Preterm infants born with extremely low birth weights have an increased risk of death during the first year of life. Although researchers have extensively studied risk factors that could contribute to the death of preterm infants, limited information is available after infants are released from the neonatal intensive care unit (NICU). A new study scheduled for publication in The Journal of Pediatrics, identifies that African-American background, longer stay in the NICU, and poorer access to healthcare can increase the risk of death after being discharged from the NICU.
Lilia C. De Jesus, MD, from Wayne State University, and colleagues retrospectively examined 5364 preterm (<27 weeks' gestational age) infants with extremely low birth weights (<1000 g), born in 2000 through 2007 at Eunice Kennedy Shriver Neonatal Research Network sites. These infants were tracked from discharge from the NICU until 18-22 months corrected age.
Of the 4807 infants with whom the authors successfully followed-up, 107 infants died after discharge from the NICU (22.3 per 1000 extremely low birth weight infants). The odds of death after NICU discharge were doubled in African-American infants (compared with other racial groups), 3 times higher in infants who were in the NICU for ≥120 days, and 15 times higher if the maternal insurance status was unknown (compared with private insurance), which may indicate poorer access to healthcare. It is also noteworthy that maternal exposure to antibiotics during pregnancy decreased the risk of infant death.
The World Factbook ranks the United States' infant mortality as 48th worldwide (6.06 deaths per 1000 live births), which is higher than other developed countries. According to Dr. De Jesus, "Every effort should be made to identify and correct modifiable factors that may account for the increased risk of death after hospital discharge in these extremely premature infants." Dr. De Jesus continues, "We feel that information from our study can be used to develop interventions that may help health practitioners with the discharge and follow-up care of these high risk infants."
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The study, reported in "Risk Factors for Post-NICU Discharge Mortality Among Extremely Low Birth Weight Infants" by Lilia C. De Jesus, MD, Athina Pappas, MD, Seetha Shankaran, MD, Douglas Kendrick, MStat, Abhik Das, PhD, Rosemary D. Higgins, MD, Edward F. Bell, MD, Barbara J. Stoll, MD, Abbot R. Laptook, MD, Michele C. Walsh, MD, MS, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, appears in The Journal of Pediatrics, DOI:10.1016/j.jpeds.2011.12.038