Prognosis of children born to mothers with HELLP-syndrome

In literature there have been differences in the assessment of the outcome of children born to mothers with HELLP syndrome. In a retrospective study we investigated six annual groups (1989-1994) at the Perinatal Center in Erlangen (11,235 births, 68 children of mothers with HELLP syndrome), 53 children were treated in our neonatal intensive care unit (NICU). The control group (n = 219) consisted of a complete age group in our NICU. The gestational age (mean 33 weeks, p < 0.003) and the birth weight (mean 1671 g, p < 0.001) were significantly lower in the HELLP group. No significant differences were detected with respect to the frequency of leucocytopenia (p = 0.518) and thrombocytopenia (p = 0.215). Despite a relatively high rate (37.7%) of RDS there was only a significant tendency to the disadvantage of HELLP children (p = 0.075). There was no difference in frequency of intracranial hemorrhage (ICH) (p = 0.566). Infections were diagnosed less frequently in HELLP children (p = 0.042). Mortality in the control group was higher only as a tendency (p = 0.07). The follow-up examinations of the neurological development covered 31 of the 53 treated children. After 6-72 months (median 24 months), 90.3% of these children showed normal development or only minor disabilities. The prognosis of children of mothers with HELLP syndrome is not as bad as has been assumed so far.     

Respiratory outcome in preterm small for gestational age fetuses with or without abnormal umbilical artery Doppler and/or maternal hypertension.

OBJECTIVE: To study respiratory outcome in preterm small for gestational age (SGA) fetuses with or without signs of intrauterine growth restriction due to placental insufficiency, and with or without maternal hypertension. METHODS: This was a retrospective study of 187 neonates with birth weight <10(th) percentile and gestational age <34 weeks. Results from umbilical artery Doppler velocimetry were used to identify the abnormal Doppler subgroup. RESULTS: No significant difference in respiratory outcome between SGA fetuses with normal (SGA-N) or abnormal (SGA-A) umbilical artery Doppler examination was found. Within the SGA-A group, the respiratory distress syndrome (RDS) incidence (OR 5.6, 95% CI 1.7-18.3), RDS grade (OR 6.7, 95% CI 1.2-38.5), and need for surfactant (OR 5.3, 95% CI 1.1-24.4) were higher in infants of women with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome as compared to those of normotensive mothers. CONCLUSIONS: Lung maturation is not accelerated with placental insufficiency. SGA-A fetuses of mothers with HELLP syndrome have a significantly poorer respiratory outcome than those with healthy mothers. Possibly, fetuses of mothers with HELLP syndrome are subjected to 'oxidative stress' causing lung damage rather than lung maturation.     

Subsequent pregnancy following labor of a very-low-birth-weight infant

During a period of 5 years (1978-1982), 55 mothers with an average age of 27.5 +/- 5.4 years, delivered 59 infants, weighing less than 1500 g. These infants had a mean birth weight of 1160.5 +/- 263 g and a mean gestational age of 28.7 +/- 2.25 weeks (range 25-32 weeks). Subsequently 47 (79.6%) survived and 12 (20.4%) died. There was a statistical difference of both mean gestational age and of mean gestational weight between survivors or infants with neonatal death. Twenty two of 29 mothers who subsequently became pregnant, gave birth to liveborn infants, who subsequently survived (four pregnancies terminated in induced abortion). Mean gestational age was 37 +/- 3 weeks (range 32-41 weeks) (P less than 0.001) and a mean birth weight was 2753.2 +/- 570 g (range 1620-3600 g) (P less than 0.001. All the 22 infants subsequently born weighed more than 1501 g, 7 (31.8%) infants weighed 1501-2500 g and 15 (68.2%) more than 2500 g. Similar data were obtained from a control group of 615 mothers (chosen at random) who delivered a normal infant at term, 202 subsequently became pregnant and 176 gave birth to a normal infant at term. Mean gestational age was 39.54 +/- 1.24 weeks (P less than 0.001) and mean birth weight was 3299.3 +/- 412 g (P less than 0.001). (In the control group 10 pregnancies terminated in induced abortions). The above data could be used in advising for future pregnancy outcome in regard to women with premature births.     

Respiratory outcome in preterm small for gestational age fetuses with or without abnormal umbilical artery Doppler and/or maternal hypertension

Objective.?To study respiratory outcome in preterm small for gestational age (SGA) fetuses with or without signs of intrauterine growth restriction due to placental insufficiency, and with or without maternal hypertension.

