Risk Factors for Post-NICU Discharge Mortality Among Extremely Low Birth Weight Infants

• Type of Material: Article
• Authors: Lilia C. De Jesus, Wayne State University; Athina Pappas, Wayne State University; Seetha Shankaran, Wayne State University; Douglas Kendrick, RTI International; Abhik Das, RTI International; Rosemary D. Higgins, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Edward F. Bell, University of Iowa; Barbara Stoll, Emory University; Abbot R. Laptook, Brown University; Michele Walsh, Case Western Reserve University
• Language: English
• Date: 2012-07-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Mosby Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpeds.2011.12.038
• Title of Journal or Parent Work: Journal of Pediatrics
• ISSN: 0022-3476
• Volume: 161
• Issue: 1
• Start Page: 70
• End Page: +
• Grant/Funding Information: Supported by grants from the National Institutes of Health and the National Institute of Child Health and Human Development (NICHD) for the Neonatal Research Network’s Generic Database and Follow-up Studies.
• Keywords: SOCIOECONOMIC DISPARITIES; Pediatrics; DEATH; COHORT; Life Sciences & Biomedicine; CHORIOAMNIONITIS; OUTCOMES; LABOR; SEPSIS; NEONATAL INFECTION; Science & Technology; STATES
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General; Health Sciences, Obstetrics and Gynecology

Abstract

Objective: The study goal was to evaluate maternal and neonatal risk factors associated with post-neonatal intensive care unit (NICU) discharge mortality among extremely low birth weight (ELBW) infants. Study design: This is a retrospective analysis of ELBW (<1000 g) and <27 weeks' gestational age infants born in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network sites between January 2000 and June 2007. Infants were tracked until death or 18 to 22 months' corrected age. Infants who died between NICU discharge and the 18- to 22-month follow-up visit were classified as post-NICU discharge mortality (P-NDM). Association of maternal and infant risk factors with P-NDM was determined using logistic regression analysis. A prediction model with 6 significant predictors was developed and validated. Results: There were 5364 infants who survived to NICU discharge; 557 (10%) infants were lost to follow-up, and 107 infants died following NICU discharge. P-NDM rate was 22.3 per 1000 ELBW infants. In the prediction model, African American race, unknown maternal health insurance, and hospital stay ≥120 days significantly increased risk, and maternal exposure to intrapartum antibiotics was associated with decreased risk of P-NDM. Conclusion: We identified African American race, unknown medical insurance, and prolonged NICU stay as risk factors associated with P-NDM among ELBW infants.