Results of mortality and morbidity in preterms hospitalized in our neonatal intensive care unit

Introduction and Purpose: Approxiametly 1.3 million infants are born each year in Turkey. About 100.000 babies born prematurely. Prematurity is still most important causes that effects the survival and quality of life in his/her life. In recent years decreases have been detected in rates of mortality and morbidity in premature infants with help of antenatal steroid application, surfactant application, advanced ventilation techniques and tight pregnancy follow-up programs. The aim of this study was to evaluate the results of mortality and morbidity of premature infants who were less than 32 weeks in our neonatal instensive care unit. Material and Method: In this retrospective study, 488 infants with a birth week less than 32 weeks, who were hospitalized in the neonatal intensive care unit in the medical faculty of Bülent Ecevit University between January 2013 and June 2017, were evaluated for mortality and prematurity problems (n=488). Cases, whose follow-up information and birth records were accessible, were included. In our study, the infants were divided into 6 goups regarding their birth weights (<750 g, 751-1000g, 1001-1250g, 1251-1500g, 1501-2000g and >2000g). Furthermore, they were distributed in 5 goups according to the week of gestational age (22-24, 25-26, 27-28, 29-30, 31-32 weeks). Findings: The total mortality rate was 13.7% (n = 67). The mortality rate was 11.2% in infants delivered in our hospital and 25.8% in infants delivered in other centers. The difference was statistically significant (p<0.005). The average birth weight of the deceased infants was 998 ± 413.3 g and the average gestation week was 27.1 ± 2.9 weeks. We found out that the mortality rate increased statistically with the decrease of the birth weight and gestational age (p < 0.001). In our study, the rate of multiparity was 21.5% (n=105) among the included infants, but there was no significant correlation between the multiparity and mortality. In our study; the mortality rate of the male infants was 16% and the mortality rate of the female infants was 11.3%. There was no significant correlation between gender and mortality (p>0.05). We found out that 73.6% (n=359) of the cases received steroid in the prenatal period and steroid was used in 47.8% of the deceased infants in the antenatal period. In cases, with antenatal steroids, the mortality rate was 8.9%, whereas the mortality rate in cases not used was 27.1%. The correlation between the antenatal steroid use and mortality was statistically significant (p < 0.001). The rate of the respiratory distress syndrome (RDS), which is one of the prematurity problems, was 83.2% (n=406) and we determined that 59.2% (n=244) of these infants received surfactant treatment. There was no significant correlation between the antenatal steroid administration and RDS. We found out that 22.7% of the infants had patent ductus arteriosus (PDA). The comparison of the presence of PDA with the patient goups with and without RDS showed that there was a significant difference (p<0.001). In our study, we measured the pH value in the cord blood for the evaluation of asphyxia. We determined that the pH rate significantly increased with the increase of the gestational week and birth weight in our study goups (p<0.001). 9.9% of our patients (n=48) had intraventricular bleeding (IVB) and most were Gade I-II bleeding (n=37). In the living IVB-positive infants, the rate of Gade I and II IVB was 6.2% and the rate of Gade III and IV IVB was 1%. In the IVB-positive infant goup, who died, the rate of Gade I and II IVB was 16.4% and rate of Gade III and IV IVB was 10.4%. Sepsis rate, which is another problem of the prematurity, was 29.1% (n=142) and 28.8% (n=41) of them died. The risk of sepsis increased significantly with the decrease of the birth weight and gestational week (p<0,001). In total patient goup NEC frequency was found 7.1% and in patient with NEC positive and surgery requiring was found 1.4%.Although we determined a statistically significant difference between NEC and mortality, there was no significant difference between NEC and birth weight and gestational week. 11.5% of the included infants had bronchopulmonary dysplasia (BPD). There was a statistically significant difference between the BPD-positive and negative goups regarding the presence of RDS (p<0,001). The infants were also evaluated for retinopathy of prematurity (ROP) in 3 goups: "ROP "; "ROP present but no treatment is necessary" and "ROP present and treated". We determined that 363 infants were ROP negative and 115 were ROP positive but did not need treatment. The remaining 10 patients (2%) were evaluated as ROP-positive and treated accordingly. There was a significant difference between the goups regarding the total duration of oxygen administration and follow-up duration in the mechanic ventilation with a nasal CPAP (p<0.001). On the other hand, there was no significant difference between the goups regarding the intubated follow-up duration with the mechanic ventilation (p=0.073). Discussion and Conclusion: In conclusion the data obtained in our study will guide the development of measures to reduce mortality and morbidity rates of prematurate babies in our neonatal intensive care unit. For this purpose, among the measures that we think will be effective in decreasing preterm mortality; pregnancy follow-ups need to be done more regularly, increasing the rate of steroid application in the antenatal period, diagnosis of patent ductus arteriosus in the postnatal period and ensuring the necessary cardiological evaluation conditions and increasing the infection control measures are seen as important points to be emphasized firstly.