The Mortality of Extremely Premature Infants and the Impact on the Overall Neonatal Mortality Rate [20C

Abstract

INTRODUCTION: Live births (LBs) in Ohio include any infant who had a heart rate, or took a breath or had any movement. In some countries infants less than 23 weeks are not counted as LBs. The study objective was to investigate the mortality in infants less than 500 grams (g) and to calculate their impact on the overall Neonatal Mortality Rate (NMR) over a 12-year period. METHODS: NMR data were extracted from the Good Samaritan Mortality Committee, CCHMC Perinatal Outreach Project and Vermont Oxford Network database from 1998–2009. RESULTS: Among 73,547 LBs were 699 deaths. The average NMR per 1,000 LBs was 11.4. The average adjusted NMR per 1,000 LB was 4.9. Overall, 349 LBs weighed less than 500 g and 336 died. The proportion of neonatal deaths less than 500 g, to the total NMR, was 48.6%. Infants' weight reported to the State included: 30–100 g (n=11), 101–200 g (n=40), and 201–300 g (n=63). Gestational age (GA) included: 15–17 weeks (n=35), 18–20 weeks (n=108), and 21–23 weeks (n=155). Causes of death included: GA less than or equal to 23 weeks (88.6%, n=298), lethal malformations (4.7%, n=16), RDS (8.6%, n=29), and sepsis (7.4%, n=25); 297 (88.3%) infants died in the delivery room. CONCLUSION: NMR from extreme prematurity was 96.2% and represented half of the overall NMR. Current LB definition and a reporting system of a 30 gram infant as a neonatal death has placed Ohio and the USA at a significant disadvantage compared with other countries with different reporting systems.