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

Jeong Min Shin; Jin A Lee; Hye Ri Yun; Sohee Oh; Jin A Sohn; Seung Han Shin; Chang Won Choi; Ee-Kyung Kim; Han-Suk Kim; Byeong-Il Kim

doi:10.14734/PN.2017.28.4.119

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Shin, Lee, Yun, Oh, Sohn, Shin, Choi, Kim, Kim, and Kim: The Influence of Pregnancy Disorders Causing Preterm Delivery on In-Hospital Outcomes in Preterm Infants at Less than 32 Weeks of Gestation

Original Article

Perinatology 2017;28(4):119-126.

Published online: 19 January 2017

DOI: https://doi.org/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

Jeong Min Shin, MD^1,², Jin A Lee, MD, PhD^1,^3,, Hye Ri Yun, MD^1,², Sohee Oh, PhD⁴, Jin A Sohn, MD, PhD^1,³, Seung Han Shin, MD, PhD^1,², Chang Won Choi, MD, PhD^1,⁵, Ee-Kyung Kim, MD, PhD^1,², Han-Suk Kim, MD, PhD^1,², Byeong-Il Kim, MD, PhD^1,⁵

¹Department of Pediatrics, Seoul National University College of Medicine Seoul National University Bundang Hospital, Seoul, Korea

²Department of Pediatrics, Seoul National University Hospital, Seoul National University Bundang Hospital, Seoul, Korea

³Department of Pediatrics, Seoul National University Bundang Hospital, Seoul, Korea

⁴Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul National University Bundang Hospital, Seoul, Korea

⁵Department of Pediatrics, Seoul National University Bundang Hospital, Seoul, Korea

Correspondence to Jin A Lee, MD, PhD Department of Pediatrics, Seoul Naitonal University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea Tel: +82-2-870-2364 Fax: +82-2-831-2826 E-mail: ljinna@snu.ac.kr

Received 16 January 20175 July 2017 Accepted 5 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 3.9820.90), 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.

Keywords: Preterm infants, Placenta disorders, Fetal growth retardation, Chorioamnionitis, Patient outcome assessment

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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.

Table 1.

Baseline Demographic Characteristics of the 4 Groups According to the Presence of SGA-P and HCA

	SGA-P only (n=77)	HCA only (n=226)	Both SGA-P and HCA (n=24)	No SGA-P nor HCA (n=245)	P-value
Gestational age	29⁺² (27⁺⁴, 30⁺³)	28⁺⁰ (26⁺⁰, 30⁺²)∗	27⁺⁶ (26⁺¹, 29⁺⁶)	29⁺⁰ (27⁺⁰, 30⁺⁶)	0.002
Birth weight (g)	710 (540, 890)∗	1,085 (845, 1,370)∗	640 (538, 795)∗	1,220 (920, 1,490)	<0.001
Male	36 (46.8)	111 (49.1)	11 (45.8)	143 (58.4)	0.118
Multiple pregnancy	23 (29.9)∗	112 (49.6)∗	5 (20.8)∗	167 (68.2)	<0.001
Cesarean section	70 (90.9)∗	99 (43.8)∗	21 (87.5)∗	144 (58.8)	<0.001
Antenatal steroid use before 12 hours after birth	62 (80.5)	175 (77.4)	17 (70.8)	188 (76.7)	0.784
Preeclampsia	39 (50.6)∗	7 (3.1)∗	15 (62.5)∗	26 (10.6)	<0.001
PROM>18 hours	12 (15.6)∗	148 (65.5)	6 (25.0)∗	141 (57.6)	<0.001
GDM	4 (5.2)	12 (5.3)	1 (4.2)	11 (4.5)	0.960
Cord pH	7.24 (7.18, 7.29)∗	7.32 (7.28, 7.35)	7.23 (7.15, 7.27)∗	7.32 (7.27, 7.35)	<0.001
1 minute Apgar score	3 (2, 5)∗	5 (2, 6)	3 (1, 5)	5 (2, 6)	0.002
5 minute Apgar score	6 (5, 7)∗	7 (5, 8)	6 (3, 7)∗	7 (5, 8)	0.003

Values are presented as median (interquartile range) or number (%). Abbreviations: SGA-P, small for gestational age with placental disorders; HCA, histologic chorioamnionitis; PROM, premature rupture of membranes; GDM, gestational diabetes mellitus.

^∗ P<0.05 versus no SGA-P nor HCA.

Table 2.

