Improving the odds of a very premature baby reaching a second birthday

Preterm infants born with extremely low birth weights (ELBW) have an increased risk of death during the first years of life.

Investigators who have identified perinatal and socioeconomic risk factors associated with increased mortality of infants with ELBW after discharge from the neonatal intensive care unit (NICU) are encouraging practitioners to develop interventions to be used in follow-up care of these high-risk babies.

Their study results show that African American race, longer stay in the NICU, and poorer access to health care can increase the risk of death once the infants are sent home. They also found that maternal use of intrapartum antibiotics was associated with a lower likelihood of post-NICU mortality.

The post-NICU discharge mortality findings were based on a retrospective study of 5,364 preterm (<27 weeks’ gestational age) infants with ELBW (<1,000 g), of which 4,807 infants were successfully tracked until 18 to 22 months corrected age, with 107 post-NICU deaths (22.3 per 1,000 infants).

The investigators found the odds of post-NICU death were doubled in African American infants (compared with other racial groups), tripled in infants who were in the NICU for 120 days or longer, and 14 times higher if the maternal insurance status was unknown (compared with private insurance).

Because prolonged hospital stay is associated with illness severity in infants with ELBW, the investigators suggest that specific medical complications of extreme prematurity such as bronchopulmonary dysplasia, brain injury, severe retinopathy of prematurity, and late-onset infection/necrotizing enterocolitis are accounted for in the prolonged hospitalization of 120 or more days.

Although they found that maternal exposure to antibiotics during pregnancy decreased the risk of infant death, the researchers were unable to speculate why the intrapartum antibiotics were protective against post-NICU discharge mortality.

The researchers said one of their goals was to develop a predictive model for post-NICU discharge mortality that could serve as a guide for clinicians treating the high-risk infants in their practices. Resources that may direct such management include care recommendations for infants with ELBW and findings on factors associated with unimpaired survival in these infants.

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