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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e318253a78b
Original Studies

Risk Factors for Diarrhea-associated Infant Mortality in the United States, 2005–2007

Mehal, Jason M. MPH*; Esposito, Douglas H. MD, MPH†‡; Holman, Robert C. MS*; Tate, Jacqueline E. PhD; Callinan, Laura S. MPH*; Parashar, Umesh D. MB BS, MPH

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Abstract

Background: Diarrhea-associated deaths among US children increased from the mid-1980s through 2006, particularly among infants. Understanding risk factors for diarrhea-associated death could improve prevention strategies.

Methods: Records of singleton infants with diarrhea listed anywhere on the death certificate were selected from the US Linked Birth/Infant Death data for the period, 2005 to 2007; characteristics of these infants were compared with those of infants who survived their first year.

Results: During 2005 to 2007, 1087 diarrhea-associated infant deaths were reported; 86% occurred among low birth weight (LBW, <2500 g) infants. Compared with normal birth weight (NBW, ≥2500 g) infants, LBW infants had a greater mortality rate (risk ratio: 91.9, 95% confidence interval: 77.4–109.0) and younger median age at death (7 versus 15 weeks, P < 0.0001). The most common codiagnoses for diarrhea-associated death among LBW and NBW infants were sepsis (26%) and volume depletion (20%), respectively. Among LBW infants, 97% of diarrhea-associated deaths occurred in inpatient settings, whereas 27% of NBW infant deaths occurred in outpatient settings and 5.3% in the decedent’s home. Male sex, black race, unmarried status and low 5-minute Apgar score (<7) increased mortality odds among LBW infants whereas, among NBW infants, low 5-minute Apgar score, black race, young maternal age (<25 years) and high birth order (third or more) increased mortality odds.

Conclusions: Efforts to reduce diarrhea-associated morality should focus on understanding and improving management of diarrhea in vulnerable LBW infants. For prevention of diarrhea-associated deaths in NBW infants, educating mothers who fit the high-risk profile regarding home hydration therapy and timely access to medical treatment is important.

© 2012 Lippincott Williams & Wilkins, Inc.

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