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Am J Perinatol 2022; 39(13): 1449-1459
DOI: 10.1055/s-0040-1722654
Original Article

Mortality and Morbidity in Premature Infants: An East and West Comparative Study

Monika Patil
1   Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Houston, Texas
2   Department of Pediatrics, Baylor College of Medicine, Houston, Texas
,
Venkateshwarlu Vardhelli
3   Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana, India
,
Joseph L. Hagan
1   Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Houston, Texas
,
Saikiran Deshabhotla
3   Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana, India
,
Srinivas Murki
3   Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana, India
› Author Affiliations Funding None.
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Abstract

Objective Survival of preterm infants differs dramatically depending on birthplace. No previous studies have compared outcomes of preterm infants between low middle-income and high-income countries such as India and the United States. The purpose of this study is to evaluate differences in care practices, resources, mortality, and morbidities in preterm infants with birth weight 700 to 1,500 g between two major neonatal centers in these countries.

Study Design This is a retrospective cohort study with de-identified data from Fernandez Hospital (FH) in Hyderabad, India, and Texas Children's Hospital (TCH) in Houston, TX, for infants born January 2016 to December 2018, and weighing 700 to 1,500 g at birth. The primary outcome was death before hospital discharge.

Results Of 1,195 infants, 736 were admitted to FH and 459 were admitted to TCH. After controlling for differences in gestational age, small for gestational age, and antenatal corticosteroid use, TCH patients had lower mortality before hospital discharge (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI]: 0.16–0.48, p < 0.001) and more bronchopulmonary dysplasia (BPD; aOR = 2.2, 95% CI: 1.51–3.21, p < 0.001). The composite outcome of death or BPD and death or any major morbidity (BPD or intraventricular hemorrhage grade II or more or periventricular leukomalacia grade II or more or retinopathy of prematurity requiring treatment) were not different.

Conclusion In this study, TCH infants had decreased odds of death before hospital discharge compared with FH but higher odds of BPD, which may be related to increased survival and differences in care practices.

Key Points

  • Few studies compared outcomes of premature infants between different high-income countries.

  • There are no studies comparing preterm infants between low middle-income and high-income countries such as India and the United States.

  • This study evaluated detailed comparison of care practices and infrastructure of NICUs in India and United states.

Keywords

preterm infants - neonatal intensive care unit - comparative analysis - outcomes research


Publication History

Received: 11 August 2020

Accepted: 11 December 2020

Article published online:
24 January 2021

© 2021. Thieme. All rights reserved.

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