Clinical and laboratory indicators of lethal outcome in premature newborns with body weight less than 1500 grams

• Timur A. Mustafin
• Anna L. Karpova
• Aleksey V. Mostovoy
• Andrew N. Kolesnikov

Abstract

Background. The problem of predicting an unfavorable outcome is still relevant, especially in premature infants, since they constitute a high-risk group on the basis of mortality, morbidity and disability.

Objective. To analyze individual clinical and laboratory parameters of the mother before delivery and of the premature newborn at the age of the first 72 h of life in order to find out the mortality indicators in the neonatal period.

Material and methods. The study is cohort, retrospective, comparative, conducted in the Donetsk Clinical Territorial Medical Association (Donetsk) in the period from 2014 to 2019. A total of 166 preterm infants with the birth weight less than 1500 grams were examined. Patients with congenital malformations, chromosomal and genetic abnormalities were excluded. 2 groups: group 1 (48 children) - lethal outcome: group 2 (118 children) -survived and discharged to home.

Results. In group 1, infants were born earlier (26.5 vs 29.0 weeks; p<0.001), with less body weight (710.0 vs 1190.0 grams; p<0.001), smaller height (32.0 vs 37.0 cm; p<0.001), as well as lower Apgar scores (2/4 points versus 5/6 points at the 1^st and 5^th minutes of life; p<0.001). The median probability of survival (95% confidence interval) was the highest for singleton pregnancies - 0.87 (0.8-0.91), less for twin pregnancies - 0.75 (0.53-0.88), the lowest in the case of triplets - 0.5 (0.11-0.8). The mothers in the group of the deceased patients had a statistically significant lower hemoglobin level [106.0 g/L [97.0; 117.0] vs 112.5 g/L [104.0; 127.0]; p=0.009], a higher platelets level [2 60.0x10⁹/L [198.5; 297.0] vs 2 28.5x10⁹/L [190.75; 263.5]; p=0.026], and a lower urea level in blood biochemistry test [3.0 mmol/L [2.6; 4.0] vs 4.0 mmol/L [3.12; 5.0]; p<0.001]. In deceased infants, the absolute number of neutrophils in the blood on the 1st day of life was statistically significantly lower in comparison to the surviving infants: 3080.0x10⁹/L [1449.0; 6837.5] vs 5 2 20.0x10⁹/L [2471.25; 8846.5]; p=0.029.

Conclusion. Multiple pregnancies, the levels of hemoglobin, platelets, eosinophils and urea in the mother's blood before childbirth and the absolute number of neutrophils on the 1^st day of life and the relative number of monocytes on the 2^nd day of life in premature infants weighing less than 1500 grams at birth can be used as additional predictors of mortality.

Keywords:premature infants, predictors of mortality, extremely low birth weight, perinatal period, premature birth

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