A NATIONAL STUDY OF RISK-FACTORS ASSOCIATED WITH MORTALITY IN VERY-LOW-BIRTH-WEIGHT INFANTS IN THE MALAYSIAN NEONATAL INTENSIVE-CARE UNITS

Objective: To determine the risk factors associated with mortality in very low birthweight (VLBW) infants admitted to the neonatal intensive care units (NIUC) in Malaysia. Method: A prospective observational st udy of outcome of all VLBW infants born between 1 January 1993 and 30 June 1993 and admitted to the NICU. Results: Data of 868 VLBW neonates from 18 centres Malaysia were collected. Their mean birthweight was 1 223 g (95% confidence intervals: 1208-1238 g). Thirty-seven point four per cent (325/868) of these infants died before discharge. After excl usion of all infants with congenital anomalies (n = 66, and nine of th em also had incomplete records) and incomplete records (n = 82), stepw ise logistic regression analysis of the remaining 720 infants showed t hat the risk factors that were significantly associated with increased mortality before discharge were: delivery in district hospitals, Chin ese race, lower birthweight, lower gestation age, persistent pulmonary hypertension of the newborn, pulmonary airleak, necrotizing enterocol itis of stage 2 or 3, confirmed sepsis, hypotension, hypothermia, acut e renal failure, intermittent positive pressure ventilation, and umbil ical arterial catheterization. Factors that were significantly associa ted with lower risk of mortality were: use of antenatal steroid, oxyge n therapy, surfactant therapy and blood transfusion. Conclusion: The m ortality of VLBW infants admitted to the Malaysian NICU was high and w as also associated with a number of preventable risk factors.