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Mortality Rate-Dependent Variations in the Timing and Causes of Death in Extremely Preterm Infants Born at 23–24 Weeks’ Gestation*

Park, Jae Hyun MD, PhD1; Chang, Yun Sil MD, PhD2; Sung, Sein MD, PhD2; Park, Won Soon MD, PhD2; Korean Neonatal Network

Pediatric Critical Care Medicine: July 2019 - Volume 20 - Issue 7 - p 630-637
doi: 10.1097/PCC.0000000000001913
Neonatal Intensive Care
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Objectives: To determine mortality rate-dependent variations in the timing and causes of death, and to subsequently identify the clinical factors associated with decreased mortality in extremely preterm infants born at 23–24 weeks’ gestation.

Design: A retrospective cohort study.

Setting: Korean Neonatal Network registry that includes all level greater than or equal to 3 neonatal ICUs in Korea.

Patients: Eligible, actively treated infants born at 23–24 weeks’ gestation (n = 574) from January 2014 to December 2016 were arbitrarily categorized based on institutional mortality rates of less than or equal to 50% (group I, n = 381) and greater than 50% (group II, n = 193). The primary outcome was mortality before discharge and the timing and causes of death according to the mortality rate.

Interventions: None.

Measurements and Main Results: The overall mortality rate was significantly lower in group I (40.7%) than in group II (79.3%). Regarding causes of death, mortalities due to cardiorespiratory, infectious, and gastrointestinal causes were significantly lower in group I than in group II. Mortality rates were significantly lower in group I, including all the subgroups that were categorized according to the timing of death, than in group II. The multivariate analyses showed that antenatal corticosteroid use, absence of oligohydramnios, birth weight, and body temperature at admission to the neonatal ICU were significantly associated with reduced mortality.

Conclusions: The reduced mortality rate among the infants born at 23–24 weeks’ gestation was attributable to decreased mortality ascribed to cardiorespiratory, infectious, and gastrointestinal causes, and it was associated with antenatal steroid use and body temperature at admission to the neonatal ICU.

1Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea.

2Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

*See also p. 676.

Drs. J. H. Park and Chang contributed equally as co-first authors.

Drs. J. H. Park, Chang, and W. S. Park conceptualized and designed the data. Drs. J. H. Park, Sung, and Korean Neonatal Network acquired the data. Drs. J. H. Park, Chang, Sung, and W. S. Park analyzed and interpreted the data. Drs. J. H. Park, Chang, Sung, and W. S. Park prepared, critically revised, and approved the final article.

Supported, in part, by grant fund (number 2016-ER6307-02) from Research of Korea Centers for Disease Control and Prevention, and they disclosed government work.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: wonspark@skku.edu; ws123.park@samsung.com

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies