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Predictors of hospital postdischarge infant mortality: implications for high-risk infant follow-up efforts
T C Hulsey1, M B Hudson, W B Pittard
1Department of Pediatrics, Medical University of South Carolina, Charleston 29425.
Insights
Infant mortality after discharge is linked to low birth weight, prematurity, and NICU stays. These factors, along with specific health conditions, significantly increase mortality risk in newborns.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Background:
- Postdischarge mortality remains a critical concern in neonatal care.
- Identifying risk factors is crucial for improving infant survival rates after hospital discharge.
Purpose of the Study:
- To determine the association between maternal/infant characteristics and postdischarge mortality.
- To identify high-risk infant groups and specific conditions contributing to postdischarge deaths.
Main Methods:
- Retrospective analysis of 19,573 infants discharged from a single regional perinatal center.
- Statistical assessment of maternal and infant factors associated with mortality postdischarge.
- Categorization of mortality risk based on birth weight, gestational age, NICU graduation, and specific medical conditions.
Main Results:
- Postdischarge mortality was not associated with infant sex, ethnicity, maternal education, marital status, delivery method, or income.
- Mortality risk was significantly increased for infants who were neonatal intensive care unit (NICU) graduates, low birth weight, preterm, or small for gestational age.
- Low birth weight, NICU graduates, and preterm infants constituted 38% of discharges but 64% of postdischarge deaths, with low birth weight infants having the highest mortality odds.
Conclusions:
- Infants with low birth weight, prematurity, or NICU graduation are at substantially higher risk for postdischarge mortality.
- Specific complications like pulmonary interstitial emphysema, patent ductus arteriosus, bronchopulmonary dysplasia, hyaline membrane disease, apnea, or intraventricular hemorrhage further elevate mortality risk within these high-risk groups.
- A significant proportion of postdischarge deaths occurred in infants with identified high-risk characteristics, highlighting the need for targeted interventions.
Abstract:
The association between maternal/infant characteristics and postdischarge mortality was determined for 19,573 infants from a single regional perinatal center. Postdischarge mortality was not associated with infant sex or ethnicity, mother's marital status, education, method of delivery, or income status. Mortality risk was statistically increased for infants who were neonatal intensive care unit graduates, of low birth weight, preterm, or small for gestational age. Infants who were either of low birth weight, neonatal intensive care unit graduates, or preterm represented 38% of hospital discharges and 64% of postdischarge deaths. Mortality odds for low-birth-weight infants exceeded that of neonatal intensive care unit graduates or preterm infants. Within these high-risk groups, mortality was further increased for infants with pulmonary interstitial emphysema, patent ductus arteriosus, bronchopulmonary dysplasia, hyaline membrane disease, apnea, or intraventricular hemorrhage III/IV. There were no postdischarge deaths among infants with meconium aspiration, persistent fetal circulation, or necrotizing enterocolitis. Partitioning infant mortality attributable to a single tertiary center suggested that 73.5% of the deaths occurred in infants who were continuously hospitalized from birth; 1.7% of the deaths occurred after discharge in infants who had lethal anomalies and were not expected to survive; 9.0% of the deaths occurred after discharge in infants without a selected risk factor; and 15.8% of the deaths occurred after discharge in infants with at least one high-risk characteristic.