Article Text

  1. A. Turlington1,
  2. L. Barton1,
  3. J. E. Hodgman1
  1. 1Division of Newborn Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.


NICU deaths beyond the neonatal period comprise a significant percentage of nursery deaths before hospital discharge, yet they are hardly identified as such. We have presented two previous reports from our hospital covering 1976-1983 and 1993-1998.1,2With decreasing neonatal mortality, we decided to review the subsequent 7 years, 1999-2005. We identified all infant deaths before discharge from the nursery aged ≥ 28 days. Clinical data for all cases and autopsy records where available were reviewed and a cause of death determined. Total nursery deaths for the 6 years were 181, of which 12 (6.6%) occurred after the neonatal period. This represents a decrease from the 12% reported in 1993-1998. Causes of death generally were divided into complications of prematurity and congenital defects. The five infants whose cause of death was prematurity all had chronic lung disease, four had abdominal surgery for perforation and resection, three had positive blood or peritoneum cultures, and two had IVH Gr IV. All infants had multiple organ failure by the time of death, and the final event was infection and/or renal failure. One preterm infant had congenital CMV and one had a tracheoesophageal fistula repaired shortly after birth. The seven congenital defects included two trisomy 21 with complications, one CHARGE association with heart defects, a hypertrophic cardiomyopathy (Pompe's disease), and one other congenital heart defect. Of the remaining infants, one had hydranencephaly and the other had multiple vascular liver tumors.

Conclusions Along with the general decrease in neonatal mortality, postneonatal mortality is decreasing even faster as a percentage of nursery deaths. The causes of death have remained similarly divided between complications of prematurity and congenital defects.

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