Risk Status at Discharge and Cause of Death for Postneonatal Infant Deaths: A Total Population Study

Kempe, Allison; Wise, Paul H.; Wampler, Nina S.; Cole, F. Sessions; Wallace, Helen M.; Dickinson, Corrine; Rinehart, Heidi; Lezotte, Dennis C.; Beaty, Brenda

doi:10.1542/peds.99.3.338

Cited by 20 publications

(13 citation statements)

References 23 publications

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“…7 In a study by Stewart and Hersh 2 of an 11-year trend in neonatal mortality at Kosair Children's Hospital in Louisville, KY, it was found that neonatal mortality due to congenital malformations had not decreased despite a decrease in overall neonatal mortality. These studies suggest that, although technologic and therapeutic advances in perinatal and newborn care have contributed to decreases in neonatal morbidity and mortality, mortality rates in infants with major congenital malformations have not been significantly altered.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Resource Utilization For Newborns with Major Congenital Malformations: The Initial NICU Admission

1999

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HYPOTHESIS:Newborns with major congenital malformations (MCM) have contributed to a significant proportion of resource utilization in a regional referral neonatal intensive care unit (NICU). SETTING:The Children's Hospital Medical Center NICU, Cincinnati, OH. SUBJECTS:Newborns with and without MCM admitted from August 1, 1993 through July 31, 1994. Total patients studied were 572; 147 with and 385 without MCM. No intervention was performed in this observational study. STATISTICS:Statistics were t test, chi-squared, and rank sum analysis. RESULTS:MCM accounted for 27.6% of NICU referrals, 32.4% of total NICU days, and 39.6% of NICU costs. Both median cost per patient and length of stay were significantly (p Ͻ 0.01) higher for patients with MCM than those without MCM. Surgery was more frequent in MCM than non-MCM cases. Thirty-three percent of the newborns with MCM received ongoing medical support at discharge. CONCLUSION:Patients with MCM remain as one of the largest and costliest groups hospitalized in a referral NICU.Congenital malformations remain the leading cause of deaths in the United States for infants less than 1 year of age, with sudden infant death syndrome and disorders of prematurity being close behind. 1 Recently, advances in the care of premature infants, including antenatal steroids and surfactant therapy, have resulted in improved survival for this neonatal intensive care unit (NICU) population. Concurrently, newborns with major congenital malformations (MCM) have contributed to a consistent and relatively higher proportion of total NICU deaths than other hospitalized NICU patients. 2 Difficult decisions involving the provision of care for newborns with malformations were the basis for the development of the "Baby Doe" rulings by the U.S. Department of Health and Human Services in 1985. The regulations placed increasing responsibility on pediatricians to treat all infants with congenital malformations by requiring that reasonable measures be done to preserve the life of an infant with a serious condition. 3,4 Today, ethical considerations remain an integral part of the care of newborns with malformations.The combination of recent advancements in neonatal care and the responsibility to treat infants with life-threatening conditions may lead to an increased contribution to hospital resource use by newborns with major congenital malformations admitted to a regionalized NICU. In this study, we examined resource utilization in a population of infants with MCM admitted to a single referral children's hospital NICU over a 1-year time period. The comparison population consisted of newborns without MCM (non-MCM) admitted to the same NICU during the same time period.We hypothesized that newborns with MCMs would contribute significantly ( p Ͻ 0.05) to the median cost and median length of the initial hospitalization compared with those without MCMs. The purpose of the study was (1) to determine the duration and cost of the initial NICU hospitalization for newborn infants with MCM compared with non-MCM patien...

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Section: Discussionmentioning

confidence: 99%

Outcomes and Resource Utilization For Newborns with Major Congenital Malformations: The Initial NICU Admission

1999

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“…Our study is 1 of a few population-based studies to investigate postdischarge mortality in VLBW infants. [13][14][15] Population-base studies in contrast to single institutions' experience [15][16][17][18] are larger and more representative, and their findings may be generalized. Two previous studies from the 1980s focused on center-specific mortality rates after NICU discharge, reporting a ninefold and sevenfold excess in postneonatal mortality among NICU graduates compared with non-NICU graduates.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2007

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“…Further, longer lives imply more opportunities for exposure to acute episodes. Kempe et al 25 report that "the vast majority of infants who died of prematurityrelated postneonatal causes never left the hospital, and only a small percentage of all infants who left the hospital before death were identified as being at high medical risk. "…”

Section: The Descriptive Epidemiology Of Infant Mortalitymentioning

confidence: 99%

Infant Mortality and Air Pollution: A Comprehensive Analysis of U.S. Data for 1990

Lipfert¹,

Zhang²,

Wyzga

2000

Journal of the Air & Waste Management Association

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This paper uses U.S. linked birth and death records to explore associations between infant mortality and environmental factors, based on spatial relationships. The IMPLICATIONS Air pollution has been one of many suspected risk factors for SIDS, as well as for other causes of infant mortality. A previous epidemiologic study based on geographic gradients found a relationship between SIDS and PM 10 and speculated that fine particles (PM 2.5 ) might be the real culprit. However, U.S. data on SIDS clearly show a strong geographic gradient from east to west that has existed for decades, with SIDS rates in the mountain states nearly 4 times those in the big population centers of the east coast. Given that east-west air pollution patterns have changed dramatically during this period, it appears that other geographic factors should be considered. This conclusion is also supported by long-term trends in SIDS in the United States and in Scandinavia that show a dramatic increase with a subsequent decrease during a period of improving air quality.Our study considered some of those other factors, and while we confirmed a positive spatial relationship with PM 10 in 1990, we found an even stronger negative relationship with SO 4 2-aerosol, which is often a major constituent of fine particles. Thus, our study provides no support for the hypothesis that SIDS is associated with outdoor ambient concentrations of generic fine particles. Instead, the underlying implication is that epidemiologic studies based on geographic patterns can be misleading if a broad range of alternative hypotheses and candidate confounders is not also investigated. For example, we found that the variability in the association between SIDS and PM 10 due to alternative regression model specification and to the selection of locations to be considered was much larger than the variation obtained using the baseline model with different mortality end points and infant subgroups. SIDS constitutes a source of profound personal tragedy, and it is incumbent upon the research community to use the best possible science to investigate ways that SIDS risks might be reduced with some assurance of certainty.analysis considers a range of infant mortality end points, regression models, and environmental and socioeconomic variables. The basic analysis involves logistic regression modeling of individuals; the cohort comprises all infants born in the United States in 1990 for whom the required data are available from the matched birth and death records. These individual data include sex, race, month of birth, and birth weight of the infant, and personal data on the mother, including age, adequacy of prenatal care, and smoking and education in most instances. Ecological variables from Census and other sources are matched on the county of usual residence and include ambient air quality, elevation above sea level, climate, number of physicians per capita, median income, racial and ethnic distribution, unemployment, and population density. The air quality variables considere...

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Risk Status at Discharge and Cause of Death for Postneonatal Infant Deaths: A Total Population Study

Cited by 20 publications

References 23 publications

Outcomes and Resource Utilization For Newborns with Major Congenital Malformations: The Initial NICU Admission

Outcomes and Resource Utilization For Newborns with Major Congenital Malformations: The Initial NICU Admission

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

Infant Mortality and Air Pollution: A Comprehensive Analysis of U.S. Data for 1990

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