines for systemic diseases and expert consensus.

Citation： XIONG Xiaoyun, CHEN Juan, LIN Zhicheng, YANG Lei. Analysis of risk factors for death of premature infants in hospital. West China Medical Journal, 2023, 38(10): 1537-1542. doi: 10.7507/1002-0179.202308036 Copy

1.	Hug L, Alexander M, You D, et al. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health, 2019, 7(6): e710-e720.
2.	Korvenranta E, Lehtonen L, Rautava L, et al. Impact of very preterm birth on health care costs at five years of age. Pediatrics, 2010, 125(5): e1109-e1114.
3.	Walani SR. Global burden of preterm birth. Int J Gynaecol Obstet, 2020, 150(1): 31-33.
4.	Xu H, Dai Q, Xu Y, et al. Time trends and risk factor associated with premature birth and infants deaths due to prematurity in Hubei Province, China from 2001 to 2012. BMC Pregnancy Childbirth, 2015, 15: 329.
5.	Patel RM, Kandefer S, Walsh MC, et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med, 2015, 372(4): 331-340.
6.	Fatttore G, Numerato D, Peltola M, et al. Variations and determinants of mortality and length of stay of very low birth weight and very low for gestational age infants in seven European countries. Health Econ, 2015, 24(Suppl 2): 65-87.
7.	Kc A, Wrammert J, Nelin V, et al. Level of mortality risk for babies born preterm or with a small weight for gestation in a tertiary hospital of Nepal. BMC Public Health, 2015, 15: 877.
8.	Tietzmann MR, Teichmann PDV, Vilanova CS, et al. Risk factors for neonatal mortality in preterm newborns in the extreme south of Brazil. Sci Rep, 2020, 10(1): 7252.
9.	Lim JW, Chung SH, Kang DR, et al. Risk factors for cause-specific mortality of very-low-birth-weight infants in the korean neonatal network. J Korean Med Sci, 2015, 30(Suppl 1): S35-S44.
10.	Chiabi A, Mah EM, Mvondo N, et al. Risk factors for premature births: a cross-sectional analysis of hospital records in a Cameroonian health facility. Afr J Reprod Health, 2013, 17(4): 77-83.
11.	Rubenstein J. ICD-10: are you ready?. Curr Urol Rep, 2014, 15(11): 449.
12.	Roncancio CP, Misnaza SP, Peña IC, et al. Trends and characteristics of fetal and neonatal mortality due to congenital anomalies, Colombia 1999-2008. J Matern Fetal Neonatal Med, 2018, 31(13): 1748-1755.
13.	Zolfizadeh F, Ghorbani M, Soltani M, et al. Factors associated with infant mortality due to congenital anomalies: a population-based case-control study. Iran J Public Health, 2022, 51(5): 1118-1124.
14.	Hardy JR, Pimenta JM, Pokras S, et al. Risk of hospitalization for common neonatal morbidities in preterm and term infants: assessing the impact of one or more major congenital anomalies. J Perinatol, 2019, 39(12): 1602-1610.
