Births of children of low and very low weight at the University Hospital in Olomouc (1993–2011)

Czech version

Authors: M. Větr
Authors‘ workplace: Porodnicko-gynekologická klinika LF UP a FN, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D.
Published in: Ceska Gynekol 2013; 78(1): 41-55

Overview

Objective:
Evaluation of the births of children of low and very low weight, analysis of factors that may influence low birth weight and selected indicators to assess the state of the neonate after birth.

Design:
Retrospective epidemiological cohort study.

Setting:
Department of Gynaecology and Obstetrics, Faculty of Medicine and University Hospital Olomouc.

Methods:
Evaluation of maternal and newborn records from databases. The studied data set includes 33,126 births of children born in the period from 1. 1. 1993 to 31. 12. 2011 at the University Hospital in Olomouc. In sub-analyzes are compared subgroups of low and very low birth weight with a control group of children in the category from 2500 grams. Cohort of children under 2500 g contains a low birth weight infants with growth retardation.

Results:
The frequency (prevalence) of the neonates LBW is 11.6% (3851 neonates). Perinatal mortality in the weight category less than 2500 g was 57 per thousand, in the category from and more than 2500 g 2 per thousand, relative risk, RR = 7.14 (95% CI 6.67 to 7.54). Perinatal mortality in the category in 1500 grams compared with the control group is 157 per mille vs 2 per mille RR = 26.20 (23.55 to 29.16) Children with low weight in the total perinatal mortality contributes 78.9%, stillbirth 1.6% vs 0.1%, RR = 5.48 (4.69 to 6.40). (Stillbirth rate is reported from 1,000 g fetal weight.) Congenital anomalies 4.3% vs 1.6%, RR = 2.32 (95% CI 2.03 to 2. 65) The frequency of caesarean births of low weight babies was 62, 6% vs control group 18.9% (RR 3.31, 95% CI 3.20 to 3.42, p = 0.00000000). Caesarean sections in a file with a very low fetal weight compared with the control group, 83.8% vs. 18.9% (RR 4.43, 95% CI 4.27 to 4.60, p = 0.00000000). Since the mid nineties, there was a significant increase in multiple pregnancies in relation to IVF (Cox-Stuart test p = 0.039); 31.6% of children of low birth weight in multiple pregnancies vs 2.4% of children in the control group, RR = 7.48 (95% CI 7.11 to 7.86). Multivariate analysis also confirmed the existence of independent risk factors, especially social nature (education, unmarried woman, body mass index, smoking, parity, maternal age).

Conclusion:
The analysis shows the increase in births of children in category 2000–2500 grams. There has been a significant increase and proportion of iatrogenic factors, multiple pregnancies and caesarean sections. Also show some influence social and health characteristics of the mother. Low weight children have higher mortality and worse health. Despite a significant decrease perinatal mortality contributes to three quarters of perinatal deaths. It is clear that it is not possible substantially affect the prevalence of low birth weight. Children with low and very low birth weight despite intensive obstetric and neonatal care are a continuing medical problem. Finding good practices can contribute to better health of children with disabilities.

Keywords:
low birth weight – risk factors – perinatal deaths – trends

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