Deaths in a Modern Cohort of Extremely Preterm Infants from the Preterm Erythropoietin Neuroprotection Trial

Knowledge about why and how extremely preterm infants die is crucial for practitioners caring for these infants. Thus a recent study examined risk factors, causes, timing, and circumstances of death in a modern cohort of extremely preterm infants.

941 infants born between 24 0/7 and 27 6/7 weeks of gestation were included in the study and Data analysis was performed.

The Main Outcomes and Measures were the Risk factors, proximal causes, timing, and circumstances of in-hospital death.

The results were as follows-

• Among the 941 enrolled infants, 11% died before hospital discharge: 38% at 24 weeks’ gestation, 30% at 25 weeks’ gestation, 19% at 26 weeks’ gestation, and 14% at 27 weeks’ gestation. 
• An additional 1% of infants died following hospital discharge. 
• In descending order, the primary causes of death were found to be respiratory distress or failure, pulmonary hemorrhage, necrotizing enterocolitis, catastrophic intracranial hemorrhage, sepsis, and sudden unexplained death. 
• 50% of deaths were found to occur within the first 10 days after birth. 
• The risk of death was found to decline with the day of life and postmenstrual age, like an infant born at 24 weeks’ gestation who survived 14 days had the same risk of death as an infant born at 27 weeks’ gestation: conditional proportional risk of death, 0.08 vs 0.06. 
• Preterm labor was found to be associated with a decreased hazard of death. 
• Infant clinical factors associated with death were found to be birth weight below the tenth percentile for gestational age, Apgar scores less than 5 at 5 minutes, sick appearance at birth, grade 2b-3 necrotizing enterocolitis, pulmonary hemorrhage, severe intracranial hemorrhage, and severe sepsis. 
• 51% of the infants were found to receive comfort care before death.

This cohort study demonstrated an association between mortality and gestational age at birth; however, for each week that an infant survived, their risk of subsequent death approximated the risk observed in infants born 1 to 2 weeks later, indicating the significance of an infant’s postmenstrual age. This information can be used to counsel families regarding the prognosis of survival.

SOURCE- Juul SE, Wood TR, Comstock BA, et al. Deaths in a Modern Cohort of Extremely Preterm Infants From the Preterm Erythropoietin Neuroprotection Trial. JAMA Netw Open. 2022;5(2):e2146404. doi:10.1001/jamanetworkopen.2021.46404