Causes and timing of death in extremely premature infants from 2000 through 2011

Ravi M. Patel, Sarah Kandefer, Michele C. Walsh, Edward F. Bell, Waldemar A. Carlo, Abbot R. Laptook, Pablo J. Sánchez, Seetha Shankaran, Krisa P. Van Meurs, M. Bethany Ball, Ellen C. Hale, Nancy S. Newman, Abhik Das, Rosemary D. Higgins, Barbara J. Stoll

Research output: Contribution to journalArticle

232 Citations (Scopus)

Abstract

BACKGROUND: Understanding the causes and timing of death in extremely premature infants may guide research efforts and inform the counseling of families.

METHODS: We analyzed prospectively collected data on 6075 deaths among 22,248 live births, with gestational ages of 22 0/7 to 28 6/7 weeks, among infants born in study hospitals within the National Institute of Child Health and Human Development Neonatal Research Network. We compared overall and cause-specific in-hospital mortality across three periods from 2000 through 2011, with adjustment for baseline differences.

RESULTS: The number of deaths per 1000 live births was 275 (95% confidence interval [CI], 264 to 285) from 2000 through 2003 and 285 (95% CI, 275 to 295) from 2004 through 2007; the number decreased to 258 (95% CI, 248 to 268) in the 2008-2011 period (P=0.003 for the comparison across three periods). There were fewer pulmonary-related deaths attributed to the respiratory distress syndrome and bronchopulmonary dysplasia in 2008-2011 than in 2000-2003 and 2004-2007 (68 [95% CI, 63 to 74] vs. 83 [95% CI, 77 to 90] and 84 [95% CI, 78 to 90] per 1000 live births, respectively; P=0.002). Similarly, in 2008-2011, as compared with 2000-2003, there were decreases in deaths attributed to immaturity (P=0.05) and deaths complicated by infection (P=0.04) or central nervous system injury (P<0.001); however, there were increases in deaths attributed to necrotizing enterocolitis (30 [95% CI, 27 to 34] vs. 23 [95% CI, 20 to 27], P=0.03). Overall, 40.4% of deaths occurred within 12 hours after birth, and 17.3% occurred after 28 days.

CONCLUSIONS: We found that from 2000 through 2011, overall mortality declined among extremely premature infants. Deaths related to pulmonary causes, immaturity, infection, and central nervous system injury decreased, while necrotizing enterocolitis-related deaths increased. (Funded by the National Institutes of Health.).

Original languageEnglish (US)
Pages (from-to)331-340
Number of pages10
JournalThe New England journal of medicine
Volume372
Issue number4
DOIs
StatePublished - Jan 22 2015

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Extremely Premature Infants
Cause of Death
Confidence Intervals
Live Birth
Nervous System Trauma
Necrotizing Enterocolitis
National Institute of Child Health and Human Development (U.S.)
Bronchopulmonary Dysplasia
Lung
National Institutes of Health (U.S.)
Hospital Mortality
Infection
Research
Gestational Age
Counseling
Central Nervous System
Parturition

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Patel, R. M., Kandefer, S., Walsh, M. C., Bell, E. F., Carlo, W. A., Laptook, A. R., ... Stoll, B. J. (2015). Causes and timing of death in extremely premature infants from 2000 through 2011. The New England journal of medicine, 372(4), 331-340. https://doi.org/10.1056/NEJMoa1403489

Causes and timing of death in extremely premature infants from 2000 through 2011. / Patel, Ravi M.; Kandefer, Sarah; Walsh, Michele C.; Bell, Edward F.; Carlo, Waldemar A.; Laptook, Abbot R.; Sánchez, Pablo J.; Shankaran, Seetha; Van Meurs, Krisa P.; Ball, M. Bethany; Hale, Ellen C.; Newman, Nancy S.; Das, Abhik; Higgins, Rosemary D.; Stoll, Barbara J.

In: The New England journal of medicine, Vol. 372, No. 4, 22.01.2015, p. 331-340.

Research output: Contribution to journalArticle

Patel, RM, Kandefer, S, Walsh, MC, Bell, EF, Carlo, WA, Laptook, AR, Sánchez, PJ, Shankaran, S, Van Meurs, KP, Ball, MB, Hale, EC, Newman, NS, Das, A, Higgins, RD & Stoll, BJ 2015, 'Causes and timing of death in extremely premature infants from 2000 through 2011', The New England journal of medicine, vol. 372, no. 4, pp. 331-340. https://doi.org/10.1056/NEJMoa1403489
Patel, Ravi M. ; Kandefer, Sarah ; Walsh, Michele C. ; Bell, Edward F. ; Carlo, Waldemar A. ; Laptook, Abbot R. ; Sánchez, Pablo J. ; Shankaran, Seetha ; Van Meurs, Krisa P. ; Ball, M. Bethany ; Hale, Ellen C. ; Newman, Nancy S. ; Das, Abhik ; Higgins, Rosemary D. ; Stoll, Barbara J. / Causes and timing of death in extremely premature infants from 2000 through 2011. In: The New England journal of medicine. 2015 ; Vol. 372, No. 4. pp. 331-340.
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AU - Patel, Ravi M.

AU - Kandefer, Sarah

AU - Walsh, Michele C.

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AU - Carlo, Waldemar A.

AU - Laptook, Abbot R.

AU - Sánchez, Pablo J.

AU - Shankaran, Seetha

AU - Van Meurs, Krisa P.

AU - Ball, M. Bethany

AU - Hale, Ellen C.

AU - Newman, Nancy S.

AU - Das, Abhik

AU - Higgins, Rosemary D.

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N2 - BACKGROUND: Understanding the causes and timing of death in extremely premature infants may guide research efforts and inform the counseling of families.METHODS: We analyzed prospectively collected data on 6075 deaths among 22,248 live births, with gestational ages of 22 0/7 to 28 6/7 weeks, among infants born in study hospitals within the National Institute of Child Health and Human Development Neonatal Research Network. We compared overall and cause-specific in-hospital mortality across three periods from 2000 through 2011, with adjustment for baseline differences.RESULTS: The number of deaths per 1000 live births was 275 (95% confidence interval [CI], 264 to 285) from 2000 through 2003 and 285 (95% CI, 275 to 295) from 2004 through 2007; the number decreased to 258 (95% CI, 248 to 268) in the 2008-2011 period (P=0.003 for the comparison across three periods). There were fewer pulmonary-related deaths attributed to the respiratory distress syndrome and bronchopulmonary dysplasia in 2008-2011 than in 2000-2003 and 2004-2007 (68 [95% CI, 63 to 74] vs. 83 [95% CI, 77 to 90] and 84 [95% CI, 78 to 90] per 1000 live births, respectively; P=0.002). Similarly, in 2008-2011, as compared with 2000-2003, there were decreases in deaths attributed to immaturity (P=0.05) and deaths complicated by infection (P=0.04) or central nervous system injury (P<0.001); however, there were increases in deaths attributed to necrotizing enterocolitis (30 [95% CI, 27 to 34] vs. 23 [95% CI, 20 to 27], P=0.03). Overall, 40.4% of deaths occurred within 12 hours after birth, and 17.3% occurred after 28 days.CONCLUSIONS: We found that from 2000 through 2011, overall mortality declined among extremely premature infants. Deaths related to pulmonary causes, immaturity, infection, and central nervous system injury decreased, while necrotizing enterocolitis-related deaths increased. (Funded by the National Institutes of Health.).

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