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Risk factors and estimation tool for death among extremely premature infants: a national study
David Bader1, Amir Kugelman, Valentina Boyko
1Bnai Zion Medical Center, Department of Neonatology, 47 Golomb St, Haifa, 31048, Israel. davidbade@gmail.com
Insights
Mortality rates for extremely premature infants (23-26 weeks gestation) have decreased. Simple estimates can now be made using gestational age, birth weight, steroid therapy, and multiple births.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Critical Care
Background:
- Infant mortality remains a significant concern, particularly for extremely premature infants.
- Understanding risk factors and trends in mortality for this vulnerable population is crucial for improving outcomes.
Purpose of the Study:
- To assess changes in risk factors and mortality rates for infants born between 23 and 26 weeks of gestation over time.
- To develop a simplified tool for estimating mortality rates in specific subgroups of these infants.
Main Methods:
- Analysis of data from the Israel national very low birth weight infant database (1995-2006).
- Inclusion of 3768 infants with gestational ages ranging from 23 to 26 weeks.
- Development of a predictive model based on key risk factors.
Main Results:
- Significant decrease in mortality rates observed across all gestational ages during the study period.
- Key predictors of mortality identified: gestational age, gender-specific birth weight percentile, prenatal steroid therapy, and multiple births.
- A validated tool was developed, estimating mortality rates for 48 subgroups with high correlation to observed rates.
Conclusions:
- Mortality rates for extremely premature infants (23-26 weeks gestation) can be effectively estimated.
- The estimation model relies on readily available parameters: gestational age, birth weight quartiles, prenatal corticosteroid use, and plurality.
- This tool can aid in risk stratification and clinical decision-making for high-risk neonates.
Objectives:
The goals were to assess risk factors and mortality rate changes over time and to develop simple estimates of mortality rates for specific groups of infants at 23 to 26 weeks of gestation.
Methods:
Data from the Israel national very low birth weight infant database on 3768 infants born in 1995-2006 with gestational ages (GAs) of 23 to 26 weeks were evaluated, and we developed a tool for estimating infants' mortality rates.
Results:
Major factors associated with death were GA, gender-specific birth weight percentile, prenatal steroid therapy, and multiple births. There was a steady decrease in mortality rates for all GAs during the study period. In 2004-2006, mortality rates before discharge were 89%, 67%, 46%, and 26% for infants with GAs of 23, 24, 25, and 26 weeks, respectively. Estimated mortality rates were calculated as the sum of the percentages determined for each of 4 parameters, as follows: GA of 26, 25, 24, or 23 weeks, 0%, 17%, 34%, and 51%, respectively (P < .001); birth weight percentile of >75th, 25th to 75th, or <25th, 0%, 16%, and 32%, respectively (P < .001); no prenatal steroid treatment, +22% (P < .001); multiple birth, +7% (P = .1). Estimated mortality rates for the 48 subgroups of infants ranged from 0% to 100% and correlated well with observed rates (intraclass correlation coefficient: 0.89).
Conclusion:
Mortality rates for infants born at 23 to 26 weeks of gestation could be estimated simply on the basis of GA, gender-specific birth weight quartiles, prenatal corticosteroid therapy, and multiple births.
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