A new study has identified longer stay in the NICU, poorer access to healthcare and being African American as factors that can increase the risk of death after discharge from the NICU.

Lilia C. De Jesus, MD, from Wayne State University, and colleagues retrospectively examined 5,364 preterm (less than 27 weeks of gestational age) infants with extremely low birth weights (less than 2.2 pounds) born in 2000 through 2007 at Eunice Kennedy Shriver Neonatal Research Network sites. The researchers tracked these infants from discharge from the NICU until 18 to 22 months of age.

Of the 4,807 infants with whom the authors successfully followed up, 107 died after discharge from the NICU (22.3 per 1,000 extremely low birth-weight infants). The odds of death after NICU discharge were doubled in African-American infants (compared with other racial groups), three times higher in infants who were in the NICU at least 120 days and 15 times higher if the maternal insurance status was unknown (compared with private insurance), which may indicate poorer access to healthcare.

The researchers also noted that maternal exposure to antibiotics during pregnancy decreased the risk of infant death after discharge from the NICU.

The World Factbook ranks the United States only 48th worldwide in infant mortality (6.06 deaths per 1,000 live births), De Jesus noted. "Every effort should be made to identify and correct modifiable factors that may account for the increased risk of death after hospital discharge in these extremely premature infants," De Jesus said. "We feel that information from our study can be used to develop interventions that may help health practitioners with the discharge and follow-up care of these high-risk infants."