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From the *Department of Pediatrics, University of Saskatchewan, Saskatoon, Sask.; the Centre for Community Health and Health Evaluation Research, Vancouver, BC; the Department of Pediatrics, University of British Columbia, Vancouver, BC; the Department of Pediatrics, University of Ottawa, Ottawa, Ont.; the ¶Department of Pediatrics, University of Manitoba, Winnipeg, Man.; and the **Department of Pediatrics, University of Toronto, Toronto, Ont.Members of the Canadian Neonatal Network Coordinator:
Shoo K. Lee, Coordinator, Canadian Neonatal Network, Vancouver, BC. Network members: Wayne Andrews, Charles A. Janeway Child Health Centre, St John's, Nfld.; Ranjit Baboolal, North York Hospital, Toronto, Ont.; Jill Boulton, St. Joseph's Health Centre, London, Ont. (previously at Mount Sinai Hospital, Toronto, Ont.); David Brabyn, Royal Columbian Hospital, New Westminster, BC; David S.C. Lee, St. Joseph's Health Centre, London, Ont.; Derek Matthew, Victoria General Hospital, Victoria, BC; Douglas D. McMillan, Foothills Hospital, Calgary, Alta.; Christine Newman, Hospital for Sick Children, Toronto, Ont.; Arne Ohlsson, Mount Sinai Hospital, Toronto, Ont. (formerly at Women's College Hospital, Toronto, Ont.); Abraham Peliowski, Royal Alexandra Hospital, Edmonton, Alta.; Margaret Pendray, Children's & Women's Health Centre of British Columbia, Vancouver, BC; Koravangattu Sankaran, Royal University Hospital, Saskatoon, Sask.; Barbara Schmidt, Hamilton Health Sciences Corporation, Hamilton, Ont.; Mary Seshia, Health Sciences Centre, Winnipeg, Man.; Anne Synnes, Children's and Women's Health Centre of British Columbia, Vancouver, BC (formerly at Montreal Children's Hospital, Montreal, Que.); Paul Thiessen, Children's & Women's Health Centre of British Columbia, Vancouver, BC; Robin Walker, Children's Hospital of Eastern Ontario and The Ottawa Hospital — General Campus, Ottawa, Ont.; Robin Whyte, IWK-Grace Health Centre for Women, Children and Families, Halifax, NS. Staff members, Canadian Neonatal Network Coordinating Centre: Li-Yin Chien, Joanna Sale, Herbert Chan and Shawn Stewart, Vancouver, BC.
Correspondence to: Dr. Shoo K. Lee, Coordinator, Canadian Neonatal Network, 4480 Oak Street, Room E 414; Vancouver BC V6H 3V4 fax 604 875-3124; shool{at}interchange.ubc.ca
Background: Most previous reports of variations in mortality rates for infants admitted to neonatal intensive care units (NICUs) have involved small groups of subpopulations, such as infants with very low birth weight. Our aim was to examine the incidence and causes of death and the risk-adjusted variation in mortality rates for a large group of infants of all birth weights admitted to Canadian NICUs.
Methods: We examined the deaths that occurred among all 19 265 infants admitted to 17 tertiary-level Canadian NICUs from January 1996 to October 1997. We used multivariate analysis to examine the risk factors associated with death and the variations in mortality rates, adjusting for risks in the baseline population, severity of illness on admission and whether the infant was outborn (born at a different hospital from the one where the NICU was located).
Results: The overall mortality rate was 4% (795 infants died). Forty percent of the deaths (n = 318) occurred within 2 days of NICU admission, 50% (n = 397) within 3 days and 75% (n = 596) within 12 days. The major conditions associated with death were gestational age less than 24 weeks (59 deaths [7%]), gestational age 24–28 weeks (325 deaths [41%]), outborn status (340 deaths [42%]), congenital anomalies (270 deaths [34%]), surgery (141 deaths [18%]), infection (108 deaths [14%]), hypoxic–ischemic encephalopathy (128 deaths [16%]) and small for gestational age (i.e., less than the third percentile) (77 deaths [10%]). There was significant variation in the risk-adjusted mortality rates (range 1.6% to 5.5%) among the 17 NICUs.
Interpretation: Most NICU deaths occurred within the first few days after admission. Preterm birth, outborn status and congenital anomalies were the conditions most frequently associated with death in the NICU. The significant variation in risk-adjusted mortality rates emphasizes the importance of risk adjustment for valid comparison of NICU outcomes.
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