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Diarrheal Mortality in US Infants
Influence of Birth Weight on Risk Factors for Death
Umesh D. Parashar, MBBS, MPH;
Paul E. Kilgore, MD, MPH;
Robert C. Holman, MS;
Matthew J. Clarke, MA;
Joseph S. Bresee, MD;
Roger I. Glass, MD, PhD
Arch Pediatr Adolesc Med. 1998;152:47-51.
Objectives To examine diarrhea-associated deaths among very low-birth-weight (VLBW) (<1500 g) infants and low- and normal-birth-weight (LNBW) ( 1500 g) infants at birth and to identify specific interventions to prevent these deaths.
Design Retrospective analyses of linked infant and birth death data on diarrhea of all causes compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Ga.
Patients Infants aged 27 days through 11 months who died with diarrhea.
Setting United States, 1991.
Results A majority (56%, n=143) of the 257 diarrhea-associated deaths reported among US infants in 1991 occurred among VLBW infants. Compared with LNBW infants, VLBW infants had a 100-fold greater diarrheal mortality (269 deaths per 100000 live births for VLBW infants vs 2.8 deaths per 100000 live births for LNBW infants), died at a younger age, and more often died in the hospital. Diarrhea-associated deaths among VLBW infants were strongly associated with prematurity and a low 1-minute Apgar score whereas African American race, less maternal education, and a low 1-minute Apgar score were associated with increased diarrheal mortality among LNBW infants.
Conclusions Infants of VLBW are at an increased risk for diarrheal deaths and new efforts are required to understand and improve the diagnosis of and therapy for diarrhea among these infants. For LNBW infants, diarrheal deaths remain a social problem and efforts need to focus on improved education and home-based rehydration therapy for children whose mothers fit the high-risk profile and who may lack adequate access to health care.
From the Epidemic Intelligence Service, Epidemiology Program Office (Dr Parashar), and the Viral Gastroenteritis Section (Drs Parashar, Kilgore, Bresee, and Glass) and Office of the Director (Messrs Holman and Clarke), Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Dr Kilgore is now with the Child Vaccine-Preventable Diseases Branch, Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention.
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