Factores obstétricos claves en los resultados neonatales y a los dos años de seguimiento en la prematuridad extrema

Abstract

Objective: Analyse morbidity and mortality in extreme preterm at birth and at 2 year follow-up evaluating the infuence of obstetrical factors. Methods: Retrospective study of 132 cases born between weeks 23 and 27 at La Paz Hospital from 2003 to 2005. Three obstetrical groups were established: Threat of Preterm Birth, Premature Rupture of Membranes and the combination of both. The following were evaluated as obstetrical variables: tocolysis, corticosteroid therapy and type of delivery. As variables in children: mortality and respiratory, neurological, visual and auditive morbidity in neonates and two years of age. Results: In the cases of threat of preterm birth a greater bronchopulmonary dysplasia and persistent ductus arteriosus appeared than in the other two obstetrical groups (p=0.03). Focusing on the threat of birth group, the cases with maternal tocolysis developed fewer neurological complications, intraventricular hemorrhage of 36.4% (12/33) and periventricular infarct of 0%, whereas the cases without tocolysis showed 68.4% (13/19) and 31.6% (6/19) respectively (p=0.03, p=0.001). Also in this subgroup, the cases that received corticosteroid therapy developed less periventricular infarct (0%) and cerebral palsy at age 2 [6.7% (2/30)] than the ones that did not receive it in which the percentages were 40% (6/15) and 40% (4/10) (p=0.0001 and p=0.02 respectively). Also, intraventricular hemorrhage and cerebral palsy were more frequent in vaginal delivery than in caesarean sections in this subgroup [63.3% (19/30) and 26.1% (6/23) against 27.3% (6/22) and 0%; p=0.01 and p=0.03)]. Conclusion: Obstetrical characteristics and behaviour can have a decisive impact in the neonatal outcome and after two-year follow-up.