medigraphic.com
Órgano Oficial del Instituto Nacional de Pediatría

2021, Number 2

<< Back Next >>

Acta Pediatr Mex 2021; 42 (2)

Mortality factors in preterm under 34 weeks gestation

Cano-Vázquez EN, Nogales-Delfín I, Valdez-Cabrera C, Monroy-Azuara MG, Arciga-Vázquez GS, Méndez-Martínez S

Language: Spanish
References: 44
Page: 66-73
PDF size: 335.31 Kb.


ABSTRACT

Objective: To determine the factors associated with mortality in premature before 34 weeks´gestation, in a second-level-hospital.
Materials and Methods: Retrospective cohort, in preterm ±34 weeks and birth weight ±1500 g admitted to the neonatal intensive care unit (NICU). We reviewed the gestational age, gender, weight, 1-minute and 5-minute Apgar scores, CRIB II score, resuscitation, ventilation type and maternal variables: age, prenatal care, disorders during pregnancy, antenatal corticosteroid therapy and neonatal mortality. The descriptive statistics analysis was employed Statistical analysis descriptive and relative risk, 95% confidence intervals.
Results: Overall mortality was 19.1% in the first 7 days of life, 55.5% female, mean weight 771.1 ± 189 g, 88.8% extremely preterm, 1 minute Apgar score of 7 a 10 was 25.5%, Apgar of 4 a 6 on 36.1% and 5 minutes ‹ 7 was 25%. Mortality increased with score CRIB II ›10. Only the score CRIB II was 18.8 is associated with mortality.
Conclusions: The mortality risk is inversely proportional to the weight and gestational age in the first days of life. The CRIB II scale is an opportune indicator for identifying mortality risk in neonates under 34 weeks of gestation.


REFERENCES

  1. Castro-Delgado OE, Salas-Delgado I, Acosta-Argoty FA, Delgado-Noguera M, Calvache JA. Muy bajo y extremo bajo peso al nacer. Pediatr. 2016; 49: 23-30. http://dx.doi. org/10.1016/j.rcpe.2016.02.002

  2. Stoll BJ, Hansen NI, Bell EF, Shankaran S, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010; 126 (3): 443-56. DOI: 10.1542/peds.2009-2959

  3. Lawn JE, Cousens S, Zupan J. Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? where? why? Lancet. 2005; 365: 891-900. https://doi.org/10.1016/ S0140-6736(05)71048-5

  4. UNICEF. Neonatal mortality. 2018. https://data.unicef.org/ topic/child-survival/neonatal-mortality/

  5. UNICEF. Kyrgyzstan ranks #79 out of 184 countries on neonatal mortality rate. 2018. Disponible en: https://www. unicef.org/kyrgyzstan/press-releases/kyrgyzstan-ranks- 79-out-184-countries-neonatal-mortality-rate

  6. Consejo Nacional de Población. Proyecciones de la población de México 2010-2050. 1era ed. Ciudad de México; 2012 p. 25. https://www.gob.mx/cms/uploads/attachment/ file/63977/Documento_Metodologico_Proyecciones_ Mexico_2010_2050.pdf

  7. Gonzalez RM, Gilleskie D. Infant Mortality Rate as a Measure of a Country's Health: A Robust Method to Improve Reliability and Comparability. Demography. 2017; 54(2):701- 720. https://doi.org/10.1007/s13524-017-0553-7

  8. Reidpath DD, Allotey P. Infant mortality rate as an indicator of population health. J Epidemiol Community Health. 2003; 57 (5): 344-346. https://doi.org/10.1136/jech.57.5.344

  9. Ndayisenga T. Maternal and Newborn Risk Factors associated With Neonatal Mortality in Gitwe District Hospital in Ruhango District, Rwanda. Int. J. Med. Public Health, 2016; 6 (2): 98-102. https://doi.org/10.5530/ijmedph.2016.2.9

  10. Selemani M, Mwanyangala MA, Mrema S, Shamte A, et al. The effect of mother’s age and other related factors on neonatal survival associated with first and second birth in rural, Tanzania: evidence from Ifakara health and demographic surveillance system in rural Tanzania. BMC Pregnancy Childbirth 2014; 14: 240 https://doi.org/10.1186/1471-2393-14-240

  11. Carrera-Muiños S, Hernández-Sarmiento M, Fernández- Carrocera LA, Cordero-González G, et al. Mortalidad neonatal en una institución de tercer nivel de atención. Perinatol Reprod Hum. 2016; 30 (3): 97-102. https://doi. org/10.1016/j.rprh.2016.11.005

  12. González-Pérez DM, Pérez-Rodríguez G, Leal-Omana JC, Ruiz-Rosas RA, González-Izquierdo JJ. Tendencia y causas de mortalidad neonatal en el Instituto Mexicano del Seguro Social 2011-2014 a nivel nacional. Rev Mex Pediatr. 2016; 83 (4): 115-123.

