Prognostic significance of antenatal and intrapartum risk factors on survival of preterm infants

N.S. Bozhbanbayeva, С. Сайранқызы, O.O. An, И.Е. Сулейменова, G.B. Altynbayeva, И.М. Адилбекова, Урстемова Камшат Кабылбековна, З.И. Бейсембаева, С.А. Есенова

2025

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DOI 10.20953/1726-1678-2025-5-43-51
Data confidence 70 medium
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Abstract

Objective. To determine key antenatal and intrapartum risk factors affecting the survival of preterm infants. Patients and methods. A two-center retrospective cohort study was conducted. Anamnestic data of pregnant women who delivered preterm (n = 1109) and were in obstetric institutions between 2021 and 2024 were retrospectively analyzed. All patients were divided into three groups: group 1 – extremely preterm (gestational age (GA) <28 weeks); group 2 – very preterm (GA: 28–31 weeks + 6 days); group 3 – moderate to late preterm (GA: 32–36 weeks + 6 days). To assess the statistical significance of differences between groups, the χ2 test was used; to correctly compare between groups with different numbers of patients, the data were normalized. To analyze statistically significant differences between specific groups, pairwise comparison was performed using the Bonferroni-correction for the χ2 test. All factors showing significant differences in the comparative analysis were analyzed using multivariate logistic regression to identify their association with the outcome (survived or not). Results. When analyzing the risk factors for neonatal death in group 1, the results showed the model’s statistical significance in general (χ2 = 67.0323, df = 8, p = 0.00001). Risk factors affecting the survival in group 1 were identified as GA (p < 0.0001, OR = 2.0176, 95% CI: 1.4417–2.8236) and pre-eclampsia (p = 0.0494, OR = 0.4065, 95% CI: 0.1657–0.9976). In group 2, the model also showed statistical significance: χ2 = 42.5495, df = 8, p = 0.00001. There was a tendency towards significance for the Apgar score at 1 minute (p = 0.0655, OR = 2.0227, 95% CI: 0.9560-4.2798). The association between the combination of factors and outcome in group 3 was confirmed by logistic regression analysis: χ2 = 31.7929, df = 8, p = 0.0001. The Apgar score at 5 minutes was found to be a statistically significant predictor of survival (p = 0.0274, OR = 9.3922, 95% CI: 1.2831–68.7486). Conclusion. Mortality among preterm infants increases in the presence of the following factors: in group 1 – maternal preeclampsia; in group 2 – the Apgar score at 1 minute; in group 3 – the Apgar score at 5 minutes. The combination of all factors is a risk factor for mortality among preterm infants. Key words: antenatal factors, pregnancy, survival of preterm infants, intrapartum factors, preterm birth, prognostic criteria