Analysis of hospitalization and its outcomes in extremely preterm infants

Ksenia Weronika Mazur, Aleksandra Łysiak, Ewa Nurska, Beata Łoniewska

Abstract


Introduction: The aim of the study is to analyze the hospitalization course of extremely preterm infants born between 2018–2022 at the Department of Neonatal Diseases at Pomeranian Medical University in Szczecin.
Materials and methods: A single-center retrospective study included 68 extremely premature infants of both sexes. Anthropometric parameters at birth and at hospital discharge, nutrition mode, and complications of prematurity were analyzed.
Results: At the Department of Neonatal Diseases at Pomeranian Medical University in Szczecin, between 2018–2022, 68 extremely preterm infants were born. The mean gestational age was 25.8 ±1.72 weeks, and the mean birth weight was 844.89 ±213.13 g. Twenty-three infants (33.82%) died before hospital discharge; 22 deaths occurred by day 6 of life and were not included in further analysis. Most infants were born in medium condition; 35 (76.08%) preterm neonates required invasive, and 11 (23.91%) noninvasive mechanical ventilation. Thirty-four (73.91%) of all babies were born with congenital infections, and 28 (60.87%) developed acquired infections. The most common complications of prematurity were bronchopulmonary dysplasia (43.47%) and hemodynamically significant patent ductus arteriosus (52.17%). Forty (86.96%) of all extremely preterm infants were breastfed at the Department, with a mean breastfeeding duration of 71.4 ±27.51 days, and 82.05% of mothers continued breastfeeding after hospital discharge. The mean time of hospitalization was 85.5 ±26.52 days.
Conclusions: Hospitalization of extremely premature infants is associated with a high risk of complications and death. The most common complications are infections and diseases typical for this age group. Many newborns do not gain weight properly. Continuous improvement in the management, prevention, and treatment of extremely preterm infants is warranted.

Keywords


prematurity; infants; neonatology; NICU; extremely preterm birth

Full Text:

PDF

References


Morgan AS, Mendonça M, Thiele N, David AL. Management and outcomes of extreme preterm birth. BMJ 2022;376:e055924. doi: 10.1136/bmj-2021-055924.

Wyniki badań bieżących. Baza Demograficzna. Główny Urząd Statystyczny. https://demografia.stat.gov.pl/bazademografia/Tables.aspx (23.01.2025).

Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008;371(9606):75-84. doi: 10.1016/S0140-6736(08)60074-4.

Morgan J, Bombell S, McGuire W. Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Cochrane Database Syst Rev 2013;2013(3):CD000504. doi: 10.1002/14651858.CD000504.pub4.

Patel RM. Short- and long-term outcomes for extremely preterm infants. Am J Perinatol 2016;33(3):318-28. doi: 10.1055/s-0035-1571202.

Vento M, Cheung PY, Aguar M. The first golden minutes of the extremely-low-gestational-age neonate: a gentle approach. Neonatology 2009;95(4):286-8. doi: 10.1159/000178770.

Thébaud B, Goss KN, Laughon M, Whitsett JA, Abman SH, Steinhorn RH, et al. Bronchopulmonary dysplasia. Nat Rev Dis Primers 2019;5(1):78. doi: 10.1038/s41572-019-0127-7.

Patel P, Bhatia J. Total parenteral nutrition for the very low birth weight infant. Semin Fetal Neonatal Med 2017;22(1):2-7. doi: 10.1016/j.siny.2016.08.002. Erratum in: Semin Fetal Neonatal Med 2018;23(1):75. doi: 10.1016/j.siny.2018.01.005.

Starr R, De Jesus O, Shah SD, Borger J. Periventricular and intraventricular hemorrhage. Treasure Island (FL) StatPearls Publishing; 2023.

Gillam-Krakauer M, Reese J. Diagnosis and management of patent ductus arteriosus. Neoreviews 2018;19(7):e394-402. doi: 10.1542/neo.19-7-e394.

Travers CP, Carlo WA, McDonald SA, Das A, Bell EF, Ambalavanan N, et. al., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Mortality and pulmonary outcomes of extremely preterm infants exposed to antenatal corticosteroids. Am J Obstet Gynecol 2018;218(1):130.e1-13.

Patel RM, Ferguson J, McElroy SJ, Khashu M, Caplan MS. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr Res 2020;88(Suppl 1):10-5. doi: 10.1038/s41390-020-1074-4.

Bell EF, Hintz SR, Hansen NI, Bann CM, Wyckoff MH, DeMauro SB, et al., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Mortality, in-hospital morbidity, care practices, and 2-year outcomes for extremely preterm infants in the US, 2013–2018. JAMA 2022;327(3):248-63. doi: 10.1001/jama.2021.23580. Erratum in: JAMA 2022;327(21):2151. doi: 10.1001/jama.2022.7723.

