Infant and Maternal Risk Factors Related to Necrotizing Enterocolitis-Associated Infant Death in the United States, 2007-2009 Öffentlichkeit

Abstract

PURPOSE: The purpose of this study is to evaluate necrotizing enterocolitis (NEC)-associated deaths among infants in the United States and to identify risk factors for NEC mortality. METHODS: The United States Period Linked Birth/Infant Death dataset for 2007-2009 was utilized to determine the infant and maternal risk factors associated with NEC-associated infant death. Infant mortality rates (IMR) were calculated and a retrospective case-control analysis was performed. A case was defined as an infant having the International Classification of Diseases, Tenth revision code for NEC listed anywhere on the death record. Controls were infants who survived at least to the end of their first year of life and were randomly selected. Multivariable logistic regression models stratified by birth weight (very low birth weight [VLBW], moderately low birth weight, and normal birth weight) were conducted to determine the risk factors for infant NEC death. Additionally, a sub-analysis of the 2003 birth certificate revision was conducted to determine the association of maternal education and NEC-associated infant death. RESULTS: The overall NEC IMR was 15.5 deaths per 100,000 live births and was higher among VLBW compared to NBW infants as well as black infants compared to white. Among VLBW infants, the multivariable analysis identified male sex, 5-minute Apgar score of < 7, maternal age of ≤ 19 years, and an interaction between maternal race and maternal marital status to be related with NEC-associated death. Among VLBW infants of white race in the 2003 birth certificate revision sub-analysis, infants with mothers completing less than a high school education had higher odds of NEC-associated death compared to an education of more than high school. DISCUSSION: Necrotizing enterocolitis-associated IMR did not significantly change from 2007-2009; however, the average annual IMR is still larger compared to previous studies. Since NEC infant death is strongly associated with VLBW, this larger IMR is possibly due to the decreased mortality rate in low birth weight infants. Race disparities may exist and should be the focus of future studies. In addition, mothers and physicians should be aware of the factors related to NEC-associated infant death to improve prevention and reduce mortality rates.

Table of Contents

List of Tables..................................................................i

List of Figures.................................................................ii 1. Introduction...............................................................1 1.1. Problem Statement....................................................1 1.2. Purpose Statement....................................................1 1.3. Significance Statement...............................................1 2. Review of the Literature................................................3 2.1. History....................................................................3 2.2. Biology....................................................................4 2.3. Treatment...............................................................5 2.4. Prevention...............................................................7 2.5. Epidemiology............................................................8 3. Methods...................................................................10 3.1. Epidemiological Methods............................................10 3.2. Age at Death..........................................................12 3.3. Infant Mortality Rates..............................................12 3.4. Case-Control Methods..............................................13 4. Results....................................................................16 4.1. Overall Analysis......................................................16 4.1.1. Infant Mortality Rates...........................................16 4.2. Stratification by Birth Weight....................................17 4.2.1. Very Low Birth Weight...........................................17 4.2.2. Moderately Low Birth Weight..................................18 4.2.3. Normal Birth Weight..............................................19 4.3. 2003 Birth Certificate Sub-Analysis............................19 5. Discussion................................................................21 References..................................................................25 Appendix.....................................................................28

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics and Bioinformatics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Stichwort	infant death necrotizing enterocolitis
Committee Chair / Thesis Advisor	Hertzberg, Vicki S, Emory University
Committee Members	Mehal, Jason, Centers for Disease Control and Prevention
Partnering Agencies	Emory University schools, faculty or affiliated programs CDC

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