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Diarrheal mortality in US infants. Influence of birth weight on risk factors for death
U D Parashar1, P E Kilgore, R C Holman
1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga., USA.
Insights
Infants with very low birth weight (VLBW) face a significantly higher risk of death from diarrhea compared to normal birth weight infants. Targeted interventions are crucial for preventing these preventable infant deaths.
Area of Science:
- Neonatalogy
- Pediatric Mortality
- Public Health
Background:
- Diarrhea remains a significant cause of infant mortality globally.
- Very low birth weight (VLBW) infants (< 1500 g) represent a vulnerable population with increased susceptibility to infections.
- Understanding risk factors associated with diarrhea-related deaths in different birth weight categories is essential for developing effective prevention strategies.
Purpose of the Study:
- To investigate diarrhea-associated mortality among very low birth weight (VLBW) infants and low- and normal-birth-weight (LNBW) infants (> or = 1500 g).
- To identify specific interventions to reduce diarrhea-related deaths in these infant populations.
Main Methods:
- Retrospective analysis of linked infant and birth death data.
- Data compiled by the National Center for Health Statistics (NCHS) for the year 1991 in the United States.
- Study included infants aged 27 days through 11 months who died from diarrhea.
Main Results:
- A majority (56%) of diarrhea-associated infant deaths in 1991 occurred among VLBW infants.
- VLBW infants exhibited a 100-fold higher diarrheal mortality rate (269/100,000 live births) compared to LNBW infants (2.8/100,000 live births).
- Factors associated with VLBW deaths included prematurity and low Apgar scores; for LNBW infants, risk factors included African American race, lower maternal education, and low Apgar scores.
Conclusions:
- VLBW infants are at substantially increased risk of death from diarrhea, necessitating improved diagnostic and therapeutic approaches.
- Diarrhea deaths in LNBW infants highlight a social issue, emphasizing the need for enhanced maternal education and accessible home-based rehydration therapy for high-risk populations.
Objectives:
To examine diarrhea-associated deaths among very low-birth-weight (VLBW) (< 1500 g) infants and low- and normal-birth-weight (LNBW) (> or = 1500 g) infants at birth and to identify specific interventions to prevent these deaths.
Design:
Retrospective analyses of linked infant and birth death data on diarrhea of all causes compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Ga.
Patients:
Infants aged 27 days through 11 months who died with diarrhea.
Setting:
United States, 1991.
Results:
A majority (56%, n = 143) of the 257 diarrhea-associated deaths reported among US infants in 1991 occurred among VLBW infants. Compared with LNBW infants, VLBW infants had a 100-fold greater diarrheal mortality (269 deaths per 100,000 live births for VLBW infants vs 2.8 deaths per 100,000 live births for LNBW infants), died at a younger age, and more often died in the hospital. Diarrhea-associated deaths among VLBW infants were strongly associated with prematurity and a low 1-minute Apgar score whereas African American race, less maternal education, and a low 1-minute Apgar score were associated with increased diarrheal mortality among LNBW infants.
Conclusions:
Infants of VLBW are at an increased risk for diarrheal deaths and new efforts are required to understand and improve the diagnosis of and therapy for diarrhea among these infants. For LNBW infants, diarrheal deaths remain a social problem and efforts need to focus on improved education and home-based rehydration therapy for children whose mothers fit the high-risk profile and who may lack adequate access to health care.