Perinatology.  2017 Dec;28(4):119-126. 10.14734/PN.2017.28.4.119.

The Influence of Pregnancy Disorders Causing Preterm Delivery on In-Hospital Outcomes in Preterm Infants at Less than 32 Weeks of Gestation

• Shin JM
• Lee JA
• Yun HR
• Oh S
• Sohn JA
• Shin SH
• Choi CW
• Kim EK
• Kim HS
• Kim BI

• KMID: 2409118
• DOI: http://doi.org/10.14734/PN.2017.28.4.119

Abstract

OBJECTIVE
We assessed the influence of small for gestational age (GA) with placental disorders (SGA-P) and histologic chorioamnionitis (HCA) on the in-hospital outcomes of preterm infants.
METHODS
Preterm infants with a GA <32 weeks born at Seoul National University Hospital between 2007 and 2014 were included and divided into 4 groups according to the presence of SGA-P and HCA: group 1, SGA-P only; group 2, HCA only; group 3, both SGA-P and HCA; and group 4, no SGA-P or HCA. Multivariate logistic regression was done to compare neonatal outcomes including death, moderate to severe bronchopulmonary dysplasia (BPD) or death, patent ductus arteriosus with treatment, sepsis, necrotizing enterocolitis ≥stage 2b, and intraventricular hemorrhage ≥grade 3.
RESULTS
A total of 572 infants were included. There were 77 patients (13.5%) in group 1, 226 patients (39.5%) in group 2, and 24 patients (4.2%) in group 3. After adjusting for GA, cesarean section, 5 minute Apgar score, multiple pregnancy, premature rupture of membrane before 18 hours prior to delivery, and preeclampsia, group 1 showed higher risks of mortality (adjusted odds ratio [aOR] 3.15, 95% confidence interval [CI] 1.13-8.80), moderate to severe BPD or death (aOR 9.12, 95% CI 3.98-20.90), sepsis (aOR 2.12, CI 1.01-4.46), and pulmonary hypertension (aOR 3.26, 95% CI 1.15-9.22) compared with group 4. There were no significant differences in mortality and in-hospital outcomes between groups 2 and 4 or between groups 3 and 4.
CONCLUSION
Close monitoring and early intervention are suggested in SGA-P infants.

Keyword

Preterm infants; Placenta disorders; Fetal growth retardation; Chorioamnionitis; Patient outcome assessment

MeSH Terms

Apgar Score
Bronchopulmonary Dysplasia
Cesarean Section
Chorioamnionitis
Ductus Arteriosus, Patent
Early Intervention (Education)
Enterocolitis, Necrotizing
Female
Fetal Growth Retardation
Gestational Age
Hemorrhage
Humans
Hypertension, Pulmonary
Infant
Infant, Newborn
Infant, Premature*
Logistic Models
Membranes
Mortality
Odds Ratio
Patient Outcome Assessment
Placenta Diseases
Pre-Eclampsia
Pregnancy*
Pregnancy, Multiple
Rupture
Seoul
Sepsis

Figure

• 

  Fig. 1 Flow chart of the study population. A total of 572 patients with <32 weeks of gestation born between 2007 and 2014 were included in the analysis. 77 patients (13.5%) were in group 1, 226 patients (39.5%) were in group 2, and 24 patients (4.2%) were in group 3. GA, gestational age; SNUCH, Seoul National University Children's Hospital; TTTS, twin to twin transfusion syndrome; PSVT, paroxysmal supraventricular tachycardia; SLE, systemic lupus erythematosus; SGA-P; small for gestational age with placental disorders; HCA, histologic chorioamnionitis.

• 

  Fig. 2 The proportion of 4 groups according to the gestational age at birth. The percentage of histologic chorioamnionitis group was decreased and the percentage of small for gestational age with placental disorders was increased as the gestational age gets older (P=0.045). SGA-P, small for gestational age with placental disorders; HCA, histologic chorioamnionitis.

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