Prematurity

Infants Born Prematurely

National Center Quick-LookSeptember 2019The National Center for Fatality Review and Prevention collects information on infants born prematurely in the National Fatality Review Case Reporting System (CRS).  From 2004 – 2016 there have been over 145,400 child death cases reviewed and entered into the CRS by participating teams.

This CRS quick-look describes over 38,600 infants born prematurely, between 20-37 weeks gestation, who died before their first birthday.

1Click here to see more quick-looks like this on the National Center’s website.

Characteristics of Premature Infants
The median gestational age of premature infants was 27 weeks, 52% were born weighing less than 1,000 grams, and 10% were part of a multiple gestation.

Age at Death
0-7 days 56%8-28 days
13%Greater than 28 days

31%Sex
Boys 56%
Girls 44%

Race
White 46%
Black 29%
Hispanic 19%
Other 6%

Information not available in vital statistics
The CRS has been refined and enhanced since inception; with the most recent deployed version, Version 5.0, launched in April 2018. The system has over 3,600 variables.

Ever breastfed: Nearly 75% of mothers reported not breastfeeding their child.
Sleep environment: 20% of deaths were reported to have been related to sleeping or the sleep environment.
Considered preventable: Fatality review teams felt 18% of these deaths were preventable.

Death certificate information of premature infants

Primary cause of death: Over 91% were determined to be from a medical condition; the top two causes being prematurity (58%) and congenital anomaly (16%).
Location of death: The majority of premature infant deaths died at the hospital (61%) or at the child’s home (24%).
Official manner of death: 83% were reported as natural deaths on the death certificate. 6% were reported as an accident; three-fourths of these were due to unintentional asphyxia.

Characteristics of biological mother

Age: Median age of mother when infant died was 26 years.
Prenatal Care: 90% of mothers received prenatal care services.
Smoking Status: About 30% of mothers smoked before and during pregnancy with higher prevalence among non-Hispanic white mothers.
Before pregnancy:White 35%Black 26%Hispanic 13%
During pregnancy:White 39%Black 27%Hispanic 15%

Where do we go from here?
There are three categories public health practitioners may consider for prevention efforts.
1. Medical/Clinical

  • Prevent non-medially indicated preterm deliveries
  • Progesterone supplementation

2. Social

  • Address racism
  • Decrease maternal stress

3. Risk reduction

  • Address smoking/tobacco use before and during pregnancy
  • Identify and treat infections
  • Attention to maternal nutrition (preconception and during pregnancy)
  • Encourage and support mothers of preterm infants to breastfeed

National Partners:
Centers for Disease Control and Prevention (CDC)
National Center for Biotechnology Information (NCBI)
American College of Obstetricians and Gynecologists
March of Dimes

Made possible in part by Cooperative Agreement Numbers UG7MC28428 from the US Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Its contents are solely the responsibility of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the US Government.1 Includes data from deaths of infants who died within the first year of life and who were born with gestational ages between 20 and 37 weeks from 2004-2016, recorded in the CRS, and reviewed by child death review teams only. These data represent a smaller percent of the cases entered into the CRS. For more information about the data contained in this Quick Look, please visit https://www.www.ncfrp.org/wp-content/uploads/NCRPCD-Docs/NCFRP_Quick_Looks_Analysis.pdf