Many NICU deaths associated with potentially modifiable factors

1. Common factors associated with infant deaths in neonatal intensive care units (NICU) varied according to gestational age.

2. A total of 31% of deaths were associated with potentially modifiable risk factors, with delivery at a health care facility without proper support being the most common.

Study Rundown: It is known that approximately two-thirds of infant deaths occur in the first 28 days of life. Public health policy makers must understand elements that are associated with this early stage mortality in order to improve outcomes. In the current study, researchers sought to understand factors associated with infant mortality in the NICU by identifying potentially preventable causes of death. It was found that factors associated with infant deaths changed with gestational age. The majority of early gestational age infants died from extremely low birth weight, intracranial hemorrhages, and sepsis. Late preterm (29-36 weeks) and term infants (> 36 weeks) died from hypoxic ischemic encephalopathy and genetic/structural anomalies. Preventable factors associated with infant deaths were found in over a quarter of all participants. Results may be limited as all factors associated with infant death could not be accounted for and not all infants underwent an autopsy to aid in identifying the cause of death. However, this study highlights the need for strong prenatal care and may aid NICU practitioners in focusing on areas that need improvement to reduce preterm mortality.

Click to read the study published today in Pediatrics

Relevant Reading: CDC grand rounds: Public health approaches to reducing U.S. infant mortality

Study Author, Dr. Reese Clark, MD, talks to 2 Minute Medicine: Vice-President and Co-Director, The Center for Research, Education, and Quality, Pediatrix Medical Group.

“The goal of our study was to better understand the factors associated with mortality and identify potentially preventable causes of death in infants admitted for NICU care. The factors associated with death in infants admitted for NICU care were multifactorial and diverse. Thirty-one percent of infant deaths were associated with potentially modifiable factors and our findings have important implications for how best to conduct quality improvement efforts related to mortality. In premature infants preventing or delaying preterm birth and optimizing therapies that decrease intraventricular hemorrhage, necrotizing enterocolitis, respiratory distress syndrome, and sepsis (both early and late onset) are the intervention most likely to reduce mortality. In more mature infants, targets should include preventing and managing hypoxic ischemic encephalopathy and defining optimal management strategies for infants with nonlethal anomalies.”

In-Depth [cross-sectional]: A total of 641 infants (55% male, 50% Caucasian, ≥ 22 weeks gestation) were included in this study. Researchers analyzed medical records and performed a root cause analysis to identify causes of death. The most common causes at early gestational ages (<25 weeks) were as follows: extreme prematurity/low birth weight (34.5%), intraventricular or intracranial hemorrhage (14.4%), sepsis (13.5%), respiratory distress syndrome (10.9%), and necrotizing enterocolitis (8.3%).  Hypoxic ischemic encephalopathy (23%), lethal anomaly (21.8%), and genetic syndromes (12.6%) accounted for the majority of infant NICU deaths at term gestation (>36 weeks). Potentially modifiable risk factors associated with infant deaths were found in 197 cases (31%). More than 1 element was identified in 75 infants (11.7%). Modifiable risk factors included: delivery at a center without appropriate level or support (10%), limited or no prenatal care (8.9%), mothers smoked tobacco during pregnancy (16%), maternal use of nonprescription drugs (7.3%), and alcohol abuse (4%).

More from this author: Use of infant bedding remains high despite recommendations, Prenatal lead exposure and calcium intake linked to postnatal growth, Individually taught, parent-implemented social intervention may improve autism outcomes

Image: PD

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