15.	Kibanga W, Mutagonda RF, Moshiro R, et al. Effectiveness of antenatal dexamethasone in reducing respiratory distress syndrome and mortality in preterm neonates: a nested case control study. BMC Pediatr, 2023, 23(1): 94.
16.	Viteri OA, Blackwell SC, Chauhan SP, et al. Antenatal corticosteroids for the prevention of respiratory distress syndrome in premature twins. Obstet Gynecol, 2016, 128(3): 583-591.
17.	Travers CP, Clark RH, Spitzer AR, et al. Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study. BMJ, 2017, 356: j1039.
18.	Melamed N, Murphy K, Barrett J, et al. Benefit of antenatal corticosteroids by year of birth among preterm infants in Canada during 2003-2017: a population-based cohort study. BJOG, 2021, 128(3): 521-531.
19.	Park JH, Chang YS, Sung S, et al. Trends in overall mortality, and timing and cause of death among extremely preterm infants near the limit of viability. PloS One, 2017, 12(1): e0170220.
20.	Sasaki Y, Ikeda T, Nishimura K, et al. Association of antenatal corticosteroids and the mode of delivery with the mortality and morbidity of infants weighing less than 1, 500 g at birth in Japan. Neonatology, 2014, 106(2): 81-86.
21.	Mwita S, Jande M, Katabalo D, et al. Reducing neonatal mortality and respiratory distress syndrome associated with preterm birth: a scoping review on the impact of antenatal corticosteroids in low- and middle-income countries. World J Pediatr, 2021, 17(2): 131-140.
22.	Foglia EE, Te Pas AB. Effective ventilation: the most critical intervention for successful delivery room resuscitation. Semin Fetal Neonatal Med, 2018, 23(5): 340-346.
23.	Li SJ, Feng Q, Tian XY, et al. Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China. Chin Med J (Engl), 2021, 134(13): 1561-1568.
24.	Perlman J. Delivery room resuscitation of extremely preterm infants. JAMA, 2019, 321(12): 1161-1162.
25.	Bajaj M, Natarajan G, Shankaran S, et al. Delivery room resuscitation and short-term outcomes in moderately preterm infants. J Pediatr, 2018, 195: 33-38. e2.
26.	Debay A, Patel S, Wintermark P, et al. Association of delivery room and neonatal intensive care unit intubation, and number of tracheal intubation attempts with death or severe neurological injury among preterm infants. Am J Perinatol, 2022, 39(7): 776-785.
27.	O'Reilly M, Sozo F, Harding R. Impact of preterm birth and bronchopulmonary dysplasia on the developing lung: long-term consequences for respiratory health. Clin Exp Pharmacol Physiol, 2013, 40(11): 765-773.
28.	Moss TJ. Respiratory consequences of preterm birth. Clin Exp Pharmacol Physiol, 2006, 33(3): 280-284.
29.	Belizán JM, McClure EM, Goudar SS, et al. Neonatal death in low- to middle-income countries: a global network study. Am J Perinatol, 2012, 29(8): 649-656.

