Competing Risk Analysis of the Health Status of Neonates with Respiratory Distress Syndrome
Abstract
Introduction: Respiratory distress syndrome (RDS) is not only the most common respiratory disorder in premature infants but also the main cause of neonatal mortality.
Methods: Competing risk framework was used to examine and identify potential prognostic factors of the health status of preterm infants with respiratory distress syndrome. Preterm infants with RDS admitted to the neonatal intensive care units (NICUs) of selected hospitals in Ethiopia were followed for 28 days and only neonates with complete cases were included in the analysis. The Fine-Gray or sub-distribution hazard model was used to identify significant prognostic factors. Three outcome variables (death due to RDS, death due to other causes and discharged alive) were considered.
Results: The Fine-Gray model fit results revealed that anemia, multiple pregnancies, birth-weight and gestational age were the prognostic factors significantly associated with the death of neonates due to Respiratory distress syndrome problem while Pneumonia, meningitis, anemia and gestational age of neonates were the significant prognostic factors for death of neonates due to other causes. Moreover, pneumonia, birth weight and gestational age were identified as the prognostic factors associated with neonates being discharged alive.
Conclusion: Offering intensive and adequate treatments for neonates with lowest birth-weights and gestational age may be useful to reduce neonatal mortality and increase the incidence of being discharged alive.
2. Wang J,LiuX,Zhu T, Yan C (2015). Analysis of neonatal respiratory distress syndrome among different gestational segments. Int J ClinExp Med. 2015 Sep 15;8(9)::16273-9. PMID: 26629144; PMCID: PMC4659032.
3. Niesłuchowska-Hoxha A, Cnota W, Czuba B, Ruci A, Ciaciura-Jarno M, Jagielska A, Wójtowicz D, Kierach R, Dąbrowski K, Sidorowicz M, Skrzypulec-Plinta W, Wloch A, Borowski D, Węgrzyn P (2018). A Retrospective Study on the Risk of Respiratory Distress Syndrome in Singleton Pregnancies with Preterm Premature Rupture of Membranes between 24+0 and 36+6 Weeks, Using Regression Analysis for Various Factors. Biomed Res Int. 2018 Oct 4;2018:7162478. doi: 10.1155/2018/7162478. PMID: 30402491; PMCID: PMC6193337.
4. Lawn JE, Cousens S, Zupan J (2005). Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why? Lancet. 2005 Mar 5-11;365(9462):891-900. doi: 10.1016/S0140-6736(05)71048-5. PMID: 15752534.
5. Muhe, L.M.; McClure, E.M.;Nigussie, A.K., et al. (2019). Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross sectional, observational study. The Lancet Global Health7(8): e1130-e1138.
6. Aluvaala J, Collins GS, Maina B, Mutinda C, Wayiego M, Berkley JA, English M (2019). Competing risk survival analysis of time to in-hospital death or discharge in a large urban neonatal unit in Kenya. Wellcome Open Res. 2019 Jun 17; 4:96. doi: 10.12688/wellcomeopenres.15302.1. PMID: 31289756; PMCID: PMC6611136
7. Gooley TA, Leisenring W, Crowley J, Storer BE. Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Statistics in Medicine 1999; 18:695–706.
8. Pintilie M (2006). Competing Risks: A Practical Perspective. John Wiley & Sons: New York, 2006. pp 24.
9. Austin PC, Lee DS, Fine JP (2016). Introduction to the Analysis of Survival Data in the Presence of Competing Risks. Circulation. 2016 Feb 9;133(6):601-609. doi: 10.1161/CIRCULATIONAHA.115.017719. PMID: 26858290; PMCID: PMC4741409.
10. Porta N,G´omez G, Calle ML, Malats N (2007). Competing Risks Methods.
11. Fine JP, Gray RJ (1999). A Proportional Hazards Model for the Subdistribution of a Competing Risk. Journal of the American Statistical Association. 1999; 94(446), 496-509. doi:10.2307/2670170
12. Mohammad KA, Fatima-Tuz-Zahura M, Bari W (2017). Fine and Gray competing risk regression model to study the cause-specific under-five child mortality in Bangladesh. BMC Int Health Hum Rights 17, 3 (2017). https://doi.org/10.1186/s12914-017-0112-8.
13. Leoce NM (2016). Prognostic Modeling in the Presence of Competing Risks: An Application to Cardiovascular and Cancer Mortality in Breast Cancer Survivors. https://doi.org/10.7916/D89S1R41.
14. Kuk D, Varadhan R (2013). Model selection in competing risks regression. Stat Med. 2013 Aug 15;32(18):3077-88. doi: 10.1002/sim.5762. Epub 2013 Feb 24. PMID: 23436643.
15. Qaril SA, Alsufyani A A, Muathin SH, Margoushy NM (2018). Prevalenceof Respiratory Distress Syndrome in Neonates. The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (2), Page 257-264.
16. Swarnkar K, Swarnkar M (2015).Neonatal respiratory distress in early neonatal period and itsoutcome. International Journal ofBiomedical and Advance Research.2015; 6(9), pp. 643-647. doi: 10.7439/ijbar.v6i9.2430.
17. Baseer KAA, Mohamed M, Abd-Elmawgood EA (2020). Risk Factors of Respiratory Diseases Among Neonates in Neonatal Intensive Care Unit of Qena University Hospital, Egypt. Ann Glob Health. 2020 Feb 26; 86(1):22. doi: 10.5334/aogh.2739. PMID: 32140431; PMCID: PMC7047767.
18. Bahwal SA, Jawass MA, Bahartha AS (2020). Respiratory Distress and Its Outcome among Neonates Admitted to Neonatal Intensive Care Unit of Mukalla Maternity and Child Hospital, Yemen. April 2020; 18 (1),DOI:https://doi.org/10.26505/DJM.18014940915.
19. Saha L, Sarkar PK, Rahman M, Baidya M, Chowdhury MA (2017).Outcome of Preterm Neonates Presented with Respiratory Distress in a Tertiary Care Hospital of Bangladesh.DS (Child) H J . 2017; 33(1): 16-20.
20. Gargari S, Kashanian M, Zendedel H, Nayeri F, Shariat M, Haghollahi F (2018). Survival and Risk Factors of Extremely Preterm Babies (< 28 weeks) in the Three Iranian Hospitals. Acta Med Iran. 56(3):181-188.http://acta.tums.ac.ir/index.php/acta/article/view/6588.
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Issue | Vol 6 No 2 (2020) | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/jbe.v6i2.4878 | |
Keywords | ||
competing risk; Death of neonates; Ethiopia; Fine-gray model; Respiratory distress syndrome |
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