Cause-specific mortality of very preterm infants and antenatal events

Carlo Corchia, Pierpaolo Ferrante, Monica Da Fre, Domenico Di Lallo, Luigi Gagliardi, Virgilio Carnielli, Silvana Miniaci, Simone Piga, Francesco Macagno, Marina Cuttini

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Objective To assess the relationship between antenatal factors and cause-specific risk of death in a large area-based cohort of very preterm infants. Study design The ACTION (Accesso alle Cure e Terapie Intensive Ostetriche e Neonatali) study recruited during an 18-month period all infants 22-31 weeks' gestational age admitted to neonatal care in 6 Italian regions (n = 3040). We analyzed the data of 2974 babies without lethal or acutely life-threatening malformations. Cause-specific risks of death adjusted for competing causes were calculated, and region-stratified multiple Cox regression analyses were used to study the association between cause-specific mortality and infants' characteristics, pregnancy complications, antenatal steroids, and place of birth. Results Deaths attributable to respiratory problems and intraventricular hemorrhage prevailed in the first 2 weeks of life, and those attributable to infections and gastrointestinal diseases afterwards. Antepartum hemorrhage was associated with respiratory deaths (hazard ratio [HR] 1.6, 95% CI 1.1-2.4), and maternal infection with deaths attributable to asphyxia (HR 32.5, 95% CI 4.1-259.4) and to respiratory problems (HR 2.8, 95% CI 1.6-5.2). Preterm premature rupture of membranes increased the likelihood of deaths due to neonatal infection (HR 1.8, 95% CI 1.0- 3.1), and preterm labor/contractions of those due to respiratory (HR 1.5, 95% CI 1.1-2.0) and gastrointestinal diseases (HR 5.8, 95% CI 2.1-16.3). In addition, a birth weight z-score <1 was associated with increasing hazards of death resulting from asphyxia, late infections, respiratory, and gastrointestinal diseases. Conclusions Different complications of pregnancy lead to different cause-specific mortality patterns in very preterm infants.

Original languageEnglish
JournalJournal of Pediatrics
Issue number6
Publication statusPublished - Jun 2013

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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