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[Changes in causes of mortality in very low birth weight neonates]
Z Stranák1, P Velebil, Z Stembera
1Ustav pro péci o matku a dítĕ, Praha.
Insights
Mortality in extremely low birth weight (ELBW) infants was 23.0%, with sepsis as the leading cause. For very low birth weight (VLBW) infants, mortality was 1.2%, with sepsis and severe periventricular-intraventricular hemorrhage as main causes.
Area of Science:
- Neonatalogy
- Epidemiology
- Perinatal Medicine
Context:
- Infant mortality remains a critical concern, particularly for premature infants.
- Understanding mortality trends in very low birth weight (VLBW) infants is crucial for improving neonatal care.
- This study examines mortality patterns in VLBW infants born between 1996 and 2001.
Purpose:
- To investigate the overall mortality rate in VLBW infants.
- To analyze changes in cause-specific mortality among VLBW infants.
- To identify leading causes of death in extremely low birth weight (ELBW) and VLBW subgroups.
Summary:
- A retrospective study of 514 VLBW infants (ELBW: <999g, VLBW: 1000-1499g) was conducted.
- Total mortality was 9.5% (23.0% in ELBW, 1.2% in VLBW).
- Sepsis was the primary cause of death in ELBW infants, while severe periventricular-intraventricular hemorrhage (PVH-IVH) and sepsis were noted in the VLBW group.
Impact:
- Findings highlight sepsis as a major mortality factor in ELBW infants.
- The study suggests a potential decline in mortality from respiratory distress syndrome due to advancements in neonatal care.
- Results underscore the need for targeted interventions to reduce mortality in VLBW and ELBW populations.
Objective:
Investigate the total mortality and changes in cause-specific mortality among very low birth weight (VLBW) infants.
Design:
Retrospective epidemiological study.
Setting:
Institute for the Care of Mother and Child, Prague, Czech Republic.
Methods:
Five hundred and fourteen inborn patients (1/1996-12/2001) were retrospectively analysed from our database. We divided our study group into two sub-groups according to their birth weight: under 999 grams (extremely low birth weight group, ELBW, n = 193) and 1000-1499 grams (very low birth weight group, VLBW, n = 321). For statistical analysis the Epi Info 6 (CDC, U.S.) software package was used.
Results:
Total mortality was 9.5% (23.0% in ELBW group, 1.2% in VLBW group). The main causes of death in ELBW group were (in order to magnitude): sepsis (49%, early to late onset sepsis ratio 1:4), severe periventricular-intraventricular haemorrhage grade III and IV (PVH-IVH, 20%), respiratory distress syndrome (13%) and other causes (bronchopulmonary dysplasia, renal failure, non-oliguric hyperkalemia: 18%). While in the VLBW group there were three cases of death due to sepsis and one due to PVH-IVH (1.2%).
Conclusions:
According to frequency analysis, sepsis is the leading cause of death among ELBW and severe PVH-IVH and other causes follow. While looking for strength of association in two most often causes (sepsis, PVH-IVH) we found highest risk of death among ELBW newborns with PVH-IVH, but not statistically significant (OR 2.63; 95% CI 0.68, 9.83). Respiratory distress syndrome, formerly reported leading cause of infant death, seems to move to lower order, probably due to introduction of new therapeutic tools into clinical perinatal practice (corticosteroids, surfactant, new modes of artificial ventilation).