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. 2017 Feb 21;17(1):59.
doi: 10.1186/s12887-017-0810-3.

Causes of death in very preterm infants cared for in neonatal intensive care units: a population-based retrospective cohort study

Tim Schindler  1   2 , Louise Koller-Smith  3 , Kei Lui  3   4 , Barbara Bajuk  5 , Srinivas Bolisetty  3   4 ; New South Wales and Australian Capital Territory Neonatal Intensive Care Units’ Data Collection
Affiliations

Causes of death in very preterm infants cared for in neonatal intensive care units: a population-based retrospective cohort study

Tim Schindler et al. BMC Pediatr. .

Abstract

Background: While there are good data to describe changing trends in mortality and morbidity rates for preterm populations, there is very little information on the specific causes and pattern of death in terms of age of vulnerability. It is well established that mortality increases with decreasing gestational age but there are limited data on the specific causes that account for this increased mortality. The aim of this study was to establish the common causes of hospital mortality in a regional preterm population admitted to a neonatal intensive care unit (NICU).

Methods: Retrospective analysis of prospectively collected data of the Neonatal Intensive Care Units' (NICUS) Data Collection of all 10 NICUs in the region. Infants <32 weeks gestation without major congenital anomalies admitted from 2007 to 2011 were included. Three authors reviewed all cases to agree upon the immediate cause of death.

Results: There were 345 (7.7%) deaths out of 4454 infants. The most common cause of death across all gestational groups was major IVH (cause-specific mortality rate [CMR] 22 per 1000 infants), followed by acute respiratory illnesses [ARI] (CMR 21 per 1000 infants) and sepsis (CMR 12 per 1000 infants). The most common cause of death was different in each gestational group (22-25 weeks [ARI], 26-28 weeks [IVH] and 29-31 weeks [perinatal asphyxia]). Pregnancy induced hypertension, antenatal steroids and chorioamnionitis were all associated with changes in CMRs. Deaths due to ARI or major IVH were more likely to occur at an earlier age (median [quartiles] 1.4 [0.3-4.4] and 3.6 [1.9-6.6] days respectively) in comparison to NEC and miscellaneous causes (25.2 [15.4-37.3] and 25.8 [3.2-68.9] days respectively).

Conclusions: Major IVH and ARI were the most common causes of hospital mortality in this extreme to very preterm population. Perinatal factors have a significant impact on cause-specific mortality. The varying timing of death provides insight into the prolonged vulnerability for diseases such as necrotising enterocolitis in our preterm population.

Keywords: Cause of death; Infant; Mortality; Preterm.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier plot illustrating the cause specific mortality according to the age of death
Fig. 2
Fig. 2
Comparison of resource utilisation from birth in relation to cause of death category: Top – length of level 3 stay (days); Middle – hours of respiratory support; Bottom – hours of parenteral nutrition. Median (bar), quartiles (box) and 95% CI (error bars) are shown
See this image and copyright information in PMC

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