Why do preterm infants die in the 1990s?
OBJECTIVE
To describe the mortality rate for preterm infants (born 23-36 completed weeks' gestational age) and to determine the causes of death, focusing on avoidable causes.


METHODS
Prospective cohort study of preterm infants born at Royal Women's Hospital, Melbourne (a tertiary referral hospital with a neonatal intensive care unit and a special care nursery) from January 1994 to December 1996.


METHODS
2475 consecutive liveborn infants with gestational ages from 23 to 36 weeks.


METHODS
Mortality rate during the primary hospitalisation, and causes of death.


RESULTS
The total mortality rate was 4.8% (118/2475). The mortality rate declined with increasing maturity. The decrease in mortality was rapid between 23 and 28 weeks' gestational age, from 64.5% at 23 weeks to 4.0% at 28 weeks, then slower, falling to 0.4% at 36 weeks. Fifty of the 118 infants who died had lethal congenital anomalies. Lethal anomalies accounted for three-quarters of deaths in infants aged 28-36 weeks. The mortality rate in infants free of lethal anomalies was 2.8% (68/2425) and only 0.2% (4/1759) for infants aged 32-36 weeks. In the 68 infants without lethal anomalies who died, few obvious preventable causes were identified.


CONCLUSIONS
Mortality rates fell rapidly between 23 and 28 weeks' gestational age. Survival rates for preterm infants born after 31 weeks' gestational age approached the survival rates of term infants. Lethal congenital anomalies were the most common cause of death; preventable causes of death were rare.
Division of Paediatrics, Royal Women's Hospital, Melbourne, VIC. l.doyle@obgyn-rwh.unimelb.edu.au
L W
LW
Doyle
S
S
Rogerson
S L
SL
Chuang
M
M
James
E D
ED
Bowman
P G
PG
Davis
D001315:Australia; D001723:Birth Rate; D002423:Cause of Death / Q000639:trends*; D000013:Congenital Abnormalities / Q000401:mortality*; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality*; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D011446:Prospective Studies; D015996:Survival Rate