  13. Jacob J, Kamitsuka M, Clark R, Kelleher A, Spitzer AR. Etiologies of NICU Deaths. Pediatrics. 2015; 1: e59-65. https:// doi.org/10.1542/peds.2014-2967

  14. Pereira-Garcia L, Mariano-Fernandes C, Traebert J. Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil. J Pediatr (Rio J). 2019; 95 (2): 194-200. https://doi.org/10.1016/j.jped.2017.12.007

  15. Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health 2019; 7 (1): pe37-46. https:// doi.org/10.1016/S2214-109X(18)30451-0

  16. Van-Wassenaer AG, Kok JH. Hypothyroxinaemia and thyroid function after preterm birth. Semin Neonatol. 2004; 9: 3-11. https://doi.org/10.1016/S1084-2756(03)00114-3

  17. Picone S, Aufieri R, Piermichele P. Adrenal insufficiency in the preterm infant. Ital J Pediatr. 2015; 41: A30. https:// doi.org/10.1186/1824-7288-41-S1-A30

  18. Lau C. Development of suck and swallow mechanisms in infants. Ann Nutr Metab. 2015; 66: 7-14. https://doi. org/10.1159/000381361

  19. Lyu Y, Shah PS, Ye XY, Warre R, et al. Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation. JAMA Pediatr. 2015; 169 (4): e150277. https://doi. org/10.1001/jamapediatrics.2015.0277

  20. Fernández R, D’Apremont I, Domínguez A, Tapia JL. Supervivencia y morbilidad en recién nacidos de muy bajo peso al nacer en una red neonatal sudamericana. Arch Argent Pediatr. 2014; 112: 405-12. http://dx.doi.org/10.5546/ aap.2014.405

  21. Janevic T, Zeitlin J, Auger N, Egovora NN, et al. Association of Race/Ethnicity with very preterm Neonatal morbidities. JAMA Pediatr. 2018; 172: 1061-69. https://doi. org/10.1001/jamapediatrics.2018.2029

  22. Rivera-Ruedaa MA, Fernández-Carrocera LA, Michel- Macías C, Carrera-Muiños S, et al. Morbilidad y mortalidad de neonatos < 1,500 g ingresados a la UCIN de un hospital de tercer nivel de atención. Perinatol Reprod Hum. 2017; 31 (4): 163-169. https://doi.org/10.1016/j.rprh.2018.03.009

  23. Parry G, Tucker J, Tarnow-Mordi W. CRIB II: an update of the clinical risk index for babies score. Lancet. 2003; 361 (9371): 1789-91. https://doi.org/10.1016/S0140-6736(03)13397-1

  24. Sankar MJ, Natarajan CK, Das RR, Agarwal R, Chandrasekaran A, Paul VK. When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries. J Perinatol. 2016; 36: S1-S11. https:// doi.org/10.1038/jp.2016.27

  25. Kabilan S, Kumar MS. Morbidity and mortality pattern of very low birth weight infants admitted in SNCU in a South Asian tertiary care centre. Int J Contemp Pediatr. 2018; 5 (3): 720-725. http://dx.doi.org/10.18203/2349-3291. ijcp20181025

  26. Yismaw AE, Gelagay AD, Sisay MM. Survival and predictors among preterm neonates admitted at University of Gondar comprehensive specialized hospital neonatal intensive care unit, Northwest Ethiopia Ital J of Pediatr. 2019; 45:4. https://doi.org/10.1186/s13052-018-0597-3

  27. Lyoke CA, Lawani OL, Ezugwu EC, Ilechukwu G, et al. Prevalence and perinatal mortality associated with preterm births in a tertiary medical center in South East Nigeria. International Journal of Women’s Health. 2014; 6: 881-888. http://dx.doi.org/10.2147/IJWH.S72229

  28. Pérez-Zamudio R, López-Terrones CR, Rodríguez-Barboza A. Morbilidad y mortalidad del recién nacido prematuro en el Hospital General de Irapuato. Bol Med Hosp Infant Mex. 2013;70(4):299-303.

