Short-term outcomes of very preterm infants in a tertiary level neonatal intensive care unit in southeast region of Turkey

Aim: To examine the mortality and short-term outcomes of very preterm infants (≤32 weeks’ gestation) at Sanliurfa Training and Research Hospital.Materials and Methods: Very preterm infants hospitalized between September 2017 and February 2019 were retrospectively included in the study. Selected short-term outcomes were bronchopulmonary dysplasia, severe intraventricular hemorrhage, sepsis, periventricular leukomalacia, severe retinopathy of prematurity and necrotizing enterocolitis.Results: Within 18 months period 486 live born very preterm infants were included in the study. The mean birth weight was 1306 ± 459 g and gestational age was 29.1 ± 2.8 weeks. The antenatal steroid administration rate was 30.9%. The mortality rate was 30.5%. In the whole group survival rate without a major neonatal morbidity was 44.2%. The incidence of respiratory distress syndrome was 73.9%, patent ductus arteriosus was 20.4%, intraventricular hemorrhage grade III-IV was 7.6%, bronchopulmonary dysplasia was %16.9, periventricular leukomalacia was 7.6%, late onset sepsis was 42.6%, and culture proven sepsis was 14%, severe retinopathy of prematurity was 5.6%, and necrotizing enterocolitis was 2.1%. Conclusion: The mortality rate is higher than that of Turkey, while short-term morbidity rates are similar to the average in Turkey. The priority for Sanliurfa is to reduce the mortality rate in very preterm infants.

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1. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006;3:CD004454.
2. Horbar JD, Carpenter JH, Badger GJ, et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics 2012;129:1019- 26.
3. Shah PS, Lui K, Sjörs G, et al.; International Network for Evaluating Outcomes (iNeo) of Neonates. Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates: An International Comparison. J Pediatr 2016;177:144-152.e6.
4. Dilli D, Kose MR, Gunduz RC, et al. Recent Declines in Infant and Neonatal Mortality in Turkey from 2007 to 2012: Impact of Improvements in Health Policies. Cent Eur J Public Health 2016;24:52-7.
5. Koc E, Demirel N, Bas AY, et al. Early neonatal outcomes of very-low-birth-weight infants in Turkey: A prospective multicenter study of the Turkish Neonatal Society. PLoS One. 2019;14:e0226679.
6. Turkish Statistical Institute, Statistical indicators 2018. https://biruni.tuik.gov.tr/ilgosterge/?locale=en access date 18.05.2020.
7. Bozkurt O. Causes of death in a neonatal intensive care unit in Southeast region of Turkey. Annals of Medical Research. 2019;26:879-83.
8. Tarnow-Mordi WO, Parry G, Moore J, et al. The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. The International Neonatal Network. Lancet 1993;342:193-8.
9. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9.
10. Papile LA, Burstein J, Burstein R, et al. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529-34.
11. Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187(1):1-7.
12. Volpe JJ. Neurobiology of periventricular leukomalacia in the premature infant. Pediatr Res 2001;50:553-62.
13. International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005;123:991-9.
14. Lui K, Lee SK, Kusuda S, et al; International Network for Evaluation of Outcomes (iNeo) of neonates Investigators. Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High- Income Countries. J Pediatr 2019;215:32-40.e14.
15. 1Santhakumaran S, Statnikov Y, Gray D, et al. Survival of very preterm infants admitted to neonatal care in England 2008-2014: time trends and regional variation. Arch Dis Child Fetal Neonatal Ed 2018;103:208-15.
16. Türkiye’deki yenidoğan merkezlerinde mortalite. Türk Neonatoloji Derneği Bülteni 2019;31:27-8.
17. Roberts D, Brown J, Medley N, et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017;3:CD004454.
18. Briceño-Pérez C, Reyna-Villasmil E, Vigil-De-Gracia P. Antenatal Corticosteroid Therapy: Historical and Scientific Basis to Improve Preterm Birth Management. Eur J Obstet Gynecol Reprod Biol 2019;234:32-7.
