Survival Predictors and Morbidity Risk Factors in Extremely Preterm Infants: A Clinical Cohort Study

Aim: Extremely preterm infants (born before 28 weeks of gestation) face substantial risks of mortality and severe morbidity. This study aimed to identify early clinical predictors of survival and major complications in this vulnerable population in order to guide individualized neonatal care strategies. Materials and Methods: A retrospective cohort analysis was conducted on 102 infants born between 22+0 and 27+6 weeks of gestation and admitted to a tertiary neonatal intensive care unit from 2017 to 2020. Demographic, perinatal, and clinical variables were extracted from their medical records. Survival and morbidity outcomes were compared across gestational subgroups. Statistical analyses included chi-square, t-tests, and receiver operating characteristic (ROC) curve analysis. Results: The overall survival rate was significantly influenced by gestational age, birth weight, and the type of respiratory support received. Infants born at 22-25 weeks exhibited lower survival rates and higher incidences of respiratory distress syndrome, invasive ventilation, and patent ductus arteriosus (PDA). Mortality was independently associated with lower birth weight (p<0.0001), invasive ventilation (p=0.0014), and the presence of hemodynamically significant PDA (p=0.0243). In contrast, longer durations of non-invasive ventilation correlated with improved survival (p<0.0001). ROC analysis demonstrated high predictive performance for birth weight [area under the curve (AUC)=0.82] and non-invasive ventilation duration (AUC=0.96). Conclusion: Early postnatal respiratory parameters, birth weight, and cardiovascular status are critical determinants of survival in extremely preterm infants. Optimizing non-invasive ventilation strategies and timely PDA management may enhance outcomes. Notably, the rate of antenatal corticosteroid administration was markedly low in our cohort, which may have contributed to adverse respiratory and survival outcomes, underscoring the need for improved perinatal care strategies in extremely preterm births.