1. Hug L, Alexander M, You D, et al. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health, 2019, 7(6): e710-e720.
2. Korvenranta E, Lehtonen L, Rautava L, et al. Impact of very preterm birth on health care costs at five years of age. Pediatrics, 2010, 125(5): e1109-e1114.
3. Walani SR. Global burden of preterm birth. Int J Gynaecol Obstet, 2020, 150(1): 31-33.
4. Xu H, Dai Q, Xu Y, et al. Time trends and risk factor associated with premature birth and infants deaths due to prematurity in Hubei Province, China from 2001 to 2012. BMC Pregnancy Childbirth, 2015, 15: 329.
5. Patel RM, Kandefer S, Walsh MC, et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med, 2015, 372(4): 331-340.
6. Fatttore G, Numerato D, Peltola M, et al. Variations and determinants of mortality and length of stay of very low birth weight and very low for gestational age infants in seven European countries. Health Econ, 2015, 24(Suppl 2): 65-87.
7. Kc A, Wrammert J, Nelin V, et al. Level of mortality risk for babies born preterm or with a small weight for gestation in a tertiary hospital of Nepal. BMC Public Health, 2015, 15: 877.
8. Tietzmann MR, Teichmann PDV, Vilanova CS, et al. Risk factors for neonatal mortality in preterm newborns in the extreme south of Brazil. Sci Rep, 2020, 10(1): 7252.
9. Lim JW, Chung SH, Kang DR, et al. Risk factors for cause-specific mortality of very-low-birth-weight infants in the korean neonatal network. J Korean Med Sci, 2015, 30(Suppl 1): S35-S44.
10. Chiabi A, Mah EM, Mvondo N, et al. Risk factors for premature births: a cross-sectional analysis of hospital records in a Cameroonian health facility. Afr J Reprod Health, 2013, 17(4): 77-83.
11. Rubenstein J. ICD-10: are you ready?. Curr Urol Rep, 2014, 15(11): 449.
12. Roncancio CP, Misnaza SP, Peña IC, et al. Trends and characteristics of fetal and neonatal mortality due to congenital anomalies, Colombia 1999-2008. J Matern Fetal Neonatal Med, 2018, 31(13): 1748-1755.
13. Zolfizadeh F, Ghorbani M, Soltani M, et al. Factors associated with infant mortality due to congenital anomalies: a population-based case-control study. Iran J Public Health, 2022, 51(5): 1118-1124.
14. Hardy JR, Pimenta JM, Pokras S, et al. Risk of hospitalization for common neonatal morbidities in preterm and term infants: assessing the impact of one or more major congenital anomalies. J Perinatol, 2019, 39(12): 1602-1610.
15. Kibanga W, Mutagonda RF, Moshiro R, et al. Effectiveness of antenatal dexamethasone in reducing respiratory distress syndrome and mortality in preterm neonates: a nested case control study. BMC Pediatr, 2023, 23(1): 94.
16. Viteri OA, Blackwell SC, Chauhan SP, et al. Antenatal corticosteroids for the prevention of respiratory distress syndrome in premature twins. Obstet Gynecol, 2016, 128(3): 583-591.
17. Travers CP, Clark RH, Spitzer AR, et al. Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study. BMJ, 2017, 356: j1039.
18. Melamed N, Murphy K, Barrett J, et al. Benefit of antenatal corticosteroids by year of birth among preterm infants in Canada during 2003-2017: a population-based cohort study. BJOG, 2021, 128(3): 521-531.
19. Park JH, Chang YS, Sung S, et al. Trends in overall mortality, and timing and cause of death among extremely preterm infants near the limit of viability. PloS One, 2017, 12(1): e0170220.
20. Sasaki Y, Ikeda T, Nishimura K, et al. Association of antenatal corticosteroids and the mode of delivery with the mortality and morbidity of infants weighing less than 1, 500 g at birth in Japan. Neonatology, 2014, 106(2): 81-86.
21. Mwita S, Jande M, Katabalo D, et al. Reducing neonatal mortality and respiratory distress syndrome associated with preterm birth: a scoping review on the impact of antenatal corticosteroids in low- and middle-income countries. World J Pediatr, 2021, 17(2): 131-140.
22. Foglia EE, Te Pas AB. Effective ventilation: the most critical intervention for successful delivery room resuscitation. Semin Fetal Neonatal Med, 2018, 23(5): 340-346.
23. Li SJ, Feng Q, Tian XY, et al. Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China. Chin Med J (Engl), 2021, 134(13): 1561-1568.
24. Perlman J. Delivery room resuscitation of extremely preterm infants. JAMA, 2019, 321(12): 1161-1162.
25. Bajaj M, Natarajan G, Shankaran S, et al. Delivery room resuscitation and short-term outcomes in moderately preterm infants. J Pediatr, 2018, 195: 33-38. e2.
26. Debay A, Patel S, Wintermark P, et al. Association of delivery room and neonatal intensive care unit intubation, and number of tracheal intubation attempts with death or severe neurological injury among preterm infants. Am J Perinatol, 2022, 39(7): 776-785.
27. O'Reilly M, Sozo F, Harding R. Impact of preterm birth and bronchopulmonary dysplasia on the developing lung: long-term consequences for respiratory health. Clin Exp Pharmacol Physiol, 2013, 40(11): 765-773.
28. Moss TJ. Respiratory consequences of preterm birth. Clin Exp Pharmacol Physiol, 2006, 33(3): 280-284.
29. Belizán JM, McClure EM, Goudar SS, et al. Neonatal death in low- to middle-income countries: a global network study. Am J Perinatol, 2012, 29(8): 649-656.

West China Medical Journal

Analysis of risk factors for death of premature infants in hospital

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