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Andrew Unger, MD; Boyd W. Goetzman, MD, PhD; Connie Chan; Arthur B. Lyons III, MD; Michael F. Miller, PhD

Am J Dis Child. 1986;140(10):1027-1033.

Abstract
• We analyzed the records of 182 new-borns with birth weights under 1000 g, who survived longer than seven days, to determine risk factors for subacute mortality and morbidity. Statistical analysis using logarithm-linear modeling was used to identify complex interactions and to minimize confounding. Nosocomial infection, necrotizing enterocolitis, male gender, and chronic lung disease (CLD) were identified as independent risk factors for subacute mortality. Male gender and CLD were associated with increased mortality only among patients who received parenteral nutrition (PN). Moreover, PN, rather than enteral nutrition (EN), was a risk factor for delayed growth, nosocomial infection, and CLD. Delayed initiation of EN was associated with decreased necrotizing enterocolitis risk only among male infants with birth weights under 775 g. Our results do not support elective withholding of EN in other groups of extremely low-birth-weight infants. We conclude that indications for PN and for withholding initiation of EN in very-very-low-birth-weight infants need to be established by prospective studies.

(AJDC 1986;140:1027-1033)

Author Affiliations
From the Division of Neonatology, Department of Pediatrics (Drs Unger and Dr Goetzman and Ms Chan), and the Division of Statistics (Dr Miller), University of California School of Medicine, Davis; and The Perinatal Center, Sutter Memorial Hospital, Sacramento, Calif (Dr Lyons). Dr Unger is now with St Luke's Hospital, Bethlehem, Pa, and Dr Miller is now with American Hoechst Corp, Sumerville, NJ.

Footnotes
Accepted for publication June 6, 1986.

Reprint requests to Division of Neonatology, TB-193, University of California, Davis, CA 95616 (Dr Goetzman).

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