Causes and Timing of Death in Extremely Premature Infants from 2000 through 2011

Abstract

BACKGROUND Understanding the causes and timing of death in extremely premature infants may guide research efforts and inform the counseling of families. METHODS We analyzed prospectively collected data on 6075 deaths among 22,248 live births, with gestational ages of 22 0/7 to 28 6/7 weeks, among infants born in study hospitals within the National Institute of Child Health and Human Development Neonatal Research Network. We compared overall and cause-specific in-hospital mortality across three periods from 2000 through 2011, with adjustment for baseline differences. RESULTS The number of deaths per 1000 live births was 275 (95% confidence interval [CI], 264 to 285) from 2000 through 2003 and 285 (95% CI, 275 to 295) from 2004 through 2007; the number decreased to 258 (95% CI, 248 to 268) in the 2008–2011 period (P = 0.003 for the comparison across three periods). There were fewer pulmonary-related deaths attributed to the respiratory distress syndrome and bronchopulmonary dysplasia in 2008–2011 than in 2000–2003 and 2004–2007 (68 [95% CI, 63 to 74] vs. 83 [95% CI, 77 to 90] and 84 [95% CI, 78 to 90] per 1000 live births, respectively; P = 0.002). Similarly, in 2008–2011, as compared with 2000–2003, there were decreases in deaths attributed to immaturity (P = 0.05) and deaths complicated by infection (P = 0.04) or central nervous system injury (P<0.001); however, there were increases in deaths attributed to necrotizing enterocolitis (30 [95% CI, 27 to 34] vs. 23 [95% CI, 20 to 27], P = 0.03). Overall, 40.4% of deaths occurred within 12 hours after birth, and 17.3% occurred after 28 days. CONCLUSIONS We found that from 2000 through 2011, overall mortality declined among extremely premature infants. Deaths related to pulmonary causes, immaturity, infection, and central nervous system injury decreased, while necrotizing enterocolitis–related deaths increased. (Funded by the National Institutes of Health.)

Outcomes of Nosocomial Viral Respiratory Infections in High-Risk Neonates

“…In the UK, 68% of extremely preterm survivors born in 2006 had BPD, unchanged from 1995 rates 5 . Current US estimates suggest there are between 5000 and 10000 new cases of BPD annually 2 , with respiratory causes of death are second only to immaturity in extremely preterm infants 6 .…”

Necrotizing Enterocolitis (NEC): A Devastating Disease of Prematurity

“…In the long term, survivors of NEC are at an increased risk of neurodevelopmental delays [4,5]. Due to technological advances in the recent years, the mortality in preterm infants due to pulmonary causes, infection and central nervous system injury have been on the decline but NEC related deaths have steadily increased [6]. Over the past three decades, the NEC related mortality (up to 40%) has not improved significantly despite advances in neonatal care and better understanding of clinical and basic sciences [4].…”

Estudio descriptivo de la mortalidad neonatal en un Hospital Institucional

“…Adscripción al Hospital General de zona numero 71, Instituto Mexicano del Seguro Social. 5 Coordinador Delegacional de Investigación Clínica. Instituto Mexicano del Seguro Social.…”

“…4 Otro estudio realizado en Hospitales del Instituto Nacional de Desarrollo Humano de EUA, en el período 2000 al 2011, presentó 6,075 muertes de 22,248 nacidos vivos, con edad gestacional de entre 22 a 28 semanas, concluyendo que la causa más frecuente de mortalidad fue la inmadurez dentro de las primeras 12 horas después de éstas, la asfixia neonatal y como tercera causa la enterocolitis necrotizante. 5 En México, según un informe de casos de recién nacidos por parto fortuito que se hospitalizaron en un hospital público de segundo nivel, del 2001 al 2010, la morbilidad y la mortalidad fueron mayores a las de los nacidos en el hospital, sobre todo en casos de parto prematuro.…”