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

• Type of Material: Article
• Authors: Ravi Patel, Emory University; Sarah Kandefer, RTI International; Michele C. Walsh, Case Western Reserve University; Edward F. Bell, University of Iowa; Waldemar A. Carlo, University of Alabama at Birmingham; Abbot R. Laptook, Women and Infants Hospital; Pablo J. Sánchez, Ohio State University; Seetha Shankaran, Wayne State University; Krisa P. Van Meurs, Stanford University; M. Bethany Ball, Stanford University; Ellen C. Hale, Emory University; Nancy S. Newman, Case Western Reserve University; Abhik Das, RTI International; Rosemary D. Higgins, National Institutes of Health; Barbara Stoll, Emory University
• Language: English
• Date: 2015-01-22
• Publisher: Massachusetts Medical Society
• Publication Version: Final Published Version
• Copyright Statement: © 2015, Massachusetts Medical Society
• Final Published Version (URL): http://dx.doi.org/10.1056/NEJMoa1403489
• Title of Journal or Parent Work: New England Journal of Medicine
• ISSN: 0028-4793
• Volume: 372
• Issue: 4
• Start Page: 331
• End Page: 340
• Grant/Funding Information: National Center for Advancing Translational Sciences, NIH (UL1TR000454 and KL2TR000455, to Dr. Patel).; NIH, for the Neonatal Research Network Generic Database Study (U10 awards HD27904, HD21364, HD68284, HD27853, HD40492, HD27851, HD27856, HD68278, HD36790, HD27880, HD53119, HD34216, HD68270, HD40461, HD53109, HD21397, HD27881, HD53089, HD68244, HD68263, HD40521, HD21415, HD40689, HD21373, HD53124, HD40498, HD21385, and HD27871); Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institutes of Health (NIH)
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery

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.).