Methods.?This was a retrospective study of 187 neonates with birth weight <10^th percentile and gestational age <34 weeks. Results from umbilical artery Doppler velocimetry were used to identify the abnormal Doppler subgroup.

Results.?No significant difference in respiratory outcome between SGA fetuses with normal (SGA-N) or abnormal (SGA-A) umbilical artery Doppler examination was found. Within the SGA-A group, the respiratory distress syndrome (RDS) incidence (OR 5.6, 95% CI 1.7–18.3), RDS grade (OR 6.7, 95% CI 1.2–38.5), and need for surfactant (OR 5.3, 95% CI 1.1–24.4) were higher in infants of women with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome as compared to those of normotensive mothers.

Conclusions.?Lung maturation is not accelerated with placental insufficiency. SGA-A fetuses of mothers with HELLP syndrome have a significantly poorer respiratory outcome than those with healthy mothers. Possibly, fetuses of mothers with HELLP syndrome are subjected to ‘oxidative stress’ causing lung damage rather than lung maturation.     

Effect of preeclampsia on blood pressure in newborn very low birth weight infants.

OBJECTIVE: To test the hypothesis that very low birth infants born to mothers with preeclampsia have higher blood pressure over the first week of life than infants whose mothers did not have preeclampsia. METHOD: Infants born at<1,350 g who survived at least one week were stratified by gestational age ( or= 29 completed weeks) and grouped by the presence or absence of preeclampsia. Highest and lowest systolic and mean and diastolic blood pressures were recorded for each of the first seven days of life. Serial blood pressures were analyzed by repeated measures ANOVA. The presence of hypertension (defined as >or= 3 days with the highest systolic blood pressure>90th percentile for gestational age stratum and day-specific range) was analyzed by binary logistic regression. RESULTS. Infants >or= 29 weeks gestational age born to mothers with preeclampsia had higher blood pressures than did controls. Infants or= 29 weeks gestation. The long-term significance of this finding is not known.     

Low risk vaginally born preterm infants: a four year psychological and neurodevelopmental follow-up study

A prospective follow-up study of 39 vaginally born low risk preterm (less than 37 weeks of gestation) and ten term control infants was carried out to estimate psychological and neurodevelopmental outcome at four years of age in relation to conceptual age and fetal acidosis at birth. The patients were divided into two groups: infants born after 29-33 weeks gestation (Group I) and those born after 34-36 weeks gestation (Group II), with or without fetal acidosis, i.e. a fetal scalp pH below or above 7.20. Acidotic infants normalized within the first hour after birth. Marked low and high performance groups for intellectual performance and hearing and vision tests were discernable within the first two years. The language performance of preterm infants was delayed compared to infants born at term, especially in Group II infants. At four years of age, a higher number of Group II infants had psychomotor developmental problems; whereas, neurological handicaps were more frequent in Group I infants with fetal acidosis. This indicates that re-evaluation of neurodevelopmental outcome is needed at a later age, e.g. six years of age, in preterm infants after low risk deliveries.     

The preterm small-for-gestational age infant: a two-year follow-up study.

Previous investigators have reported unfavorable neurologic and developmental outcome of small-for-gestational age (SGA) infants (birth weight less than 1,500 grams born at term or at less than 30 weeks. of gestation. Since obstetrical considerations for the delivery of a SGA fetus often arise between 30 and 38 weeks, the outcome of these survivors becomes a relevant issue. In 1975 and 1976, twenty-eight of 47 such infants survived and 21 were followed sequentially during the first two years. Their birth weight was 1,220 +/- 195 grams (mean +/- S.D.) and the gestation 33.4 +/- 2 weeks. Each SGA infant was paired with a birth weight-matched appropriate-for-gestation (AGA) infant whose birth weight was 1,195 +/- 190 grams and gestation 29 +/- 2 weeks. The weight, length, and head circumference of the SGA infants attained the tenth percentile by 6 to 8 months and were similar to the AGA group. Quarterly neurologic examinations showed similar findings during the first year in the two groups. At 2 years, two SGA (diplegia) and one AGA (hemiplegia) infants were abnormal. The quarterly Bayley scores of the SGA infants were lower during the first 18 months but at 24 months, the two groups had similar scores. The favorable outcome in preterm SGA infants weighing less than 1,500 grams may serve as useful information in making clinical decisions for the management of mothers with suspected intrauterine growth retardation.     

