Changes in Cause - specific mortality
among very low birth weight infants
Stra¨¾¨¢k Z, Janota J, Velebil P
Institute for the Care of Mother and Child, Prague,
Czech Republic
Objective: The aim of the study was
to investigate the cause specific infant mortality among extremely low
birth weight (ELBW) and very low birth weight (VLBW) infants.
Methods: Four hundred and forty-one inborn patients with birth weight under
1500 grams were included in this retrospective study. We divided our study
group into two sub-groups according to their birth weight: under 1000 grams
(ELBW group; n=161) and 1000-1499 grams (VLBW group; n=280). For statistical analysis the Epi
Info software package was used.
Result: Total mortality was 9.1%
(23.0% in ELBW group; 1.0% in VLBW group). The main causes of death in ELBW
group were (in order of magnitude): sepsis (49%, early to late onset sepsis
ratio 1:4), severe intraventricular hemorrhage grade III and IV (24%),
respiratory distress syndrome (14%) and other causes (13%). While in the
VLBW group were only three cases of death due to sepsis (1.0%). While
comparing two most frequent causes of death (sepsis, PVH-IVH grade III and
IV) using 2 x 2 table analysis we found stronger association of severe
PVH-IVH with infant death (OR 2.63; 95% CI 0.68, 9.83).
Conclusion: According to frequency
analysis only, sepsis is the leading cause of death among ELBW newborns and
severe PVH-IVH and RDS follow. While looking for strength of association we
found highest risk of death among ELBW newborns with PVH-IVH. The RDS,
formerly reported leading cause of infant death, seems to move to lower
order, probably due to introduction of new therapeutic tools into clinical
perinatal practice (corticosteroids, surfactant, new modes of artificial
ventilation).