19. Fanaroff AA, Stoll BJ, Wright LL, et al. NICHD Neonatal Research Network. Trends in Neonatal Morbidity and Mortality for Very Low Birthweight Infants. Am J Obstet Gynecol 2007;196:147.e1-8
20. Moro M, Pérez-Rodriguez J, Figueras-Aloy J, et al. Grupo SEN1500. Predischarge Morbidities in Extremely and Very Low-Birth-Weight Infants in Spanish Neonatal Units. Am J Perinatol 2009;26:335- 43.
21. Wu F, Liu G, Feng Z, et al. Short-term Outcomes of Extremely Preterm Infants at Discharge: A Multicenter Study From Guangdong Province During 2008-2017. BMC Pediatr 2019;19:405.
22. Guran O, Bulbul A, Uslu S, et al. The change of morbidity and mortality rates in very low birth weight infants over time. Turk Pediatr Ars 2013;48:102-9.
23. Atasay B, Gunlemez A, Unal S, et al. Outcomes of very low birth weight infants in a newborn tertiary center in Turkey, 1997-2000. Turk J Pediatr 2003;45:283-9.
24. Aygun F, Koksal N, Bostan OM, et al. A major cause of mortality and morbidity of very low birth weight infants: Patent ductus arteriosus. J Current Pediatr 2012;10:8-12.
25. Riad Abou Zahr AA. Mary Marron-Corwin Neonatal pulmonary hemorrhage NeoReviews 2012;13:e302-6.
26. Ferreira CH , Carmona F, Martinez FE. Prevalence, Risk Factors and Outcomes Associated with Pulmonary Hemorrhage in Newborns. J Pediatr (Rio J) 2014;90:316-22.
27. Berger TM, Allred EN, Van Marter LJ. Antecedents of clinically significant pulmonary hemorrhage among newborn infants. J Perinatol 2000;2:295-300.
28. Garland J, Buck R, Weinberg M. Pulmonary hemorrhage risk in infants with a clinically diagnosed patent ductus arteriosus: A retrospective cohort study. Pediatrics 1994;94:719-23.
29. Pandit PB, O’Brien K, Asztalos E, et al. Outcome following pulmonary haemorrhage in very low birthweight neonates treated with surfactant. Arch Dis Child Fetal Neonatal Ed 1999;81:40-4.
30. Chen YY, Wang HP, Lin SM, et al; Taiwan Premature Infant Development Collaborative Study Group. Pulmonary Hemorrhage in Very Low-Birthweight Infants: Risk Factors and Management. Pediatr Int 2012;54:743-7.
31. Serce O, Benzer D, Gursoy T, et al. Outcomes of very low birth weight infants in a reference hospital with a tertiary neonatal intensive care unit in İstanbul. Medical Bulletin of Zeynep Kamil 2014;45:30-7.
32. Tomaszewska M, Stork E, Minich NM, et al. Pulmonary hemorrhage: clinical course and outcomes among very low-birth-weight infants. Arch Pediatr Adolesc Med 1999;153:715-21.
33. Chee YY, Wong MSC, Wong RMS, et al. Neonatal Outcomes of Preterm or Very-Low-Birth-Weight Infants Over a Decade From Queen Mary Hospital, Hong Kong: Comparison With the Vermont Oxford Network. Hong Kong Med J 2017;23:381-6.
34. Farooqi A, Hägglöf B, Sedin G, et al. Impact at Age 11 Years of Major Neonatal Morbidities in Children Born Extremely Preterm. Pediatrics 2011;127:1247-57.
35. Holsti A, Serenius F, Farooqi A .Impact of Major Neonatal Morbidities on Adolescents Born at 23-25 Weeks of Gestation. Acta Paediatr 2018;107:1893- 901.
36. Rüegger C, Hegglin M, Adams M, et al. Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years. BMC Pediatr 2012;12:17. Ğ8
37. Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset Sepsis in Very Low Birth Weight Neonates: The Experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285-91.
38. Patel AL, Panagos PG, Silvestri JM. Reducing Incidence of Necrotizing Enterocolitis. Clin Perinatol. 2017 Sep;44(3):683-700.
39. Deng W, Pleasure J, Pleasure D. Progress in Periventricular Leukomalacia. Arch Neurol 2008;65:1291-5.