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Background <p>Neonatal mortality has decreased during the last 50 yrs. To determine associations between changes in in-hospital mortality with race/ethnicity, gestational age (GA) and medical interventions, we studied very preterm neonates ( &lt; 33wks GA, VPT).</p> Methods <p>This retrospective cohort study includes neonates born 22–32wks GA at Parkland Hospital, Dallas, TX January 1977-June 2024 and included in a validated, prospectively collected database. Neonates with congenital anomalies or absolute birthweight Z-score &gt;5 were excluded.</p> Results <p>Overall, in-hospital mortality among 10,882 inborn VPT neonates decreased from 47.8% in 1977–1981 to 15.5% in 1987–1991 and 8.2% in 2023–2024. Mortality decreased 97–98% by 1986 in neonates 30–32wks GA and 92-93% by 1991 in neonates 27–30wks GA. Mortality in neonates 22–23wks GA remained &gt;95% until 2010 and decreased 50% 2016–2024. Decreased mortality was associated with changes in prenatal and neonatal care. Although racial disparities in GA-specific mortality disappeared in 2009, higher mortality with male sex continued in 2024.</p> Conclusions <p>Using a 47 yr database we documented serial decreases in&#xa0;in-hospital mortality in VPT neonates that are GA-dependent and occurred earliest in neonates 30–32wks GA, but not until after 2010 in those 22–23wks GA, paralleling changes in processes of maternal and neonatal care. Racial disparities in GA-specific mortality disappeared in 2009.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Maintenance of a well-validated NICU database permits continuous assessment of local changes in care, their impact on local mortality/morbidity, and permits comparisons with national/international trends.</p> </ItemContent> <ItemContent> <p>In-hospital mortality decreased in association with changes in clinical care, first in neonates 32–33wks gestational age (GA) and last in those 22–23wks GA. Although racial disparity in mortality disappeared in 2009, higher mortality persisted in males.</p> </ItemContent> <ItemContent> <p>Long-term assessment of local changes in clinical care permits annual analysis of their impact on mortality/morbidity in comparison with neonatal/perinatal trends.</p> </ItemContent> </UnorderedList></p>

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Changes in mortality in very preterm neonates in a single institution in Dallas, Texas, 1977–2024: a cohort study

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  • 发表日期：

    2026年5月23日

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  • Luc P. Brion,
  • Charles R. Rosenfeld,
  • Patti J. Burchfield,
  • Kikelomo Babata,
  • Larry Steven Brown,
  • Mambarambath Jaleel

摘要

Background

Neonatal mortality has decreased during the last 50 yrs. To determine associations between changes in in-hospital mortality with race/ethnicity, gestational age (GA) and medical interventions, we studied very preterm neonates ( < 33wks GA, VPT).

Methods

This retrospective cohort study includes neonates born 22–32wks GA at Parkland Hospital, Dallas, TX January 1977-June 2024 and included in a validated, prospectively collected database. Neonates with congenital anomalies or absolute birthweight Z-score >5 were excluded.

Results

Overall, in-hospital mortality among 10,882 inborn VPT neonates decreased from 47.8% in 1977–1981 to 15.5% in 1987–1991 and 8.2% in 2023–2024. Mortality decreased 97–98% by 1986 in neonates 30–32wks GA and 92-93% by 1991 in neonates 27–30wks GA. Mortality in neonates 22–23wks GA remained >95% until 2010 and decreased 50% 2016–2024. Decreased mortality was associated with changes in prenatal and neonatal care. Although racial disparities in GA-specific mortality disappeared in 2009, higher mortality with male sex continued in 2024.

Conclusions

Using a 47 yr database we documented serial decreases in in-hospital mortality in VPT neonates that are GA-dependent and occurred earliest in neonates 30–32wks GA, but not until after 2010 in those 22–23wks GA, paralleling changes in processes of maternal and neonatal care. Racial disparities in GA-specific mortality disappeared in 2009.

Impact

Maintenance of a well-validated NICU database permits continuous assessment of local changes in care, their impact on local mortality/morbidity, and permits comparisons with national/international trends.

In-hospital mortality decreased in association with changes in clinical care, first in neonates 32–33wks gestational age (GA) and last in those 22–23wks GA. Although racial disparity in mortality disappeared in 2009, higher mortality persisted in males.

Long-term assessment of local changes in clinical care permits annual analysis of their impact on mortality/morbidity in comparison with neonatal/perinatal trends.