Risk factors for hospitalization within 24 h postnatally and respiratory support in late preterm and term neonates

Objective‍ To explore the risk factors of hospitalization within 24 h after birth and respiratory support in late preterm and term neonates. Methods A case-control study was conducted on 1 468 neonates with gestational ages ≥34 weeks and <42 completed weeks delivered at the University-Town Hospital of Chongqing Medical University from January 2023 to March 2024. Maternal health parameters and neonatal outcomes were systematically obtained through standardized case report forms during the study period. The neonates were stratified into the hospitalization group and the non-hospitalization group based on neonatal ward admission within 24 h. For those hospitalized with infectious diseases, subgroup analysis was conducted with further categorization into respiratory support and the non-respiratory support subgroups according to ventilatory assistance requirements. The perinatal risk factors were compared between groups and subgroups, and the independent risk factors for hospitalization and the need for respiratory support within 24 h in neonates were identified. The indicators with P<0.1 in the univariate analysis were included in the multivariate logistic regression analysis, and the stepwise regression analysis was used to fit the multivariate logistic regression model. Results There were 213 cases (14.5%) in the hospitalization group and 1 255 cases (85.5%) in the non-hospitalization group. A total of 150 neonates were hospitalized due to infectious diseases, including 48 cases (32.0%) in the respiratory support subgroup and 102 cases (68.0%) in the non-respiratory support subgroup. The multivariate logistic regression analysis showed that non-regular maternal prenatal examination (OR=2.687, 95%CI: 1.175~6.141, P=0.019), intrauterine growth retardation (OR=2.711, 95%CI: 1.106~6.646, P=0.029), premature rupture of membranes (OR=1.667, 95%CI: 1.139~2.438, P=0.008), chorioamnionitis (OR=4.852, 95%CI: 2.114~11.135, P<0.001), infectious diseases in the first week before delivery (OR=1.531, 95%CI: 1.015~2.310, P=0.042), turbidity of amniotic fluid (OR=3.170, 95%CI: 2.099~4.787, P<0.001), abnormal placenta (OR=2.335, 95%CI: 1.202~4.534, P=0.012), complications during pregnancy (OR=2.367, 95%CI: 1.360~4.118, P=0.002), and the use of glucocorticoids before delivery (OR=2.744, 95%CI: 1.219~5.528, P=0.009) were positively correlated with hospitalization within 24 h postnatally in late preterm and term neonates. Gestational age (OR=0.693, 95%CI: 0.602~0.797, P<0.001), 5-minute Apgar score (OR=0.026, 95%CI: 0.003~0.212, P=0.001), umbilical cord blood pH (OR=0.044, 95%CI: 0.002~0.793, P=0.034), and umbilical cord blood BE (OR=0.885, 95%CI: 0.823~0.823, P=0.001) were negatively correlated with it. Premature rupture of membranes (OR=0.207, 95%CI: 0.070~0.618, P=0.005), infectious diseases in the first week before delivery (OR=0.245, 95%CI: 0.070~0.854, P=0.027), 5-minute Apgar score (OR=0.063, 95%CI: 0.008~0.526, P=0.011), and abnormal C-reactive protein of newborns (OR=0.145, 95%CI: 0.046~0.460, P=0.001) were negatively correlated with the need for respiratory support in neonates hospitalized due to infectious diseases.Conclusion‍ ‍Risk factors for neonatal hospitalization within 24 h postnatal late preterm and term are identified as irregular antenatal care, fetal growth restriction and premature rupture of membranes in late preterm and term neonates. premature rupture of membranes, antenatal maternal infections within 1 week prior to delivery and 5-minute Apgar score ≥7 emerge as significant protective factors against respiratory support requirement in neonates hospitalized with infectious diseases.