Factors differentiating postponed neonatal death from survival in low birth weight infants.
Although survival of low birth weight infants during the neonatal period has improved, an increasing percentage of infants succumb after 28 days but before discharge from the nursery. In a retrospective study we compared 11 postponed neonatal deaths (PND) with survivors matched for birth weight, gestational age, gender, race, inborn or outborn status, and year of birth in an attempt to identify possible differentiating factors early in the clinical course. Evaluation of antenatal, intrauterine, and early nursery events could not differentiate the two groups. By day 14, however, significantly more PND required assisted ventilation because of poor respiratory effort and total parenteral nutrition because of poor gastrointestinal motility. Metabolic differences were noted at this time in the serum bilirubin, phosphorus, and chloride levels. At autopsy all infants had evidence of CNS injury, and moderate chronic lung disease, and in addition nine infants had bronchopneumonia. The major differences between the PNDs and survivors may primarily involve neurologic control of respiration and gastrointestinal motility. Early recognition of PND may have important medical, ethical, and financial implications for newborn intensive care.
D001049:Apnea / Q000209:etiology; D002493:Central Nervous System Diseases / Q000209:etiology; D002779:Cholestasis / Q000209:etiology; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight / Q000097:blood / Q000502:physiology; D007231:Infant, Newborn; D008173:Lung Diseases, Obstructive / Q000209:etiology; D010102:Oxygen Inhalation Therapy; D010288:Parenteral Nutrition / Q000009:adverse effects; D010758:Phosphorus / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D010758:Phosphorus