Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. e788-e794 (doi:10.1542/peds.2006-3765)
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ARTICLE

Postdischarge Infant Mortality Among Very Low Birth Weight Infants: A Population-Based Study

Amir Kugelman, MDa, Brian Reichman, MBChBb,c, Irena Chistyakov, MDa, Valentina Boyko, MScb, Orna Levitski, BAb, Liat Lerner-Geva, MD, PhDb,c, Arieh Riskin, MDa, David Bader, MD, MHAa in collaboration with the Israel Neonatal Network

a Department of Neonatology, Bnai Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
b Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
c Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

OBJECTIVE. The objective of this study was to identify factors that were associated with death after discharge from the NICU of very low birth weight infants in a population-based study.

METHODS. From a national cohort of 13430 very low birth weight infants who were born in Israel from 1995 to 2003, 10602 infants were discharged from the hospital and composed the study population. Demographic and clinical data regarding the pregnancy, delivery, and neonatal course were obtained from the Israel national very low birth weight infant database. Data on each case of death during the postdischarge period until 1 year of age were provided by the Ministry of Health from national linked birth and death certificates. Univariate analyses and a multivariable logistic regression analyses were performed to examine the perinatal and neonatal risk factors for postdischarge death.

RESULTS. The postdischarge mortality rate was 7.5 per 1000 (80 of 10602 infants discharged from the hospital). The death rate was significantly higher in non-Jewish infants, infants who were born to young mothers, and infants who were born to low-educated mothers. After adjustment for demographic characteristics and perinatal and neonatal variables, postdischarge mortality was independently associated with congenital malformations, neonatal seizures, necrotizing enterocolitis, and bronchopulmonary dysplasia.

CONCLUSION. Although the postdischarge death rate was relatively low in our cohort of very low birth weight infants, attention should be focused on the subgroups of infants who are at higher risk to decrease their mortality further.

Key Words: discharge • infant mortality • VLBW infants

Abbreviations: SIDS—sudden infant death syndrome • VLBW—very low birth weight • IMR—infant mortality rate • SGA—small for gestational age • RDS—respiratory distress syndrome • BPD—bronchopulmonary dysplasia • PDA—patent ductus arteriosus • NEC—necrotizing enterocolitis • IVH—intraventricular hemorrhage • PVL—periventricular leukomalacia • OR—odds ratio • CI—confidence interval • ICH—intracranial hemorrhage

Accepted Feb 23, 2007.