In-hospital Outcomes of the 4 Groups According to the Presence of SGA-P and HCA

	SGA-P only (n=77)	HCA only (n=226)	Both SGA-P and HCA (n=24)	No SGA-P nor HCA (n=245)	P-value
Mortality	14 (18.2)∗	19 (8.4)	6 (25.0)∗	18 (7.3)	0.004
Surfactant use	43 (55.8)	100 (44.2)	16 (66.7)	111 (45.3)	0.069
PDA treatment	41 (53.2)	126 (55.8)	16 (66.7)	120 (49.0)	0.253
Pharmacological	38 (49.4)	110 (48.7)	14 (58.3)	106 (43.3)	0.387
Surgical	7 (9.1)	49 (21.7)	6 (25.0)	46 (18.8)	0.066
Moderate or severe BPD at 36 weeks	30 (45.5)∗	72 (34.4)	6 (30.0)	58 (25.1)	0.011
Severe BPD at 36 weeks	13 (19.7)	27 (12.9)	4 (20.0)	29 (12.6)	0.348
Sepsis	23 (29.9)	60 (26.5)	6 (25.0)	44 (18.0)	0.067
Early sepsis	6 (7.8)	16 (7.1)	1 (4.2)	8 (3.3)	0.172
Late sepsis	20 (26.0)	51 (22.6)	6 (25.0)	41 (16.7)	0.196
NEC≥stage 2b	9 (11.7)	15 (6.6)	1 (4.2)	15 (6.1)	0.392
IVH≥grade 3	4 (5.2)	19 (8.4)	4 (16.7)	16 (6.5)	0.244
ROP with surgery or VEGF	9 (13.2)	39 (18.5)	4 (20.0)	31 (13.3)	0.394
iNO use <14 days from birth	6 (7.8)	17 (7.5)	1 (4.2)	15 (6.1)	0.885
Pulmonary hypertension	11 (14.3)	14 (6.2)	4 (16.7)	17 (6.9)	0.046
Duration of hospital stay	60 (43, 94)	64 (39, 88)	65 (41, 106)	54 (35, 79)	0.209
Discharge with respiratory support	18 (23.4)	59 (26.1)	6 (25.0)	43 (17.6)	0.154

Values are presented as number (%) or median (interquartile range). Abbreviations: SGA-P, small for gestational age with placental disorders; HCA, histologic chorioamnionitis; PDA, patent ductus arteriosus; BPD, bronchopulmonary dysplasia NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; ROP, retinopathy of prematurity; VEGF, vasculo-endothelial growth factor; iNO, inhaled nitric oxide.

^∗ P<0.05 versus no SGA-P nor HCA.

Table 3.

Multivariable Analysis of Mortality and In-hospital Outcomes according to the Presence of SGA-P or HCA (Reference: No SGA-P nor HCA)

	SGA-P only		HCA only		Both SGA-P and HCA
	aOR (95% CI)	P-value	aOR (95% CI)	P-value	aOR (95% CI)	P-value
Death	3.15 (1.13, 8.80)	0.029	0.88 (0.42, 1.87)	0.741	2.76 (0.73, 10.41)	0.133
Moderate to severe BPD or death	9.12 (3.98, 20.90)	<0.001	1.05 (0.61, 1.81)	0.853	1.53 (0.44, 5.32)	0.509
Severe BPD or death	3.73 (1.62, 8.58)	0.002	0.68 (0.39, 1.21)	0.191	1.82 (0.55, 6.03)	0.325
PDA treatment	0.98 (0.51, 1.90)	0.961	1.14 (0.74, 1.78)	0.553	1.14 (0.40, 3.28)	0.806
Sepsis	2.12 (1.01, 4.46)	0.046	1.38 (0.84, 2.26)	0.207	1.07 (0.35, 3.27)	0.913
Early sepsis	3.79 (1.04, 13.81)	0.044	2.06 (0.82, 5.15)	0.122	1.70 (0.17, 16.95)	0.651
Late sepsis	1.65 (0.77, 3.54)	0.200	1.19 (0.71, 2.00)	0.499	1.00 (0.33, 3.08)	0.998
IVH≥grade 3	0.48 (0.13, 1.81)	0.277	1.00 (0.47, 2.12)	0.999	1.34 (0.34, 5.36)	0.675
NEC≥stage 2b	2.42 (0.79, 7.43)	0.123	0.79 (0.35, 1.75)	0.554	0.47 (0.05, 4.28)	0.499
Pulmonary hypertension	3.26 (1.15, 9.22)	0.026	0.71 (0.33, 1.54)	0.383	2.37 (0.56, 9.97)	0.240
ROP with surgery or VEGF	1.64 (0.51, 5.24)	0.404	1.23 (0.65, 2.33)	0.535	1.65 (0.34, 8.04)	0.536

Adjusted for Gestational age at birth (weeks), cesarean section, 5 minute Apgar score, multiple pregnancy, premature rupture of membranes before 18 hours prior to delivery, and preeclampsia. Abbreviations: SGA-P, small for gestational age with placental disorders; HCA, histologic chorioamnionitis; aOR, adjusted odds ratio; CI, confidence interval; BPD, bronchopulmonary dysplasia; PDA, patent ductus arteriosus; IVH, intraventricular hemorrhage; NEC, necrotizing enterocolitis; ROP, retinopathy of prematurity; VEGF, vasculo-endothelial growth factor.

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