doiSerbia

Morbidity and mortality of premature neonates after introduction of national in vitro fertilisation programme: Our experience

Spasojević Slobodan (Institut za zdravstvenu zaštitu dece i omladine Vojvodine, Novi Sad)
Konstantinidis Georgios (Institut za zdravstvenu zaštitu dece i omladine Vojvodine, Novi Sad)
Doronjski Aleksandra (Institut za zdravstvenu zaštitu dece i omladine Vojvodine, Novi Sad)

Introduction. Infertility occurs in approximately10% of couples and in vitro fertilisation (IVF) is its most efficient treatment method. The National IVF Programme started in October 1st, 2006. Objective. Examination of morbidity and mortality of premature neonates conceived by IVF after initiation of the National IVF Programme. Methods. Retrospective analysis of history charts of IVF premature neonates treated at the Neonatal Intensive Care Unit (NICU) of the Institute of Child and Youth Healthcare of Vojvodina, Novi Sad, Serbia, from March 1st, 2007 to March 1st, 2008. Results. Of 189 treated premature neonates, 25 (13.23%) were IVF conceived, with mean gestational age (GA) of 29.46±3.28 gestational weeks (GW), one-minute Apgar score 5.44±2.45, five-minute Apgar score 7.16±1.92 and birth weight (BW) 1299±484.35 g; from singleton 12 (48%), twin 10 (40%), and trigeminal 3 (12%) gestations. The largest number of neonates were of GA between 29 and 31.9 GW (12; 48%) and BW between 1500 and 2499 g (9; 36%). All of them were treated due to respiratory distress syndrome, complicated in 2 (8%) with air leak syndromes and in 4 (16%) with pulmonary haemorrhage. Congenital anomalies were detected in 2 (8%) and intracranial haemorrhage developed subsequently in 21 (84%) neonates. Lethal outcome occurred in 7 (28%) neonates, in all cases in lower gestation groups (<29 GW). Variable analysis showed significantly higher incidence of chorioamnionitis (p=0.0004) and lower GA (p~0.00), BW (p~0.00), one-minute Apgar score (p=0.0007) as well as significant difference in prophylactic surfactant application (p~0.00) and mean arterial pressure on admission (p=0.002). Conclusion. Morbidity and mortality of IVF premature neonates does not differ significantly from that of other premature neonates treated at NICU. Prematurity and low BW are important factors in pathology of these neonates and final outcome is influenced by perinatal asphyxia, risk of systemic infection, prophylactic surfactant application and arterial hypotension.

Keywords: premature neonates, in vitro fertilisation, morbidity, mortality