Outcome of infants delivered between 24 and 28 weeks' gestation in women with severe pre-eclampsia.

OBJECTIVE: To determine whether there are differences in neonatal outcome between infants born to mothers with severe pre-eclampsia and those born to normotensive mothers with preterm labor and intact membranes between 24 and 28 weeks' gestation. MATERIALS AND METHODS: Over a 4-year period between 1991 and 1995, neonates of women with severe pre-eclampsia delivering between 24 and 28 weeks were matched for maternal age, antenatally assigned gestational age and mode of delivery to normotensive women delivering during the same period. RESULTS: Fifty-eight women with severe pre-eclampsia were matched to 58 normotensive controls who delivered as a result of preterm labor. Antenatal steroids were used more often in pre-eclamptic women (75% vs. 47%, p < 0.01). The mean birth weight of pre-eclamptic neonates was significantly lower than that of controls, 767 g vs. 989 g, respectively. Other neonatal complications were similar for both groups. Neonates of pre-eclamptics required longer ventilator support (21 vs. 16 median days, p = 0.03). Neonatal survival was similar for both groups (72% and 79% for pre-eclamptics and normotensives, respectively). CONCLUSIONS: Neonates born to patients with severe pre-eclampsia have similar survival but a lower birth weight and require longer ventilator support than neonates born to women with preterm labor.     

Maternal alcohol ingestion and the incidence of respiratory distress syndrome

The risk of respiratory distress syndrome in infants born to mothers with varying quantities of alcohol intake during pregnancy was assessed. In infants less than 37 weeks' gestation, there was a decreasing incidence of respiratory distress syndrome with increasing maternal alcohol consumption (p less than 0.02). In addition, in infants less than 37 weeks' gestation, maternal alcohol ingestion was associated with a decreased risk of respiratory distress syndrome even when adjusted for other factors such as smoking, gestational age, birth weight, Apgar score, and sex of the infant. It is suggested that maternal alcohol ingestion enhances the maturation of the fetal lung.     

Effect of Preeclampsia on Blood Pressure in Newborn Very Low Birth Weight Infants

Objective. To test the hypothesis that very low birth infants born to mothers with preeclampsia have higher blood pressure over the first week of life than infants whose mothers did not have preeclampsia. Method. Infants born at < 1,350 g who survived at least one week were stratified by gestational age ( ≤ 28 weeks and ≥ 29 completed weeks) and grouped by the presence or absence of preeclampsia. Highest and lowest systolic and mean and diastolic blood pressures were recorded for each of the first seven days of life. Serial blood pressures were analyzed by repeated measures ANOVA. The presence of hypertension (defined as ≥ 3 days with the highest systolic blood pressure > 90th percentile for gestational age stratum and day-specific range) was analyzed by binary logistic regression. Results. Infants ≥ 29 weeks gestational age born to mothers with preeclampsia had higher blood pressures than did controls. Infants ≤ 28 weeks gestational age born to preeclamptic and nonpreeclamptic mothers had similar blood pressures. In the combined cohort, hypertension was not more prevalent among infants born to women with preeclampsia. Conclusions. Preeclampsia is associated with higher blood pressure in very low birth weight neonates who are ≥ 29 weeks gestation. The long-term significance of this finding is not known.     

Hemolytic uremic syndrome in twin pregnancy at 32 weeks gestation with HELLP syndrome. Case report]

Renal failure occurring in pregnancy or post partum is an unusual but well-described complication. Acute renal failure seems to be associated more often with HELLP syndrome rather than with pre-eclampsia or chronic hypertension. Probable overlapping of HELLP and hemolytic uremic syndrome in pregnancy or postpartum should be taken into consideration when treating pregnant women who show signs of proteinuria, hypertension, hematuria, increase of reticulocytes, decrease of haptoglobin with thrombocytopenia and microangiopathic hemolytic anemia. Our case refers to a 32 year old woman at 32 weeks gestation in twin pregnancy who presented with HELLP syndrome and renal failure. Immediately postpartum oliguria was noted and the laboratory analyses suggested the coexistence of HELLP and hemolytic uremic syndrome. In patients with gestosis and/or HELLP syndrome presenting oliguria combined with a decrease of hemoglobin level not due to intraoperative hematic leaks it is always necessary to ask for haptoglobin dosage. In treating hemolytic uremic syndrome it is very important to use a high dosage of plasma and sometimes plasmapheresis. HELLP syndrome contributes to various complications which are sometimes responsible for kidney or maternal mortality. In treating these patients early diagnosis combined with a specific treatment can considerably reduce kidney and maternal mortality.     

