Postneonatal Infant Mortality in Infants Admitted to a Neonatal Intensive Care Unit

PEDIATRICS ◽  
1978 ◽  
Vol 62 (2) ◽  
pp. 178-183 ◽  
Author(s):  
Prakash Kulkarni ◽  
Robert T. Hall ◽  
Philip G. Rhodes ◽  
Michael B. Sheehan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
General Population ◽  
Infant Mortality ◽  
Neonatal Intensive Care Unit ◽  
Sudden Infant Death Syndrome ◽  
Infant Death ◽  
Neonatal Intensive Care ◽  
Sudden Infant Death ◽  
Sudden Infant

The postneonatal infant mortality (PNIM) of 2,205 infants admitted to a neonatal intensive care unit from January 1971 to December 1974 was 44 in 1,000 infants who survived to age 28 days. This rate is approximately ten times that of the general population. Congenital malformations (59%), infections (12%), sudden infant death syndrome (10%), and asphyxial brain damage (10%) were the most common causes of death. One third (26) of the infants remained in the hospital whereas two thirds (52) had been dismissed prior to death. All who remained in the hospital plus 36 who had been dismissed died of severe illnesses that were incompatible with prolonged survival. The remaining PNIM was 10 in 1,000 neonatal survivors. This rate is still twice that of the general population. These deaths occurred in infants who were apparently well at the time of dismissal and subsequent examinations. Sudden infant death syndrome and infections constituted the largest portion of this mortality. Factors contributing to mortality in this group were poor socioeconomic status and low birth weight. Maternal age, race, marital status, and neonatal illnesses including apnea were not significantly related. Factors that appear to be important in the birth of high-risk infants continued to be operative in the postneonatal period, and contribute to a high mortality in apparently normal infants dismissed from the neonatal intensive care unit.

Prolonged Apnea and Cardiac Arrhythmias in Infants Discharged from Neonatal Intensive Care Units: Failure to Predict an Increased Risk for Sudden Infant Death Syndrome

PEDIATRICS ◽  
1982 ◽  
Vol 70 (6) ◽  
pp. 844-851 ◽  
Author(s):  
D. P. Southall ◽  
J. M. Richards ◽  
K. J. Rhoden ◽  
J. R. Alexander ◽  
E. A. Shinebourne ◽  
...  
Keyword(s):  
Intensive Care ◽  
Sudden Infant Death Syndrome ◽  
Infant Death ◽  
Cardiac Arrhythmias ◽  
Neonatal Intensive Care ◽  
Sudden Infant Death ◽  
Neonatal Intensive Care Units ◽  
Sudden Infant ◽  
Prolonged Apnea ◽  
Premature Beats

Twenty-four hour recordings of respiratory wave form and ECG were made on low-birth-weight and/ or premature infants within one week of discharge from eight neonatal intensive care units. Eight infants (0.7%) had episodes of apnea >30 seconds in duration, all of which were accompanied by bradycardia <100 beats per minute; 25 infants (2.3%) had a total of 36 apneic episodes between 20 and 30 seconds in duration, 29 of which were accompanied by bradycardia ≤100 beats per minute; and 19 infants (1.7%) had episodes of bradycardia ≤50 beats per minute without prolonged apnea (as shown by a lack of breathing movement). Five infants had ventricular premature beats (including one with ventricular tachycardia). Eleven infants had supraventricular premature beats (including two with supraventricular tachycardia and one with preexcitation). Four infants had both supraventricular and ventricular premature beats. Two infants had preexcitation. Eleven infants who underwent 24-hour recordings died. Five infants were victims of sudden infant death syndrome. One infant death was sudden and unexpected and was attributed to bronchopneumonia. Two deaths were associated with congenital heart disease and three were associated with major cerebral disorders. None of the six babies who died suddenly and unexpectedly had apnea ≥20 seconds, bradycardia ≤50 beats per minute, or cardiac arrhythmias on their 24-hour recordings.

