Apgar index
For each study group, the Apgar index was analyzed in terms of median, maximum, and minimum. Thus, for all 3 study groups, the following results were obtained for a 95% confidence interval. Group 1 had a median Apgar index of 7, with a minimum value of 1 and a maximum value of 9. Group 2 was characterized by a median of the Apgar index of 8, a minimum value of 0, and a maximum value of 10. Study group 3 was characterized by a median Apgar index of 9, a minimum value of 1 and a maximum value of 10 (Fig 2).
Regarding the mode of birth, for all the 3 study groups, birth through cesarean section predominated (Table 3). The greatest difference in percentage was in the group of premature infants with low birth weight for the gestational age, with a difference of more than 3 times the percentage (23%) for the spontaneous birth and for the cesarean birth (77%).
The smallest difference was obtained for the term low birth cases with low weight for the gestational age, with a difference of 16%, favoring birth through caesarean section. For the entire study group, birth by cesarean section predominated, and there was also a statistical significant difference between the 3 study groups, P = 0.004.
As we have already mentioned in the subchapter dedicated to the working method, we independently analyzed obstetric and neonatal parameters both from a descriptive point of view and from the statistical differences that exist between the 3 study groups.
The incidence of obstetric aspects, namely fetal presentation, obstetric pathology in the spectrum of hypertensive pregnancy disorders, fetal malformations, multiple nuchal cord, or true umbilical cord knot is summarized in Figure 3.
As can be seen, the incidence of pelvic presentation predominates in pregnancies with low gestational age, that is, in both normal and low-weight premature pregnancies, and hypertensive pregnancy pathology has predominated in study groups characterized by low weight; however, there was no statistical difference for the low birth weight group in our study.
All the neonatal complications, including the incidence of the complications within each study group, and the existence or not of statistical significance for the study groups are shown in the table below (Table 4).
Analyzing each parameter separately, we obtained a statistically significant difference, predominantly in preterm infants with low weight for the gestational age, for the following complications: cardio-vascular arrest occurred in 6% of the subjects in group 1, with a significant difference of 1% in the incidence of complications between groups 2 and 3; for acute respiratory insufficiency, the difference in incidence was even greater, in which the premature infants with low weight for the gestational age (24% compared to 8% and 2% corresponding to the other groups); a difference in the incidence for ulcer-necrotic enterocolitis (group 1, 13%; group 2, 1%; and group 3, 0%), having statistical significance was otherwise obtained according to the collected data; hypoxia also predominated among preterm infants: 58% of infants with low weight for gestational age, 23% for premature infants with weight corresponding to gestational age, and 9% for term infants with low weight for gestational age.
Respiratory distress had an incidence of 29% in group 1, significantly higher than group 2 (13%) and group 3 (0%), and cerebral edema occurred only in premature cases, with an incidence of 6% for those with low weight for gestational age and 2% for those with appropriate weight.
Neonatal complications, such as cerebral edema, pulmonary hemorrhage, neonatal seizures and disseminated intravascular coagulation, persistence of the arterial canal, cerebral hemorrhage, hyaline membrane disease, and retinopathy had a 0% incidence in the term neonatal group with low birth weight. Each of these complications predominated in the group of preterm newborns with intrauterine growth restriction, with the exception of the persistence of the arterial canal, which predominated in study group 2, with an incidence of 1%, and was absent in group 1. For cerebral edema, pulmonary edema and disseminated intravascular coagulation, the difference in incidence was statistically significant. For group 3, complications such as intraventricular hemorrhage and neonatal anemia presented minimum incidences of 1% and 2%, respectively. For these complications, the predominance was also the highest in group 1 (premature infants with low weight for the gestational age), namely 28% and 32%, respectively, which are significantly higher percentages than those obtained in the other study groups.
Regarding the incidence of neonatal infections, a significant incidence was noted in all 3 study groups, with a significant predominance among the group of premature infants with low-weight for the gestational age (38%); meanwhile, for the premature infants with the weight corresponding to the gestational age, the incidence was 19 %, similar to that of term newborns with low weight for gestational age (16%). Regarding neonatal sepsis, a higher incidence was obtained of infants with low birth weight for gestational age (15%) and significant but smaller incidence obtained for the other 2 study groups (6% and 8%, respectively).
Regarding the need for neonatal intensive care, it was 18% for group 1, 5% for group 2, and 1% for group 3, with a statistically significant difference between the 3 groups. Additionally, a statistically significant difference was obtained for the rate of neonatal death, which predominated by 8% in preterm infants with low weight for gestational age and was absent in term infants with low weight for gestational age.