Changing trends of neonatal and postneonatal deaths in very-low-birth-weight infants

Area of Science:

• Neonatalogy
• Perinatal Care
• Epidemiology

Background:

• Advances in perinatal care have reduced mortality for very-low-birth-weight infants (< 1.5 kilograms).
• There has been an observed extension of the mortality period for these vulnerable infants.
• The relevance of neonatal mortality as an outcome indicator requires re-evaluation.

Purpose of the Study:

• To determine the current relevance of neonatal mortality as an indicator of outcome for very-low-birth-weight infants.
• To analyze the timing and causes of death in very-low-birth-weight infants admitted between 1975-1977.

Main Methods:

• Retrospective documentation of all deaths among 427 very-low-birth-weight infants admitted during 1975-1977.
• Categorization of deaths into early neonatal (0-6 days), late neonatal (7-27 days), and postneonatal periods.

Main Results:

• A total of 145 infants died.
• 62% of deaths occurred in the early neonatal period, 24% in the late neonatal period, and 14% post-neonatally.
• 17 of 20 postneonatal deaths were due to neonatal complications of prematurity, with 16 occurring during initial hospitalization.

Conclusions:

• A significant proportion of deaths among very-low-birth-weight infants now occur in the postneonatal period.
• These postneonatal deaths are frequently linked to neonatal complications of prematurity.
• The shift in mortality timing has epidemiologic implications and necessitates reconsidering reporting mechanisms for very-low-birth-weight infant outcomes.