Impact of different treatment attitudes on survival and risk factors for poor clinical outcomes in extremely preterm infants: a retrospective real-world study
LI Meng-Meng, LI Shu-Shu, QIAN Miao, ZHANG Min, HAN Shu-Ping
Department of Pediatrics, Women's Hospital of Nanjing Medical University/Nanjing Women and Children's Healthcare Hospital, Nanjing 210004, China
Abstract Objective To explore the impact of different treatment attitudes on the survival status of extremely preterm infants (EPIs) and evaluate the mortality and occurrence of severe complications in actively treated infants, as well as their risk factors. Methods A retrospective analysis was conducted on perinatal data of EPIs born between January 1, 2016, and December 31, 2023, who were admitted to the neonatal intensive care unit of Nanjing Women and Children's Healthcare Hospital within 24 hours after birth. The analysis focused on the attributable risk of mortality associated with different treatment attitudes in EPIs of varying gestational ages and birth weights. A multivariate logistic regression model was used to analyze the risk factors for mortality and severe complications in the actively treated group. Results A total of 485 EPIs were included. As gestational age or birth weight increased, the attributable risk of mortality with care withdrawal increased. Active treatment significantly improved the survival status of EPIs born at a gestational age of ≥24 weeks. Multivariate logistic regression analysis indicated that lower gestational age and the need for mechanical ventilation within 72 hours after birth were independent risk factors for mortality or severe complications in EPIs (P<0.05). Conclusions Active treatment can significantly extend the survival time of EPIs born at a gestational age of ≥24 weeks. Lower gestational age and the need for mechanical ventilation within 72 hours after birth are closely associated with poor survival outcomes in EPIs.
Corresponding Authors:
Han S-P, Email: shupinghan@njmu.edu.cn
E-mail: shupinghan@njmu.edu.cn
Cite this article:
LI Meng-Meng,LI Shu-Shu,QIAN Miao et al. Impact of different treatment attitudes on survival and risk factors for poor clinical outcomes in extremely preterm infants: a retrospective real-world study[J]. CJCP, 2025, 27(3): 269-278.
LI Meng-Meng,LI Shu-Shu,QIAN Miao et al. Impact of different treatment attitudes on survival and risk factors for poor clinical outcomes in extremely preterm infants: a retrospective real-world study[J]. CJCP, 2025, 27(3): 269-278.
Kaempf J, Morris M, Steffen E, et al. Continued improvement in morbidity reduction in extremely premature infants[J]. Arch Dis Child Fetal Neonatal Ed, 2021, 106(3): 265-270. PMID: 33109606. DOI: 10.1136/archdischild-2020-319961.
Helenius K, Sj?rs G, Shah PS, et al. Survival in very preterm infants: an international comparison of 10 national neonatal networks[J]. Pediatrics, 2017, 140(6): e20171264. PMID: 29162660. DOI: 10.1542/peds.2017-1264.
Arnold C, Inthorn J, Roth B, et al. Attitudes and values towards decisions at the margin of viability among expectant mothers at risk for preterm birth[J]. Acta Paediatr, 2024, 113(3): 442-448. PMID: 37942656. DOI: 10.1111/apa.17033.
Wilcox AJ, Cortese M, McConnaughey DR, et al. The limits of small-for-gestational-age as a high-risk category[J]. Eur J Epidemiol, 2021, 36(10): 985-991. PMID: 34661814. DOI: 10.1007/s10654-021-00810-z.
Zhang WW, Yu YH, Dong XY, et al. Treatment status of extremely premature infants with gestational age < 28 weeks in a Chinese perinatal center from 2010 to 2019[J]. World J Pediatr, 2022, 18(1): 67-74. PMID: 34767193. PMCID: PMC8761149. DOI: 10.1007/s12519-021-00481-6.
Horbar JD, Greenberg LT, Buzas JS, et al. Trends in mortality and morbidities for infants born 24 to 28 weeks in the US: 1997-2021[J]. Pediatrics, 2024, 153(1): e2023064153. PMID: 38053449. DOI: 10.1542/peds.2023-064153.
Norman M, Hallberg B, Abrahamsson T, et al. Association between year of birth and 1-year survival among extremely preterm infants in Sweden during 2004-2007 and 2014-2016[J]. JAMA, 2019, 321(12): 1188-1199. PMID: 30912837. PMCID: PMC6439685. DOI: 10.1001/jama.2019.2021.