Yang Y, Gu XY, Lin ZL, Pan SL, Sun JH, Cao Y, et al. Effect of different courses and durations of invasive mechanical ventilation on respiratory outcomes in very low birth weight infants. Sci Rep 2023;13(1):18991. doi: 10.1038/s41598-023-46456-7.

da Cunha Durães MI, Flor-De-Lima F, Rocha G, Soares H, Guimarães H. Morbidity and mortality of preterm infants less than 26 weeks of gestational age. Minerva Pediatr 2019;71(1):12-20. doi: 10.23736/S0026-4946.16.04609-0.

Dong XY, Qi JH, Zhuo QC, Ding YJ, Qiao X, Wang Y, et al. Association of antenatal corticosteroids with mortality and morbidities in very preterm infants born to women with hypertensive disorders of pregnancy: a multicenter prospective cohort study. BMC Pregnancy Childbirth 2024;24(1):109. doi: 10.1186/s12884-023-06195-z.

Cao Y, Jiang S, Sun J, Hei M, Wang L, Zhang H, et al. Assessment of neonatal intensive care unit practices, morbidity, and mortality among very preterm infants in China. JAMA Netw Open 2021;4(8):e2118904. doi: 10.1001/jamanetworkopen.2021.18904.

Ninan K, Liyanage SK, Murphy KE, Asztalos EV, McDonald SD. Evaluation of long-term outcomes associated with preterm exposure to antenatal corticosteroids: a systematic review and meta-analysis. JAMA Pediatr 2022;176(6):e220483. doi: 10.1001/jamapediatrics.2022.0483.

Perez K, Puia-Dumitrescu M, Comstock BA, Wood TR, Mayock DE, Heagerty PJ, et al. Patterns of infections among extremely preterm infants. J Clin Med 2023;12(7):2703. doi: 10.3390/jcm12072703.

Gillam-Krakauer M, Reese J. Diagnosis and Management of Patent Ductus Arteriosus. Neoreviews 2018;19(7):e394-402. doi: 10.1542/neo.19-7-e394.

Su BH, Lin HY, Chiu HY, Tsai ML, Chen YT, Lu IC. Therapeutic strategy of patent ductus arteriosus in extremely preterm infants. Pediatr Neonatol 2020;61(2):133-41. doi: 10.1016/j.pedneo.2019.10.002.

Sung SI, Chang YS, Kim J, Choi JH, Ahn SY, Park WS. Natural evolution of ductus arteriosus with noninterventional conservative management in extremely preterm infants born at 23–28 weeks of gestation. PLoS One 2019;14(2):e0212256. doi: 10.1371/journal.pone.0212256.

Jensen EA, Edwards EM, Greenberg LT, Soll RF, Ehret DEY, Horbar JD. Severity of bronchopulmonary dysplasia among very preterm infants in the United States. Pediatrics 2021;148(1):e2020030007. doi: 10.1542/peds.2020-030007.

Siffel C, Kistler KD, Lewis JFM, Sarda SP. Global incidence of bronchopulmonary dysplasia among extremely preterm infants: a systematic literature review. J Matern Fetal Neonatal Med 2021;34(11):1721-31. doi: 10.1080/14767058.2019.1646240.

Pande GS, Vagha JD. A Review of the occurrence of intraventricular hemorrhage in preterm newborns and its future neurodevelopmental consequences. Cureus 2023;15(11):e48968. doi: 10.7759/cureus.48968.

Alganabi M, Lee C, Bindi E, Li B, Pierro A. Recent advances in understanding necrotizing enterocolitis. F1000Res 2019;8:F1000. doi: 10.12688/f1000research.17228.1.

Battersby C, Santhalingam T, Costeloe K, Modi N. Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review. Arch Dis Child Fetal Neonatal Ed 2018;103(2):F182-9. doi: 10.1136/archdischild-2017-313880.

Ingemyr K, Elfvin A, Hentz E, Saggers RT, Ballot DE. Factors influencing survival and short-term outcomes of very low birth weight infants in a tertiary hospital in Johannesburg. Front Pediatr 2022;10:930338. doi: 10.3389/fped.2022.930338.

Kulkarni D, Murki S, Pawale D, Jena S, Sharma D, Vardhelli V, et al. Enablers and barriers for enteral feeding with mother's own milk in preterm very low birth weight infants in a tertiary care neonatal intensive care unit. Turk J Pediatr 2021;63(4):564-74. doi: 10.24953/turkjped.2021.04.003.

EXPRESS Group. Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatr 2010;99(7):978-92. doi: 10.1111/j.1651-2227.2010.01846.x.

Perrin T, Pradat P, Larcade J, Masclef-Imbert M, Pastor-Diez B, Picaud JC. Postnatal growth and body composition in extremely low birth weight infants fed with individually adjusted fortified human milk: a cohort study. Eur J Pediatr 2023;182(3):1143-54. doi: 10.1007/s00431-022-04775-3.




DOI: https://doi.org/10.21164/pomjlifesci.1101

Copyright (c) 2025 Ksenia Mazur, Aleksandra Łysiak, Ewa Nurska, Beata Łoniewska

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/