Risk factors for early death among extremely low-birth-weight infants

OBJECTIVE: The purposes of this study were to compare the clinical characteristics of extremely low-birth-weight infants (501-1000 g birth weight) who die early (<12 hours of age) with those of infants who die >12 hours after birth and infants who survive to neonatal intensive care unit discharge and to develop a model of risk for early death. STUDY DESIGN: Perinatal data were prospectively collected on 5986 infants in the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network from March 1993 through December 1997. Maternal and neonatal characteristics of infants who died early were compared with infants who survived and infants who died beyond 12 hours of age. A model for risk for early death was developed by logistic regression analysis, with results expressed as odds ratio with 95% Cl. RESULTS: Mothers of infants who died early were more likely to be delivered in an inborn setting and experience labor and were less likely to have hypertension or preeclampsia, to receive antenatal corticosteroids, or to be delivered by cesarean birth than mothers of infants who died >12 hours after birth or infants who survived. Infants who died early were more likely to have lower Apgar scores and lower gestational age/birth weight and were less likely to be intubated at birth and to receive mechanical ventilation and surfactant therapy than infants who died >12 hours after birth or infants who survived. Greater risk for early death versus survival to neonatal intensive care unit discharge was associated with the lack of surfactant administration (odds ratio, 8.6; 95% Cl, 6.3-11.9), lack of delivery room intubation (odds ratio, 5.3; 95% Cl, 3.5-8.1), lack of antenatal corticosteroid use (odds ratio, 2.3; 95% Cl, 1.6-3.2), lower 1-minute Apgar score (odds ratio, 2.0; 95% Cl, 1.8-2.2), male sex (odds ratio, 1.7; 95% Cl, 1.3-2.3), multiple gestation (odds ratio, 1.7; 95% Cl, 1.2-2.5), no tocolytics (odds ratio, 1.7; 95% Cl, 1.2-2.3), lower gestational age per week (odds ratio, 1.4; 95% Cl, 1.3-1.6), and lower birth weight per 50 g (95% Cl, 1.2-1.4). CONCLUSION: Early death (<12 hours of age) among extremely low-birth-weight infants may reflect an assessment of nonviability by obstetricians and neonatologists.