Survival and Risk Factors of Extremely Preterm Babies (< 28 weeks) in the Three Iranian Hospitals


The present study aimed to evaluate the survival rate of extremely  preterm  infant (<28 weeks), predictive factors, and the risk of mortality in three training hospitals of Tehran city to make better decisions to improve public health and reduce neonatal mortality. This prospective, cohort study was conducted during 2014 to 2015. Infants with the gestational age ≤28 weeks were enrolled. Their information was collected by using data collection forms and clinical risk index for infants. Infants were followed up until one month after the birth, and their outcomes were determined. Chi-square test was used for survival analysis. Binary Logistic regression was also applied to find out the factors associated with infants’ survival. Among the 325 followed up infants, 166 (51%) were intra-uterine fetal death (IUFD), and 159 (49%) remained alive after birth. The infants’ overall survival rate was 62 (39%) within one month after birth. Multivariate  Logistic regression analysis indicated that three factors of birth weight, gestational age (GA), and fifth minute Apgar score had a negative  significant relationship with the survival rate of infants (P<0.05). Receiving corticosteroid and female neonatal can had a positive significant relationship with the survival rate of infants (P<0.05). The survival rate of preterm infants was 39%. Younger maternal age, lower neonatal birth weight, and GA can increase the risk of neonatal mortality. Also, receiving corticosteroid and female gender of neonate can decrease the risk of neonatal mortality. These items were important that affected infants’ survival and could be considered in predicting it in neonatal intensive care units.

Organization WHo. Preterm birth fact sheet No363. (Accessed January 2018, 18, at Http// www.Who.Ink/ Media Centre/Fact Sheets/Fs363/En).

Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008;371:261-9.

World Health Organization. March of Dimes; The Partnership for Maternal NCHStCBtstgaropb (Accessed Januari 2018, 12, at

Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008;371:261-9.

Hamilton BE, Hoyert DL, Martin JA, Strobino DM, Guyer B. Annual summary of vital statistics: 2010–2011. Pediatrics 2013;131:548-58.

Demendi C. Premature delivery as a multifactorial disorder [Dissertation]. Budapest: Semmelweis Univ., 2012.

Behrman RE, Butler AS, eds. Preterm birth: causes, consequences, and prevention. Washington (DC): National Academies Press (US), 2007.

Eichenwald EC, Stark AR. Management and outcomes of very low birth weight. N Engl J Med 2008;358:1700-11.

Fanaroff AA, Hack M, Walsh MC. The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Semin Perinatol 2003;27:281-7.

Horbar JD, Badger GJ, Carpenter JH, et al. Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics 2002;110:143-51.

Upadhyay K, Pourcyrous M, Dhanireddy R, Talati AJ. Outcomes of neonates with birth weight _ 500 g: a 20-year experience. J Perinatol 2015;35:768-72.

Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012. JAMA 2015;314:1039-51.

Patel RM, Kandefer S, Walsh MC, Bell EF, Carlo WA, Laptook AR, et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 2015;372:331-40.

Horbar JD, Carpenter JH, Badger GJ, Kenny MJ, Soll RF, Morrow KA, et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics 2012;129:1019-26.

Ancel PY, Goffinet F, Group EW, Kuhn P, Langer B, Matis J, et al. Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr 2015;169:230-8.

Shah PS, Sankaran K, Aziz K, Allen AC, Seshia M, Ohlsson A, et al. Outcomes of preterm infants <29 weeks gestation over 10-year period in Canada: a cause for concern? J Perinatol 2012;32:132-8.

Kusuda S, Fujimura M, Uchiyama A, Totsu S, Matsunami K, Neonatal Research Network J. Trends in morbidity and mortality among very-low-birth-weight infants from 2003 to 2008 in Japan. Pediatr Res 2012;72:531-8.

Ishii N, Kono Y, Yonemoto N, Kusuda S, Fujimura M, Neonatal Research Network J. Outcomes of infants born at 22 and 23 weeks' gestation. Pediatrics 2013;132:62-71.

Su BH, Hsieh WS, Hsu CH, Chang JH, Lien R, Lin CH, et al. Neonatal outcomes of extremely preterm infants from taiwan: comparison with Canada, Japan, and the USA. Pediatr Neonatol 2015;56:46-52.

Darlow BA, Cust AE, Donoghue DA. Improved outcomes for very low birthweight infants: evidence from New Zealand national population based data. Arch Dis Child Fetal Neonatal Ed 2003;88:F23-8.

Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants—2010 update. Neonatology 2010;97:402-17.

Manuck TA, Rice MM, Bailit JL, Grobman WA, Reddy UM, Wapner RJ, et al. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. Am J Obstet Gynecol 2016;215:103.e1-14.

Sritipsukho S, Suarod T, Sritipsukho P. Survival and outcome of very low birth weight infants born in a university hospital with level II NICU. J Med Assoc Thai 2007;90:1323-9.

Navaei F, Aliabady B, Moghtaderi J, Moghtaderi M, Kelishadi R. Early outcome of preterm infants with birth weight of 1500 g or less and gestational age of 30 weeks or less in Isfahan city, Iran. World J Pediatr 2010;6:228-32.

Alleman BW, Bell EF, Smith B, Ambalavanan N, Laughon MM, Stoll BJ, et al. Individual and center-level factors affecting mortality among extremely low birth weight infants. Pediatrics 2013;132:e175-84.

