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Published on: December 31, 2015
First-Year Mortality in Infants Born Moderately Preterm and Late Preterm: A National Register Study
Kati Kallio1,2, Riitta Ojala3,4, Tiina Luukkaala5,6
1Doctoral Program in Medicine, Tampere University, Tampere, Finland.
Insights
Infants born moderately preterm (MP) and late preterm (LP) face higher early mortality risks than term infants. Targeted interventions can reduce preventable deaths and improve survival rates for these vulnerable newborns.
Area of Science:
- Neonatalogy
- Perinatal Epidemiology
- Public Health
Background:
- Preterm birth is a significant global health concern.
- Infants born moderately preterm (MP; 32-33 weeks) and late preterm (LP; 34-36 weeks) represent a substantial proportion of premature births.
- Understanding their mortality risks compared to very preterm and term infants is crucial for targeted interventions.
Purpose of the Study:
- To investigate first-year mortality, predictors, and causes of death in MP and LP infants.
- To compare mortality rates in MP and LP infants with very preterm and term infants.
- To analyze mortality rates by region, hospital level, and time.
Main Methods:
- Utilized national register data for 1,546,787 infants born in Finland (1991-2016).
- Focused analysis on preterm infants (5.9% of total births), specifically MP and LP groups.
- Examined early, late, and postneonatal mortality, as well as first-year survival.
Main Results:
- Mortality decreased with advancing gestational age, but MP and LP infants had higher early neonatal mortality than term infants.
- Early neonatal mortality declined over time only in MP and LP groups; first-year mortality also declined.
- Predictors of death included small for gestational age, low Apgar score, and ventilator treatment. Congenital anomalies were the leading cause of death.
Conclusions:
- MP and LP infants exhibit an elevated risk of early neonatal mortality compared to term infants.
- Preventable causes like asphyxia and respiratory distress require targeted interventions.
- Counseling interventions may reduce sudden infant death syndrome and improve late and postneonatal survival.
Objective:
To investigate first-year mortality and predictors and causes of death in infants born moderately preterm (MP; birth at 320/7-336/7 weeks of gestation) and late preterm (LP; 340/7-366/7) compared with infants born very preterm (<320/7) and term (≥370/7-416 /7) and to establish mortality rates by region, hospital level, and time.
Study Design:
Data on all infants (n = 1 546 787) born in Finland between 1991 and 2016 were collected from national registers. Of those born prematurely (5.9%), infants born MP and LP accounted for 85,9%.
Results:
Early, late, and postneonatal mortality decreased with advancing gestational age. Despite overall declines, early neonatal mortality remained significantly greater in infants born MP and LP than in infants born at term. Over time, early neonatal mortality decreased only in MP and LP groups, whereas first-year mortality declined in infants born MP and LP. Predictors of death in all mortality categories in infants born MP and LP included small for gestational age, low Apgar score, and ventilator treatment. Some regional and hospital-level differences in early neonatal mortality were observed. Causes of death in infants born MP and LP resembled those of term more than infants born very preterm, with congenital anomalies being the most common, albeit not easily preventable causes of death.
Conclusions:
Infants born MP and LP had an elevated risk of early neonatal mortality compared with infants born at term. Continued reductions may be achieved by targeting preventable causes such as asphyxia and respiratory distress, while counseling-based interventions may help prevent sudden infant death syndrome and reduce late neonatal and postneonatal mortality.
