| BackgroundApproximately 15 million preterm infants are born each year worldwide,accounting for 11% of all newborns,and about 1.8 million preterm infants are born in China each year.Preterm birth,defined as birth less than 37 weeks’ gestation,is the leading cause of neonatal death and morbidity,as well as a major risk factor for neurodevelopmental disorders.Premature infants,especially very premature infants,are a challenging problem in the field of perinatal medicine.Preterm birth can be caused by many potential causes,and there are a variety of classification methods,but clinical preterm birth is mainly divided into iatrogenic preterm birth and spontaneous preterm birth.Several studies have investigated and analyzed the influence of different causes of preterm birth on neonatal outcomes.With the development of research,more and more people are aware of the role of pathological mechanisms in the death and prognosis of preterm infants.In the view of the heterogeneity of premature births,it is helpful to explore effective measures for the prevention of preterm birth by analyzing the causes separately from various perspectives and clarifying the specific characteristics of each clinical etiology.However,there is limited data on how the indications of preterm birth affect the outcome of infants,and it is not clear whether the prognosis of newborns varies due to different causes of preterm birth.ObjectiveThe aim of this study was to analyze and compare the differences in neonatal outcomes between iatrogenic preterm birth and spontaneous preterm birth,and to explore the relationship between the causes of preterm birth and the complications and neurodevelopmental outcomes of preterm infants.MethodsWe performed a retrospective cohort study of preterm infants less than 32 weeks’ gestation in the Third Affiliated Hospital of Zhengzhou University from 1 July 2014 to 30 June 2019.According to the causes of delivery,preterm births were categorized as spontaneous or iatrogenic.Clinical data were collected and these groups were compared for neonatal characteristics.All infants surviving at discharge were followed up at 12 months of corrected age.Neurodevelopment was evaluated using the Bayley Scales of Infant and Toddler,to compare the neurodevelopmental outcomes.Results1.A total of 1689 neonates were included,and the preterm population consisted of 1038 spontaneous preterm infants(61.5%)and 651 iatrogenic preterm infants(38.5%).There was a significant difference in the incidence of small for gestational age between the two groups(2.7% vs.21.7%,p < 0.001).2.Among the high-risk factors in the spontaneous preterm delivery group,premature rupture of membranes accounted for the highest proportion(23%);among the high-risk factors in the iatrogenic preterm delivery group,the proportion of pregnancy-induced hypertension was the highest(21%).3.Infants born following spontaneous labor presented with a higher risk of intraventricular hemorrhage(35.0% vs.29.6%,p < 0.05),whereas iatrogenic preterm birth was associated with higher risk of necrotizing enterocolitis [OR = 2.629,95%CI:1.409-4.908,p = 0.002],coagulopathy [OR = 1.760,95%CI: 1.255-2.469,p =0.001],and pathoglycemia [OR = 3.750,95%CI: 1.144-12.291,p = 0.029].4.In this study,325 premature infants died in hospital,the main cause was respiratory distress syndrome.There was no difference in mortality between the two groups(p > 0.05).5.Follow-up data were available for 1114 infants,and no differences in neurodevelopmental outcomes were observed between the two preterm birth subtypes at 12 months of corrected age(p > 0.05).ConclusionIatrogenic preterm birth and spontaneous preterm birth were respectively associated with some neonatal complications,but not with neurodevelopmental outcomes at 12 months of corrected age. |
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