Survival until Discharge of Very-Low-Birth-Weight Infants in Two Croatian Perinatal Care Regions: A Retrospective Cohort Study of Time and Cause of Death

Abstract

We investigated mortality, causes, timing and risk factors for death until hospital discharge in very-low-birth-weight (VLBW) infants born in two Croatian perinatal care regions. This retrospective study included 252 live born VLBW infants. The mortality rate until hospital discharge was 30.5% (77/252). VLBW infants who died had by 4 weeks lower gestational age (GA) than surviving infants (median GA, 25 vs. 29 weeks), lower birth weight (BW) (mean BW, 756.4 vs. 1126.4 g), lower 5-minute Apgar score (median 5 vs. 8) and were more often resuscitated at birth (41.6 vs. 19.4%; p<0.001 all). Infants who survived were more often small-for-gestational age (SGA) (28.0 vs. 15.6%; p=0.04) and more often received continuous-positive-airway-pressure (CPAP) in delivery room (13.1 vs. 2.6%; p=0.01). Multivariate logistic regression revealed that parameters influencing death until hospital discharge were 5-minute Apgar score (OR 0.780, 95% CI 0.648-0.939) and higher Clinical Risk Index for Babies (CRIB) score (OR 1.677, 95% CI 1.456-1.931). ROC analysis showed that CRIB score (AUC 0.927, sensitivity 92.2, specificity 81.1; p<0.001) was the strongest predictor of death until hospital discharge. In infants who died within 12 hours, death was most commonly attributed to immaturity and in those surviving >12 hours to necrotizing enterocolitis.

Mortality in very low birth weight (VLBW) infants in the South American NEOCOSUR Neonatal Network: timing and causes

“…In this study, most deaths occurred in the first 12 hours of life. 9 A single center study from Korea described the causes of death in preterm infants born between 23 and 26 weeks of gestational age over 2 periods. 10 In the first period (2001-2005, n = 382), the prevailing causes of death were sepsis, air leak, and bronchopulmonary dysplasia (BPD).…”

“…11 In our study, the main causes of death in the DR were severe congenital malformations and, after admission to the NICU, respiratory diseases and infections, and this is consistent with studies conducted in developing countries. 9,12 The analyses of mortality and its causes in other networks are variable. Such variability depends on the target population and excluded patients.…”

Mortalidad en recién nacidos de muy bajo peso al nacer en la Red Neonatal NEOCOSUR: causalidad y temporalidad

“…En este estudio, la mayoría de las muertes ocurrieron en las primeras 12 horas de vida. 9 En un estudio que evalúa de un centro en Corea, se describen las causas de muerte en dos períodos en prematuros entre 23 y 26 semanas de edad gestacional. 10 En el primer período (2001-2005, n = 382), las causas predominantes fueron la sepsis, escapes aéreos y displasia broncopulmonar (DBP).…”

“…11 En nuestro estudio se describen, como p r i n c i p a l c a u s a d e m u e r t e e n S P , l a s malformaciones congénitas graves y, luego del ingreso a UCIN, las enfermedades respiratorias e infecciosas, lo que concuerda con otros estudios de países en vías de desarrollo. 9,12 Los análisis de mortalidad y sus causas en otras redes son variables. Esta variabilidad depende de la población que se decide analizar y qué pacientes se excluyen.…”

“…Al igual que en otras redes, la prematuridad es causa de mortalidad especialmente en SP y en los primeros días de vida. 8,9 Las causas de origen respiratorio son predominantes durante las primeras semanas de vida y las infecciones, posteriores a la primera o segunda semana, donde también se manifiestan los fallecidos por enterocolitis necrotizante.…”