Characterization of mothers at risk of delivery at the limit of viability and factors related to infant survival

J Matern Fetal Neonatal Med. 2017 Sep;30(18):2198-2203. doi: 10.1080/14767058.2016.1243095. Epub 2016 Oct 25.

Abstract

Objectives: To determine the sociodemographic and clinical characteristics of mothers of infants at the limit of viability and to know the perinatal factors associated to infants' survival.

Method: Single-center cohort study of mothers and newborns assisted in our tertiary care center (2004-2010). Demographic and perinatal variables were compared between mothers who gave birth ≤26 weeks GA and the general population. The association between perinatal factors and neonatal survival was studied by Cox regression analysis.

Results: Mothers of newborns ≤26 weeks (n = 136) had less education and pregnancy control. They had more frequently assisted reproductive technologies (ART) (5.2% versus 2.3%; p< 0.05), multiple gestations (16.6% versus 2.1%; p < 0.05), pregnancy complications and C-section (39.7% versus 13.4%; p < 0.001). After correcting for confounders, the perinatal factors independently associated with a variation in the risk of mortality were the administration of antenatal steroid [aHR (95%CI): 0.465 (0.254-0.853), p = 0.013], singleton pregnancy [aHR (95%CI): 0.482 (0.279-0.834), p = 0.009], infant's temperature on admission [aHR (95%CI): 0.642 (0.426-0.968), p = 0.035] and CRIB score [aHR (95%CI): 1.151 (1.058-1.251), p = 0.001].

Conclusions: Mothers of preterm infants at the limit of viability had more ART, multiple pregnancies, obstetrical complications and C-section. Infants' survival was independently associated to antenatal steroids, singleton pregnancy, temperature on admission and CRIB score.

Keywords: Extremely preterm newborn; cesarean section; limits of viability; risk factors; survival.

MeSH terms

  • Adult
  • Delivery, Obstetric / statistics & numerical data
  • Female
  • Gestational Age
  • Humans
  • Infant
  • Infant Mortality*
  • Infant, Extremely Low Birth Weight*
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Male
  • Mothers / statistics & numerical data
  • Pregnancy
  • Premature Birth / epidemiology*
  • Proportional Hazards Models
  • Prospective Studies
  • Reproductive Techniques, Assisted / statistics & numerical data
  • Risk Factors
  • Socioeconomic Factors*
  • Young Adult