Postponed neonatal death in the premature infant
S. B. Turkel, M. E. Sims and M. E. Guttenberg
Improved obstetrical and neonatal care has increased survival for many
small premature infants. However, there remains a distinct group who die of
complications later in infancy. The autopsy findings associated with these
"postponed neonatal deaths" were the subject of our retrospective study of
18 premature infants (mean estimated gestational age, 28.6 +/- 0.6 weeks)
who survived from 4 weeks to 4 months of age (mean, 70 +/- 11 days). All 18
infants required prolonged artificial ventilatory support and parenteral
nutrition. The major findings at autopsy were similar in all cases and
included bronchopulmonary dysplasia, hepatic cholestasis and fibrosis,
abnormalities of endochondral ossification, and diffuse cerebral gliosis
and infarction. Infection was the most common cause of death, and most of
the infants died with acute bronchopneumonia. These postponed neonatal
deaths, while they do not appear in standard neonatal mortality statistics,
represent a problem of concern.