  29. Cupen K, Barran A, Singh V, Dialsingh I. Risk Factors Associated with Preterm Neonatal Mortality: A Case Study Using Data from Mt. Hope Women’s Hospital in Trinidad and Tobago. Children. 2017; 4 (12): 108. https://doi. org/10.3390/children4120108

  30. Park JH, Chang YS, Ahn SY, Sung SI, Park WS. Predicting mortality in extremely low birth weight infants: Comparison between gestational age, birth weight, Apgar score, CRIB II score, initial and lowest serum albumin levels. PLoS ONE. 2018; 13 (2): e0192232. https://doi.org/10.1371/ journal.pone.0192232

  31. Schindler T, Koller-Smith L, Lui K, Bajuk B, Bolisetty S. Causes of death in very preterm infants cared for in neonatal intensive care units: a population-based retrospective cohort study. BMC Pediatr. 2017; 17 (1): 59. https://doi. org/10.1186/s12887-017-0810-3

  32. Manuck TA, Rice MM, Bailit JL, Grobman WA, et al. Preterm Neonatal Morbidity and Mortality by Gestational Age: A Contemporary Cohort. Am J Obstet Gynecol. 2016; 215 (1): 103.e1-103.e14. https://doi.org/10.1016/j. ajog.2016.01.004

  33. Ambalavanan N, Carlo WA, Tyson JE, Langer JC, et al. Outcome Trajectories in Extremely Preterm Infants. Pediatrics. 2012; 130 (1): e115-e125. https://doi.org/10.1542/ peds.2011-3693

  34. Tagare A, Chaudhari S, Kadam S, Vaidya U, Pandit A, Sayyad MG. Mortality and morbidity in extremely low birth weight (ELBW) infants in a neonatal intensive care unit. Indian J Pediatr. 2013; 80 (1): 16-20. https://doi.org/10.1007/ s12098-012-0818-5

  35. Genes L, Lacarrubba J, Caballero C, Fonseca R. Morbimortalidad en recién nacidos de muy bajo peso al nacer. Unidad de neonatología. Centro materno infantil. Hospital de clínicas. Pediatr Asunción. 2010; 37:9-22.

  36. Thukral A, Sankar MJ, Chandrasekaran A, Agarwal R, Paul VK. Efficacy and safety of CPAP in low- and middle-income countries. J Perinatol. 2016; 36 (1): S21-S28. https://doi. org/10.1038/jp.2016.29

  37. Rojas-Reyes MX, Morley CJ, Soll R. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2012; 3: CD000510. https://doi.org/10.1002/14651858. CD000510.pub2

  38. Chun J, Sung SI, Ho YH, Kim J, et al. Prophylactic versus Early Rescue Surfactant Treatment in Preterm Infants Born at Less than 30 Weeks Gestation or with Birth Weight Less than or Equal 1,250 Grams. J Korean Med Sci. 2017; 32 (8): 1288-1294. https://doi.org/10.3346/jkms.2017.32.8.1288

  39. Bahadue FL1, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2012; 11: CD001456. https:// doi.org/10.1002/14651858.CD001456.pub2

  40. Choi YB, Lee J, Park J, Jun YH. Impact of Prolonged Mechanical Ventilation in Very Low Birth Weight Infants: Results From a National Cohort Study. J Pediatr. 2018; 194: 34-39. e3. https://doi.org/10.1016/j.jpeds.2017.10.042

  41. Neal S, Channon AA, Chintsanya J. The impact of young maternal age at birth on neonatal mortality: Evidence from 45 low and middle income countries. PLos One. 2018; 5: e0195731. https://doi.org/10.1371/journal.pone.0195731

  42. Pérez-Ramírez RO, Lona-Reyes JC, Ochoa-Meza CA, Gómez- Ruiz LM, et al. Neonatal morbidity and mortality associated with low adherence to prenatal corticosteroids. An Pediatr. 2019; 91 (2): 105-111. https://doi.org/10.1016/j. anpedi.2018.11.011

  43. Ramírez-Huerta AC, Grober-Páez F, Higareda-Almaraz MA, Higareda-Almaraz E, Castillo-Sánchez R. Clinical risk index for babies II (CRIB II) and weight to predict mortality in preterm infants less than 32 weeks treated with surfactant. Gac Med Mex. 2015; 151: 179-83.

  44. Fernández-Carrocera LA, Guevara-Fuentes CA, Salinas- Ramírez V. Risk factors associated with mortality in infants weighing less than 1500 g using the CRIB II scale. Bol Med Hosp Infant Mex. 2011; 68 (5): 330-336.




2020     |     www.medigraphic.com