新生児生物学ジャーナル

概要

Maternal Risk Factors, Complications and Outcome of Very Low Birth Weight Babies: Prospective Cohort Study from a Tertiary Care Centre in Odisha

Nandini Naskar, Arakhita Swain, Kedar Nath Das and Abhaya Kumar Patnayak

Background: Last two decades have witnessed a steady improvement in the quality of perinatal care in India. Better understanding of the pathophysiology and newer treatment strategies like antenatal steroid, surfactant use, newer modes of ventilation and stringent aseptic measures have contributed to the improved survival of very low birth weight babies.

Methods: In a prospective cohort study conducted in a tertiary care center over two years period (October 2011- September 2013), 744 VLBW babies (birth weight <1500 g) were assessed for gestational age, maturity, maternal risk factors and administration of antenatal steroids. Morbidities like birth asphyxia, sepsis, jaundice, respiratory distress syndrome, intraventricular haemorrhage, necrotisingenterocolitis, apnoea, pulmonary haemorrhage and patent ductusarteriosus were noted. Screening for retinopathy of prematurity and hearing impairment was done. Outcome in terms of survival till discharge was recorded.

Results: Out of 744 VLBW babies, 496 (66.67%) survived till discharge. Maternal risk factors associated with birth of VLBW babies were primiparity (58.06%), poor socio economic status (40.86%), multiple gestations (36.83%), PROM (26.34%), hypertension (13.44%) and under nutrition (12.36%). Jaundice (43.31%), apnoea (26.34%), birth asphyxia (20.43%), RDS (19.89%) and sepsis (18.82%) were found to be significant morbidities. Mortality was higher among males (20.43%) than females (12.9%). None below 27 weeks of gestation and birth weight of 800 g survived. RDS was the main cause of death (46.15%) followed by birth asphyxia (23%), sepsis (19.2%) and IVH (11.5%). Antenatal steroid improved the survival (72.9%) and reduced the incidence of RDS, NEC and IVH. ROP was detected in 30.49% VLBW babies. 33.3 % of the survivors failed in the initial hearing screening.

Conclusions: Higher birth weight, gestational age, female sex and antenatal steroids improved survival amongst VLBW babies. Antenatal steroids reduced incidence of RDS, NEC and IVH when preterm delivery was inevitable. Judicial use of supplemental oxygen and blood products prevent development of ROP.