Clinico etiological profile, management practices, and outcomes of preterm neonates: A prospective observational study from a tertiary care Neonatal Intensive Care Unit (NICU)

Objective: Preterm births pose a significant challenge in neonatology, contributing to high morbidity and mortality rates. This study evaluates the clinico-etiological profile, management practices, and outcomes of preterm neonates in a tertiary care NICU, emphasizing maternal risk factors.

Methods:  A prospective observational study was conducted on 138 preterm neonates (22 to 36+6 weeks gestational age). Data were analyzed using descriptive and inferential statistical methods, including chi-square tests, logistic regression, and Kaplan-Meier survival analysis. A p-value < 0.05 was considered statistically significant.

Results: Of the 138 preterm neonates, 60.14% were late preterm (34–<37 weeks). Appropriate for gestational age (AGA) babies constituted 75.36%, while 23.19% were small for gestational age (SGA). Male preponderance was observed (64.49%). Morbidities included neonatal hyperbilirubinemia (NNH, 34.78%), respiratory distress syndrome (RDS, 26.08%), and sepsis (18.11%). The mortality rate was 4.34%, with respiratory distress syndrome (RDS) and intraventricular hemorrhage (IVH) being the leading causes. Mortality was significantly higher in neonates born <32 weeks gestation (20.83%) compared to those ≥32 weeks gestation (0.88%, p < 0.05).  Key maternal risk factors included bad obstetric history (BOH: Previous preterm labour/ Abortion, 46.38%), preterm premature rupture of membranes (PPROM/PROM, 37.68%), multiple gestation (26.81%), poly/oligohydramnios (23.91%), in vitro fertilization (IVF, 23.19%), and pre-eclampsia/eclampsia (9.42%). Management practices such as antenatal corticosteroid administration, surfactant therapy, advanced NICU care, and Kangaroo Mother Care (KMC) were associated with a significant reduction in morbidity and mortality among preterm neonates.

Conclusion: This study highlights the importance of antenatal care and advanced neonatal interventions in addressing key risk factors for preterm birth and improving neonatal outcomes.