False alarms in the nursery

PEDIATRICS ◽  
1978 ◽  
Vol 61 (4) ◽  
pp. 665-666
Author(s):  
J. F. L.
Keyword(s):  
Intensive Care ◽  
Sudden Infant Death Syndrome ◽  
Infant Death ◽  
Home Monitoring ◽  
Sudden Infant Death ◽  
Alarm Calls ◽  
Sudden Infant ◽  
False Alarms ◽  
Intensive Care Nursery ◽  
The Cost

British police no longer answer burglar-alarm calls with enthusiasm. Who can blame them? Statistics indicate that 98.8% of automatic burglar-alarm calls are false. It is estimated that false alarms are costing British taxpayers $36 million a year.1 What connection does this observation have with pediatrics? The article by Kelly et al. in this issue (p. 511) recommends home monitoring with apnea alarms to perhaps abort the sudden infant death syndrome (SIDS) in a group of infants judged to be at risk. I can't help but wonder about the "cost" of false alarms in this situation and in the intensive care nursery, where their use is universal.

Simple Apnea Monitoring May Not Work

PEDIATRICS ◽  
1977 ◽  
Vol 60 (4) ◽  
pp. 561-561
Author(s):  
NORMAN LEWAK
Keyword(s):  
Intensive Care ◽  
American Academy ◽  
Sudden Infant Death Syndrome ◽  
Infant Death ◽  
Sudden Infant Death ◽  
Sudden Infant ◽  
American Academy Of Pediatrics ◽  
Apnea Monitoring ◽  
Intensive Care Nursery ◽  
Made In

To the Editor: In August 1975 (Pediatrics 56:296, August 1975) I reported on an infant who died of sudden infant death syndrome (SIDS) despite apnea monitoring in an intensive care nursery. My communication was made to counter lay articles advocating use of apnea monitors to “prevent” SIDS. Similar responses to home apnea monitor advocates have been made in a Pediatrics commentary1 and an American Academy of Pediatrics committee statement.2 An article has since appeared that

scholarly journals 108 Palliative care for neonates: Retrospective mixed methods review of infant death in the Neonatal Intensive Care Unit

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e45-e45
Author(s):  
Marina Journault ◽  
Simone Stenekes ◽  
Robin McClure ◽  
Chelsea Ruth
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Infant Death ◽  
End Of Life Care ◽  
Neonatal Intensive Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Age At Death

Abstract Background Neonatal palliative care is an under researched yet growing field in the provision of intensive care to neonates. There are currently no studies which explore infant death in the Neonatal Intensive Care Unit (NICU) itself where a shift from intensive to palliative care may occur. Objectives The purpose of this study was to explore the circumstances of infant death in the NICU and understand current utilization of specialist palliative care in this area. It aimed to characterize the infants’ clinical course and add unique understanding by analyzing documentation related to end of life care. Design/Methods A retrospective chart review of infants who died in a single centre NICU between January 2017 and March 2018 was undertaken. Infants of any gestational and post-natal age were included, excluding infants who died prior to arrival to the NICU or were discharged or transferred prior to death. Chart notes relating to prognosis, advanced care planning, and palliative interventions were sampled, coded, and collated for thematic analysis. Results Twenty-five infants met study criteria. Of these, 92% were preterm with more than half below 28 weeks gestation. Median age at death was 5.2 days (IQR 1, 26.2). All infants required ventilator support with planned withdrawal occurring in 60%. Specialist palliative care was involved in 28%; these infants tended to be older (mean age at death = 78 days). Most infants were labelled as “critical” 2-5 days prior to death. Seventy-six percent of infants were held on their last day of life with 72% of families having memory making documented as part of their care. Qualitative excerpts revealed themes of hope and acceptance, parental presence, and framed discussion. Within these emerged concepts of “parental agreement” and “palliative language/approach”. Conclusion There is a growing need for both primary and specialist palliative care in the NICU. This study highlights an under researched area and generates many more important questions. By exploring documented language, we aim to understand and improve the ability to frame the discussion while ensuring quality end of life care for dying infants and their families in the NICU.

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