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
Rights statement
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