Causes and timing of death in extremely premature infants from 2000 through 2011

Ravi M Patel; Sarah Kandefer; Michele C Walsh; Edward F Bell; Waldemar A Carlo; Abbot R Laptook; Pablo J Sánchez; Seetha Shankaran; Krisa P Van Meurs; M Bethany Ball; Ellen C Hale; Nancy S Newman; Abhik Das; Rosemary D Higgins; Barbara J Stoll; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

doi:10.1056/NEJMoa1403489

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Causes and timing of death in extremely premature infants from 2000 through 2011

Journal article

Open access

Peer reviewed

Causes and timing of death in extremely premature infants from 2000 through 2011

Ravi M Patel, Sarah Kandefer, Michele C Walsh, Edward F Bell, Waldemar A Carlo, Abbot R Laptook, Pablo J Sánchez, Seetha Shankaran, Krisa P Van Meurs, M Bethany Ball, …

The New England journal of medicine, Vol.372(4), pp.331-340

01/22/2015

DOI: 10.1056/NEJMoa1403489

PMCID: PMC4349362

PMID: 25607427

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Abstract

Understanding the causes and timing of death in extremely premature infants may guide research efforts and inform the counseling of families. 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. 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. 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.).

Cause of Death

Congenital Abnormalities - mortality

Enterocolitis, Necrotizing - mortality

Gestational Age

Humans

Infant

Infant Mortality - trends

Infant, Extremely Premature

Infant, Newborn

Infant, Premature, Diseases - mortality

Infant, Very Low Birth Weight

Risk Factors

United States - epidemiology

Details

Title: Subtitle: Causes and timing of death in extremely premature infants from 2000 through 2011
Creators: Ravi M Patel - From the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P., E.C.H., B.J.S.); the Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, NC (S.K.); the Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland (M.C.W., N.S.N.), and Department of Pediatrics, Nationwide Children's Hospital-Ohio State University, Columbus (P.J.S.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B.); the Division of Neonatology, University of Alabama at Birmingham, Birmingham (W.A.C.); the Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI (A.R.L.); the Department of Pediatrics, Wayne State University School of Medicine, Detroit (S.S.); the Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (K.P.V.M., M.B.B.); and the Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville (A.D.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda (R.D.H.) - both in Maryland
Sarah Kandefer
Michele C Walsh
Edward F Bell - University of Iowa, Stead Family Department of Pediatrics
Waldemar A Carlo
Abbot R Laptook
Pablo J Sánchez
Seetha Shankaran
Krisa P Van Meurs
M Bethany Ball
Ellen C Hale
Nancy S Newman
Abhik Das
Rosemary D Higgins
Barbara J Stoll
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Resource Type: Journal article
Publication Details: The New England journal of medicine, Vol.372(4), pp.331-340
DOI: 10.1056/NEJMoa1403489
PMID: 25607427
PMCID: PMC4349362
ISSN: 0028-4793
eISSN: 1533-4406
Grant note: UG1 HD053089 / NICHD NIH HHS U10 HD27856 / NICHD NIH HHS UG1 HD040492 / NICHD NIH HHS UG1 HD027904 / NICHD NIH HHS U10 HD68284 / NICHD NIH HHS UG1 HD068284 / NICHD NIH HHS U10 HD53089 / NICHD NIH HHS U10 HD027871 / NICHD NIH HHS U10 HD27880 / NICHD NIH HHS U10 HD68270 / NICHD NIH HHS UG1 HD027880 / NICHD NIH HHS U10 HD040498 / NICHD NIH HHS U10 HD27904 / NICHD NIH HHS U10 HD021373 / NICHD NIH HHS U10 HD040492 / NICHD NIH HHS U10 HD040521 / NICHD NIH HHS U10 HD27853 / NICHD NIH HHS U10 HD053089 / NICHD NIH HHS U10 HD040689 / NICHD NIH HHS U10 HD36790 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS KL2TR000455 / NCATS NIH HHS U10 HD40498 / NICHD NIH HHS UL1 TR000454 / NCATS NIH HHS U10 HD068284 / NICHD NIH HHS U10 HD68263 / NICHD NIH HHS UG1 HD040689 / NICHD NIH HHS U10 HD40492 / NICHD NIH HHS U10 HD021385 / NICHD NIH HHS UG1 HD034216 / NICHD NIH HHS U10 HD040461 / NICHD NIH HHS UG1 HD027856 / NICHD NIH HHS UG1 HD021364 / NICHD NIH HHS U10 HD53119 / NICHD NIH HHS UG1 HD027853 / NICHD NIH HHS UL1TR000454 / NCATS NIH HHS UG1 HD068278 / NICHD NIH HHS UG1 HD068244 / NICHD NIH HHS U10 HD053124 / NICHD NIH HHS UG1 HD027851 / NICHD NIH HHS U10 HD34216 / NICHD NIH HHS U10 HD27851 / NICHD NIH HHS U10 HD68244 / NICHD NIH HHS U10 HD053119 / NICHD NIH HHS U10 HD53109 / NICHD NIH HHS U10 HD21397 / NICHD NIH HHS UG1 HD053109 / NICHD NIH HHS KL2 TR000455 / NCATS NIH HHS U10 HD021397 / NICHD NIH HHS U10 HD068244 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS U10 HD21415 / NICHD NIH HHS U10 HD68278 / NICHD NIH HHS U10 HD068270 / NICHD NIH HHS U10 HD21364 / NICHD NIH HHS UG1 HD068263 / NICHD NIH HHS UG1 HD021385 / NICHD NIH HHS U10 HD053109 / NICHD NIH HHS U10 HD027856 / NICHD NIH HHS U10 HD27871 / NICHD NIH HHS U10 HD027880 / NICHD NIH HHS U10 HD027853 / NICHD NIH HHS U10 HD40689 / NICHD NIH HHS U10 HD021364 / NICHD NIH HHS U10 HD068278 / NICHD NIH HHS U10 HD027851 / NICHD NIH HHS U10 HD40461 / NICHD NIH HHS U10 HD21385 / NICHD NIH HHS UG1 HD068270 / NICHD NIH HHS UG1 HD087229 / NICHD NIH HHS U10 HD034216 / NICHD NIH HHS U10 HD40521 / NICHD NIH HHS U01 HD036790 / NICHD NIH HHS U10 HD21373 / NICHD NIH HHS U10 HD27881 / NICHD NIH HHS U10 HD068263 / NICHD NIH HHS U10 HD53124 / NICHD NIH HHS
Language: English
Date published: 01/22/2015
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984093454402771

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