title: Risk Factors for Cause-specific Mortality of Very-Low-Birth-Weight Infants in the Korean Neonatal Network.
abstract: This study attempted to assess the risk factors for mortality of very-low-birth-weight (VLBW) infants in the neonatal intensive care unit (NICU, n=2,386). Using data from the Korean Neonatal Network, we investigated infants with birth weights <1,500 g and gestational ages (GAs) of 22-31 weeks born between January 2013 and June 2014. Cases were defined as death at NICU discharge. Controls were randomly selected from live VLBW infants and frequency matched to case subjects by GA. Relevant variables were compared between the cases (n=236) and controls (n=236) by Cox proportional hazards regression to determine their associations with cause-specific mortality (cardiorespiratory, neurologic, infection, gastrointestinal, and others). In a Cox regression analysis, cardiorespiratory death were associated with a foreign mother (hazard ratio, HR, 4.33; 95% confidence interval, CI, 2.08-9.02), multiple gestation (HR, 1.65; 95% CI, 1.07-2.54), small for gestational age (HR, 2.06; 95% CI, 1.25-3.41), male gender (HR, 1.69; 95% CI, 1.10-2.60), Apgar score ≤3 at 5 min (HR, 1.97; 95% CI, 1.18-3.31), and delivery room resuscitation (HR, 2.60; 95% CI, 1.53-4.40). An Apgar score ≤3 at 5 min was also associated with neurological death (HR, 2.95; 95% CI, 1.29-6.73). Death due to neonatal infection was associated with outborn delivery (HR, 5.09; 95% CI, 1.46-17.74). Antenatal steroid and preterm premature rupture of membranes reduced risk of cardiorespiratory death (HR, 0.43; 95% CI, 0.27-0.67) and gastrointestinal death (HR, 0.30; 95% CI, 0.13-0.70), respectively. In conclusion, foreign mother, multiple gestation, small gestation age, male gender, Apgar score ≤3 at 5 min, and resuscitation in the delivery room are associated with cardiorespiratory mortality of VLBW infants in NICU. An Apgar score ≤3 at 5 min and outborn status are associated with neurological and infection mortality, respectively.
authors.affiliation: Department of Pediatrics, College of Medicine, Konyang University, Daejon, Korea.
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Lim
authors.affiliation: Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Sung-Hoon
authors.initials: SH
authors.lastname: Chung
authors.affiliation: Office of Biostatistics, School of Medicine, Ajou University, Suwon, Korea.
authors.forename: Dae Ryong
authors.initials: DR
authors.lastname: Kang
authors.affiliation: Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Chang-Ryul
authors.initials: CR
authors.lastname: Kim
mesh_terms: D001034:Apgar Score; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D066088:Infant Death; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D053208:Kaplan-Meier Estimate; D008297:Male; D011247:Pregnancy; D011272:Pregnancy, Multiple; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012151:Resuscitation; D012307:Risk Factors; D012737:Sex Factors
keywords: Cause of Death; Infant, Very-Low-Birth-Weight; Mortality; Risk Factors