TỶ LỆ TỬ VONG VÀ CÁC YẾU TỐ LIÊN QUAN TRONG SUY HÔ HẤP Ở TRẺ SƠ SINH NON THÁNG TẠI BỆNH VIỆN NHI ĐỒNG 1

Abstract

Background: Preterm birth remains a leading cause of neonatal mortality. More than 90% of neonates admitted to the Neonatal Intensive Care Unit (NICU) present with severe respiratory distress requiring advanced respiratory support[1]. Although respiratory distress in preterm neonates has been extensively studied worldwide and in Vietnam, recent center-specific and focused investigations remain limited. This study was therefore conducted to evaluate factors associated with mortality due to respiratory distress among preterm neonates admitted to the NICU of Children’s Hospital 1.

Objectives: To identify factors associated with mortality due to respiratory distress in preterm neonates admitted to the Neonatal Intensive Care Unit of Children's Hospital 1.

Methods: A cross-sectional study from January 1, 2025, to June 30, 2025, at Children's Hospital 1.

Results: A total of 145 preterm neonates with respiratory distress were included. The median gestational age was 34.0 weeks (29.4 – 35.0), and the median birth weight was 1,900g (1,300 – 2,300g); extremely preterm infants accounted for 12.4%. The most common causes of respiratory distress were surgical-related conditions (36.6%), respiratory distress syndrome (34.5%), and pneumonia (24.1%). Major treatments included invasive mechanical ventilation (74.5%), non-invasive ventilation (73.1%), surfactant replacement therapy (34.5%), and caffeine administration (35.2%). Respiratory-related complications occurred in 31.0% of cases, with bronchopulmonary dysplasia accounting for 9.0%. Clinical outcomes included discharge (87.0%) and death (13.0%). Factors significantly associated with mortality were gestational age < 28 weeks (OR = 30.95; 95% CI: 3.12 – 306.86; p = 0.003), antenatal steroid use (OR = 0.022; 95% CI: 0.002 – 0.199; p = 0.001), indication for surfactant therapy (OR = 0.045; 95% CI: 0.003 – 0.644; p = 0.022), surfactant administration ≥ 2 doses (OR = 19.45; 95% CI: 1.22 – 308.33; p = 0.035), metabolic acidosis at admission (OR = 6.72; 95% CI: 1.34 – 33.56; p = 0.020).

Conclusion: The most common causes of respiratory distress in preterm neonates were surgical-related conditions (36.6%) and respiratory distress syndrome (34.5%), with invasive mechanical ventilation used in 74.5% of cases. The overall mortality rate was 13.0%. Mortality was significantly associated with gestational age < 28 weeks, antenatal steroid use, surfactant indication, multiple surfactant doses, metabolic acidosis at admission, and invasive mechanical ventilation. Effective antenatal management, along with timely diagnosis and appropriate treatment strategies, is essential to reduce mortality in this vulnerable population.