Antenatal parameters to predict mortality and major morbidity in very low birth weight preterm neonates

Abstract

Objectives: The objective of this study was to determine effect of maternal factors and abnormal antenatal color Doppler of umbilical artery on mortality and major morbidity in very low birth weight (VLBW) neonates. Materials and Methods: This prospective study was conducted in the Department of Pediatrics, of a teaching institution of central India. All consecutive intramural live-born preterm neonates, delivered with BW of 1000–<1500 g, were included in the study. All preterm neonates received standardized neonatal care as per the unit protocol. A total of 400 intramural live-born VLBW, preterm neonates (diagnosed as per WHO criteria) were included in the study; out of which, 103 had absent or reversed end-diastolic blood flow and 117 had forward enddiastolic blood flow and in the remaining 180 babies, color Doppler could not be done. All the VLBW neonates were followed up till the time of discharge or death. The mortality and major morbidity (one or more of the following: intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC) during hospital stay were assessed in all the babies. Results: A total of 400 preterm neonates were enrolled in study, out of which, 109 died (27.25%). The causes of neonatal mortality included septicemia (44.9%), birth asphyxia (18.34%), hyaline membrane disease (30.6%), pulmonary hemorrhage (11.34%), prematurity (10.09%), aspiration
pneumonia (8.25%), IVH (1.83%), and NEC (1.83%). Abnormal antenatal Doppler 15.1 (8.7–25.5) (p=0.0001) was an important factor for the major morbidities. Among maternal risk factors, premature rupture of membrane (p=0.015), meconium-stained liquor (p=0.01), fetal distress (p=0.001), and the absence of antenatal steroid (p=0.0001) significantly predict the mortality. Conclusion: Among maternal factors, premature rupture of membrane, meconium-stained liquor, and abnormal antenatal color Doppler are the important predictors of early mortality and major morbidities such as respiratory distress syndrome, IVH, NEC in VLBW neonates