Express method for determining the probability of developing congenital pneumonia in preterm infants with low body weight

Authors

  • A.N. Harachka Belarusian State Medical University, Minsk, Belarus
  • A.V. Sukalo Belarusian State Medical University, Minsk, Belarus

DOI:

https://doi.org/10.22141/2224-0551.16.3.2021.233908

Keywords:

express method, model, risk factors, premature infants, congenital pneumonia

Abstract

Background. According to the World Health Organization, more than 2 million children under the age of five die from pneumonia every year, accounting for almost 1 in 5 deaths. Therefore, the aim of the study was to develop a mathematical model for determining the probability of developing congenital pneumonia in premature infants with low body weight by the express method. Materials and methods. A comprehensive examination of 171 newborns who stayed at the maternity physiology department, the department of anesthesiology and resuscitation (with wards for newborns) and the pediatric department for premature newborns of the State Institution “Republican Scientific and Practical Center “Mother and Child” was conducted. Results. A comparative analysis was carried out of more than 200 life history data, outcomes of previous pregnancies, complications of present pregnancy and clinical and laboratory methods of research in newborns in the first three days of life. Subsequently, the most significant factors associated with the development of congenital pneumonia in premature infants with low body weight were determined. The mathematical analysis of more than 380 million connections of variables is carried out. As a result of the survey, compared with the comparison group and the control group, the most significant factors were established: from the obstetric-gynecological and somatic history of the mother’s life — non-developing pregnancy (odds ratio (OR) = 13.46 (10.11–17.91); OR = 32.72 (24.76–43.22)) and spontaneous miscarriage (OR = 3.79 (2.69–5.35); OR = 19.19 (14.57–25.26)); from the complications of a present pregnancy — chronic fetoplacental insufficiency (OR = 3.47 (2.48–4.87); OR = 38.29 (28.78–50.91)), intrauterine growth restriction syndrome (OR = 11.56 (8.70–15.35)) and the threatened miscarriage (OR = 2.73 (1.76–4.23); OR = 3.96 (2.51–6.25)); according to the results of clinical manifestations in infant in the first three days of life — severe respiratory failure (OR = 6.90 (5.01–9.49)). Based on the obtained data, a mathematical model was developed with a sensitivity of 76.4 %, specificity — 83.0 %, and the area under the ROC curve = 0.840 ± 0.056 (0.76–0.91), p < 0.001. Conclusions. Using the model, threshold values were calculated: for non-developing pregnancy — 0.769, spontaneous miscarriage — 0.493, chronic fetoplacental insufficiency — 0.366, intrauterine growth restriction syndrome — 0.334, threatened miscarriage — 0.283, respiratory failure degree III — 0.703, which at the threshold values ≥ 0.49 allows us to single out a high-risk group for the development of congenital pneumonia among premature infants with low body weight.

References

Wardlaw TM, Johansson EW, Hodge M; World Health Organization(WHO); United Nations Children’s Fund (UNICEF). Pneumonia: the forgotten killer of children. Geneva: WHO-press; 2006. 40 p.

Lang TA, Secikc M. How to report statistics in medicine: annotated guidelines for authors, editors and reviewers. 2nd ed. Philadelphia PA: American College of Physicians; 2006. 490 p.

Rebrova OIu. Statisticheskii analiz meditsinskikh dannykh. Primenenie paketa prikladnykh programm STATISTICA [Statistical analysis of medical data. Application of the STATISTICA application package]. 3rd ed. Moscow: MediaSfera; 2006. 312 p. (in Russian).

Petri A, Sabin C. Medical Statistics at a Glance. 3rd ed. Oxford, USA: Wiley-Blackwell; 2013. 180 p.

Bhutta ZA, Das JK, Walker N, et al. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet. 2013 Apr 20;381(9875):1417-1429. doi:10.1016/S0140-6736(13)60648-0.

Kos'ianchuk AV. Infectious factor in women with non-developing pregnancy and chronic endometritis. In: Proceeding of the X Congress of Obstetricians-Gynecologists and Neonatologists of the Republic of Belarus. 2017, November 9-10; Minsk, Republic of Belarus. Reproductive Health. Eastern Europe. 2017;7(5):791-795. (in Russian).

Gill CJ, Young M, Schroder K, et al. Bottlenecks, barriers, and solutions: results from multicountry consultations focused on reduction of childhood pneumonia and diarrhoea deaths. Lancet. 2013 Apr 27;381(9876):1487-1498. doi:10.1016/S0140-6736(13)60314-1.

Mozheiko LF. Nevynashivanie beremennosti: uchebno-metodicheskoe posobie [Miscarriage: a study guide]. Minsk: Belarusian State Medical University; 2013. 38 p. (in Russian).

McGuire W, Clerihew L, Fowlie PW. Infection in the preterm infant. BMJ. 2004 Nov 27;329(7477):1277-1280. doi:10.1136/bmj.329.7477.1277.

Mudrov VA. The possibility of modifications methods of determine volume of amniotic fluid. Journal of Obstetrics and Women's Diseases. 2016;65(3):12-17. doi:10.17816/JOWD65312-17. (in Russian).

Malevich IuK, Shostak VA. Fetoplatsentarnaia nedostatochnost' [Fetoplacental insufficiency]. Minsk: Belarus'; 2007. 158 p. (in Russian).

Savel'eva GM, Fedorova MV, Klimenko PA, Sichinava LG. Platsentarnaia nedostatochnost' [Placental insufficiency]. Moscow: Meditsina; 1991. 272 p. (in Russian).

Tiutiunnik VL. Khronicheskaia platsentarnaia nedostatochnost' pri bakterial'noi i virusnoi infektsii (patogenez, diagnostika, profilaktika, lechenie). Diss. dokt. med. nauk [Chronic placental insufficiency in bacterial and viral infections (pathogenesis, diagnosis, prevention, treatment). Dr. med. sci. diss.]. Moscow: Meditsina; 2002. 46 p. (in Russian).

Antonov AG, Baibarina EN, Balashova EN, et al. Congenital pneumonia (clinical guidelines). Neonatology: News, Opinions, Training. 2017;(18):133-148. doi: 10.24411/2308-2402-2017-00049. (in Russian).

Volodin NN, Mukhina IuG, Chubarova AI, editors. Detskie bolezni: uchebnik dlia studentov meditsinskikh vuzov. Тom 1. Neonatologiia [Childhood diseases: a textbook for medical students. Vol 1. Neonatology]. Moscow: Dinastiia; 2011. 511 p. (in Russian).

Shabalov NP. Neonatologiia: uchebnoe posobie. Tom 1 [Neonatology: a study guide. Vol 1]. 3rd ed. Moscow: MED press-inform; 2004. 608 p. (in Russian).

Sukalo AV, Bovbel' IE. Spravochnik po poliklinicheskoi pediatrii [Outpatient pediatrics handbook]. Minsk: Belaruskaia navuka; 2015. 313 p. (in Russian).

Roos R, Genzel-Boroviczény O, Proquitté H. Checkliste Neonatology. 4th ed. Stuttgart: Thieme Verlag; 2010. doi:10.1055/b-002-5204. 512 p. (in German).

Published

2021-06-22

Issue

Section

Clinical Pediatrics