Velaphi SC, Mokhachane M, Mphahlele RM, Beckh-Arnold E, Kuwanda ML, Cooper PA. Survival of very-low-birth-weight infants according to birth weight and gestational age in a public hospital. S Afr Med J 2005;95:504-9.

Express Group, Fellman V, Hellstrom-Westas L, Norman M, Westgren M, Kallen K, et al. One-year survival of extremely preterm infants after active perinatal care in Sweden. JAMA 2009;301:2225-33.

Finnstrom O, Olausson PO, Sedin G, Serenius F, Svenningsen N, Thiringer K, et al. The Swedish national prospective study on extremely low birthweight (ELBW) infants. Incidence, mortality, morbidity and survival in relation to level of care. Acta Paediatr 1997;86:503-11.

Ancel PY, Goffinet F, Epipage- Writing Group , Kuhn P, Langer B, Matis J, et al. Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr 2015;169:230-8.

Ghorbani F, Heidarzadeh M, Dastgiri S, Ghazi M, Rahkar Farshi M. Survival of Premature and Low Birth Weight Infants: A Multicenter, Prospective, Cohort Study in Iran. Iran J Neonatol 2017:8:16-22.

Nayeri F, Dalili H, Nili F, Amini E, Ardehali A, Khoshkrood Mansoori B, Shariat M. Risk factors for neonatal mortality among very low birth weight neonates. Acta Med Iran 2013;51:297-302.

Draper ES, Zeitlin J, Fenton AC, Weber T, Gerrits J, Martens G, et al. MOSAIC research group. Investigating the variations in survival rates for very preterm infants in 10 European regions: the MOSAIC birth cohort. Arch Dis Child Fetal Neonatal Ed 2009;94:F158-63.

Zeitlin J, Draper ES, Kollée L, Milligan D, Boerch K, Agostino R, et al. MOSAIC research group. Differences in rates and short-term outcome of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort. Pediatrics 2008;121:e936-44.

Rogowski JA, Horbar JD, Staiger DO, Kenny M, Carpenter J, Geppert J. Indirect vs direct hospital quality indicators for very low-birth-weight infants. JAMA 2004;291:202-9.

Hayter MA, Anderson L, Claydon J, Magee LA, Liston RM, Lee SK, et al. Canadian Neonatal Network. Variations in early and intermediate neonatal outcomes for inborn infants admitted to a Canadian NICU and born of hypertensive pregnancies. J Obstet Gynaecol Can 2005;27:25-32.

Alleman BW, Bell EF, Li L, Dagle JM, Smith PB, Ambalavanan N, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Individual and center-level factors affecting mortality among extremely low birth weight infants. Pediatrics 2013;132:e175-84.

Janvier A, Lantos J. Delivery room practices for extremely preterm infants: the harms of the gestational age label. Arch Dis Child Fetal Neonatal Ed 2016;101:F375-6.

Khani S, Mohamadpour RA, Ghaffari Saravi V, Abdollahi F, Sabaghi R, Bavand M. 200 and governmental hospitals in Sari by survival analysis technique during 2005-7. J Mazandaran Univ Med Sci 2008;17:54-62.

Vincer MJ, Armson BA, Allen VM, Allen AC, Stinson DA, Whyte R, et al. An algorithm for predicting neonatal mortality in threatened very preterm birth. J Obstet Gynaecol Can 2015;37:958-65.

Ravelli AC, Schaaf JM, Mol BW, Tamminga P, Eskes M, van der Post JA, et al. Antenatal prediction of neonatal mortality in very premature infants. Eur J Obstet Gynecol Reprod Biol 2014;176:126-31.

Basu S, Rathore P, Bhatia BD. Predictors of mortality in very low birth weight neonates in India. Singapore Med J 2008;49:556-60.

Fallahi M, Joudaki N, Bandpey HM. Evaluation of causes of neonatal mortality in Shohadaye Tajrish hospital, during years 2004-2007. Pajoohandeh 2009;14:43-6.

Indredavik MS, Vik T, Evensen KA, Skranes J, Taraldsen G, Brubakk AM. Perinatal risk and psychiatric outcome in adolescents born preterm with very low birth weight or term small for gestational age. J Dev Behav Pediatr 2010;31:286-94.

Almeida MF, Guinsburg R, Martinez FE, Procianoy RS, Leone CR, Marba ST, et al. Perinatal factors associated with early deaths of preterm infants born in Brazilian Network on Neonatal Research centers. J Pediatr (Rio J) 2008;84:300-7.

Watson SI, Arulampalam W, Petrou S, Marlow N, Morgan AS, Draper ES, et al. The effects of designation and volume of neona¬tal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study. BMJ Open 2014;4:e004856.

Woodward Lianne J, Peter J. Anderson, Nicola C. Austin, Kelly Howard. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006;355:685-94.

IssueVol 56, No 3 (2018) QRcode
Extremely preterm neonate Intensive care unit Infant mortality Gestational age

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Saleh Gargari S, Kashanian M, Zendedel H, Nayeri F, Shariat M, Haghollahi F. Survival and Risk Factors of Extremely Preterm Babies (&lt; 28 weeks) in the Three Iranian Hospitals. Acta Med Iran. 56(3):181-188.