title: Etiologies of NICU deaths.
abstract: OBJECTIVE
  Infant mortality is an indicator of overall societal health, and a significant proportion of infant deaths occur in NICUs. The objectives were to identify causes of death and to define potentially preventable factors associated with death as areas for quality improvement efforts in the NICU.
  
  
  METHODS
  In a prospectively defined study, the principal investigator in 46 level III NICUs agreed to review health care records of infants who died. For each infant, the principal investigator reviewed the medical record to identify the primary cause of death and to look for preventable factors associated with the infant's death. Infants born at ≥22 weeks estimated gestational age who were born alive were included. Stillborn infants were excluded.
  
  
  RESULTS
  Data were collected on 641 infants who died. At lower gestational ages, mortality was most commonly due to extreme prematurity and the complications of premature birth (respiratory distress progressing to respiratory failure, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis). With increasing gestational age, the etiology of mortality shifted to hypoxic-ischemic encephalopathy and genetic or structural anomalies. Reviewers of clinical care identified 197 (31%) infants with potentially modifiable factors that may have contributed to their deaths.
  
  
  CONCLUSIONS
  The factors associated with death in infants admitted for intensive care are multifactorial and diverse, and they change with gestational age. In 31% of the deaths, potentially modifiable factors were identified, and these factors suggest important targets for reducing infant mortality.
authors.affiliation: Pediatrix Medical Group, Center for Research and Education, Sunrise, Florida.
authors.forename: Jack
authors.initials: J
authors.lastname: Jacob
authors.affiliation: Pediatrix Medical Group, Center for Research and Education, Sunrise, Florida.
authors.forename: Michael
authors.initials: M
authors.lastname: Kamitsuka
authors.affiliation: Pediatrix Medical Group, Center for Research and Education, Sunrise, Florida reese_clark@pediatrix.com.
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.affiliation: Pediatrix Medical Group, Center for Research and Education, Sunrise, Florida.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Kelleher
authors.affiliation: Pediatrix Medical Group, Center for Research and Education, Sunrise, Florida.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Spitzer
mesh_terms: D002423:Cause of Death; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality*; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies
keywords: death; death certificate; mortality; neonate; newborn; prenatal care