Wayne State University School of Medicine researchers on staff at the Detroit Medical Center's Hutzel Women's Hospital have discovered that babies who die after discharge from a Neonatal Intensive Care Unit (NICU) are more often from an African-American background, have had longer stays in the NICU than other preterm babies and have unknown or no health insurance.
The study, "Risk Factors for Post-NICU Discharge Mortality Among Extremely Low Birth Weight Infants," is scheduled for publication in The Journal of Pediatrics and is available on http://www.pubmed.com/.
Among researchers who worked on the study were Wayne State University School of Medicine Assistant Professor of Pediatrics Lilia C. DeJesus, M.D., lead investigator; Assistant Professor of Pediatrics Athina Pappas, M.D., the study's follow-up director; and Professor of Pediatrics Seetha Shankaran, M.D., the National Institute of Child Health and Development Neonatal Research Network site principal investigator and division chief of Neonatal/Perinatal Medicine at Children's Hospital of Michigan and Hutzel Women's Hospital.
The team conducted an exploratory study and used logistic regression models to identify risk factors associated with infant death post-NICU. They examined 5,364 preterm infants who were born between 2000 and 2007 at or before 27 weeks of gestational age (seven months of pregnancy), and had a birth weight of less than 2.2 pounds. The data was collected through the 16 academic research sites within the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Neonatal Research Network. The network includes Hutzel Women's Hospital.
Of the 4,807 infants the study successfully followed until 18 to 22 months of age, 107 died after discharge. The team discovered that the odds of death after NICU discharge were double in African-American infants compared to other racial groups, three times higher in infants who were in the NICU for more than 120 days and 15 times higher if the mother's insurance status was unknown.
The latter conclusion was certainly the most astounding, the researchers said, and indicates the mothers likely had poorer access to health care, including appropriate follow-up care.
"Initially it was a surprise. We were expecting the same risk factors for in-hospital and for post-NICU discharge death. What we learned is that post-NICU discharge death is not only associated with a longer duration of hospital stay (which indicates severity of illness) but was also associated with certain socio-economic factors," Dr. Shankaran said.
The team wanted to do the study because of the disproportionately high post-NICU discharge infant death at Hutzel Women's Hospital. Fellow researcher Yvette Johnson, M.D., assistant professor of Pediatrics at Baylor College of Medicine and Texas Children's Hospital in Houston, first raised this issue in 2001 while she was still working in Detroit.
"Our center has one of the highest rates of post-NICU infant deaths among all the centers in the Neonatal Research Network. We are spending millions of dollars each year to improve the survival rate and overall outcomes of these extremely low-birth weight infants. However, despite our best efforts, some of them will not survive after discharge from NICU," Dr. DeJesus said.
"Therefore, identifying these risk factors will help us formulate interventions on how to care and follow these high-risk infants after discharge from NICU," she added. "In fact, our post-NICU discharge mortality has decreased recently due to more careful discharge plans arranged by our discharge coordinators at Hutzel Women's Hospital."