Clinical and laboratory indicators of lethal outcome in premature newborns with body weight less than 1500 grams
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 1st and 5th 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 1st day of life and the relative number of monocytes on the 2nd 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
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
Contribution. Organization of research, data collection, writing of an article - Mustafin T.A.; statistical processing, data analysis, writing an article, preparing materials for publication - Karpova A.L.; data analysis, article writing, preparation of materials for publication - Mostovoy A.V.; editing and preparation of materials for publication - Kolesnikov A.N.
For citation: Mustafin T.A., Karpova A.L., Mostovoy A.V., Kolesnikov A.N. Clinical and laboratory indicators of lethal outcome in premature newborns with body weight less than 1500 grams. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2021; 9 (3): 9-15. DOI: https://doi.org/10.33029/2308-2402-2021-9-3-9-15 (in Russian)
1. Dem’yanova T.G., Grigor’yants L.Ya., Avdeeva T.G. Monitoring deeply premature babies in the first year of life. Moscow: Medpraktika-M, 2006: 148 p. (in Russian)
2. Petrova A.S., Zakharova N.I., Narogan M.V. The effectiveness of modern principles of resuscitation and intensive care for extremely low and very low birth weight premature babies. Rossiyskiy vestnik perina-tologii i pediatrii [Russian Bulletin of Perinatology and Pediatrics]. 2012; (1): 25-8. (in Russian)
3. Kostina N.N., Veterkova Z.A., Reshetnikova O.V., et al. Risk factors for birth and morbidity patterns in children with extremely low and very low birth weight. Orenburgskiy meditsinskiy vestnik [Orenburg Medical Bulletin]. 2017; 5 (2): 15-21. URL: https://www.orgma.ru/files/Izdatelstvo/OMV/magazines/2017/%D0%A2%D0%BE%D0%BC_V_2.pdf (in Russian)
4. Meyer R.E., Thompson S.J., Addy C.L., Garrison C.Z., Best R.G. Maternal serum placental alkaline phosphatase level and risk for preterm delivery. Am J Obstet Gynecol. 1995; 173 (1): 181-6. DOI: https://doi.org/10.1016/0002-9378(95)90187-6
5. Ferianec V., Linhartova L. Extreme elevation of placental alkaline phosphatase as a marker of preterm delivery, placental insufficiency and low birth weight. Neuro Endocrinol Lett. 2011; 32 (2): 154-7.
6. Mehler K., Oberthuer A., Keller T., Becker I., Valter M., Roth B., Kribs A. Survival among infants born at 22 or 23 weeks’ gestation following active prenatal and postnatal care. JAMA Pediatr. 2016; 170 (7): 671-7. DOI: https://doi.org/10.1001/jamapediatrics.2016.0207
7. Glass H.C., Costarino A.T., Stayer S.A., Brett C.M., Cladis F., Davis PJ. Outcomes for extremely premature infants. Anesth Analg. 2015; 120 (6): 1337-51. DOI: https://doi.org/10.1213/ANE.0000000000000705
8. Vieira L.A., Warren L., Pan S., Ferrara L., Stone J.L. Comparing pregnancy outcomes and loss rates in elective twin pregnancy reduction with ongoing twin gestations in a large contemporary cohort. Am J Ob-stet Gynecol. 2019; 221 (3): 253.e1-8. DOI: https://doi.org/10.1016/j.ajog.2019.04.001
9. Raffe-Devine J., Somerset D.A., Metcalfe A., Cairncross Z.F. Maternal, fetal, and neonatal outcomes of elective fetal reduction among multiple gestation pregnancies: a systematic review. J Obstet Gynaecol Can. 2021; Aug 16: S1701-2163(21)00610-1. DOI: https://doi.org/10.1016/j.jogc.2021.07.020
10. Basu S., Kumar D., Anupurba S., Verma A., Kumar A. Effect of maternal iron deficiency anemia on fetal neural development. J Perinatol. 2018; 38 (3): 233-9. DOI: https://doi.org/10.1038/s41372-017-0023-5
11. Ohuma E.O., Young M.F., Martorell R., Ismail L.C., Pena-Rosas J.P., Purwar M., et al. International values for haemoglobin distributions in healthy pregnant women. EClinicalMedicine. 2020; 29-30: 100660. DOI: https://doi.org/10.1016Zj.eclinm.2020.100660
12. Del Vecchio A., Christensen R.D. Neonatal neutropenia: what diagnostic evaluation is needed and when is treatment recommended? Early Hum Dev. 2012; 88 (suppl 2): S19-24. DOI: https://doi.org/10.1016/S0378-3782(12)70007-5
13. Mouzinho A., Rosenfeld C.R., Sanchez P.J., Risser R. Revised reference ranges for circulating neutrophils in very-low-birth-weight neonates. Pediatrics. 1994; 94 (1): 76-82.