Neonatal survival and perinatal factors in infants born at 24 to 32 weeks of gestation

Clinical associations between neonatal survival and perinatal factors were studied in very premature infants delivered at Kurashiki Central Hospital Perinatal Center during April 1979 to March 1983. The very premature singleton infants without congenital anomaly were studied in the present work, including 45 live-birth infants born at 24 to 32 weeks of gestation and weighing 590 to 2,000g at birth. The mortality rate for male infants was higher than that for female infants, but this difference was not statistically significant. The mortality rate for infants born at 28 to 32 weeks of gestation was 2.9%, and that for infants weighing 1,000g or more at birth, respectively. The cause of all these neonatal death was massive aspiration syndrome with intracranial hemorrhage, and severe neonatal asphyxia. The mortality rate for infants born at 24 to 32 weeks of gestation was 60%, and that of infants weighing 999g or less, 60%, respectively. The cause of all these neonatal deaths was respiratory distress syndrome with intracranial hemorrhage. Clinically, it was suggested that cesarean section after onset of labor, PROM, and Betamethasone prior to delivery increased the survival rate of these infants statistically significantly. The most important neonatal complication in the prognosis of very premature infants was intracranial hemorrhage. The most correlated perinatal factors of neonatal intracranial hemorrhage were one min. Apgar score and fetal lung maturation.     

Neonatal outcome in growth-restricted versus appropriately grown preterm infants

The objective of this paper is to examine whether growth-restricted preterm infants have a different neonatal outcome than appropriately grown preterm infants. All consecutive, singleton preterm deliveries between 27-35 weeks' gestation were included over a 4-year period. Infants with congenital anomalies and infants of diabetic mothers were excluded. Infants were categorized as small-for-gestational-age (SGA) when birth weight was at or below the 10th percentile, and appropriate-for-gestational-age (AGA) when between the 11th and 90th percentiles. Outcome variables included: neonatal death, respiratory distress syndrome (RDS), sepsis, intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Neonatal morbidity and mortality were examined by univariate and stepwise multivariate logistic regression analyses. Factors controlled for during the analysis included: maternal age; gestational age; mode of delivery; presence of preeclampsia, HELLP syndrome, prolonged premature rupture of membranes (PROM), placental abruption, placenta previa, prenatal steroid exposure, infant gender, and low Apgar score. Seventy-six infants were included in the SGA group and 209 in the AGA group. SGA infants had a higher mortality rate (p = 0.003). They also had more culture-proven sepsis episodes (p = 0.001). No differences were found with respect to the other outcomes. The results were similar when analyzed separately for the group of infants born at or below 32 weeks' gestation. Growth-restricted preterm infants were found to have both higher mortality and infection rates compared with AGA preterm infants. Growth restriction in the preterm neonate was not found to protect against other neonatal outcomes associated with prematurity. When considering elective preterm delivery for this high-risk group of pregnancies, the increased risks in the neonatal period should be taken into account.     

The HELLP-syndrome; maternal-fetal outcome and follow up of infants

OBJECTIVE: To investigate maternal-fetal outcome of infants born after pregnancies complicated by (H)ELLP syndrome. STUDY DESIGN: A retrospective cohort study was performed on patients with the HELLP or ELLP syndrome. Maternal and perinatal complications were recorded. The follow-up period of the infants was at least 18 months. A multivariate regression analysis was done to define the variables mostly contributing to adverse outcome. RESULTS: No maternal deaths occurred. Eighteen infants of the HELLP group and six infants of the ELLP group died; total perinatal mortality was 17.6%. After 18 months four infants had major handicaps, making a total adverse outcome of 22.8%. Statistical analysis shows early gestational age, prolongation of pregnancy and administration of antihypertensive medication as the factors influencing outcome of the infants most. CONCLUSIONS: Prolongation of pregnancy contributed to better perinatal outcome, while administration of antihypertensive medication and early gestational age were related to a more unfavorable outcome.     

Doppler sonographic findings for hypertension in pregnancy and HELLP syndrome

Doppler examinations of the umbilical artery, both uterine arteries, and the fetal middle cerebral artery were performed in the third trimester in 18 patients with pregnancy induced hypertension, 52 patients with preeclampsia, and 32 patients with HELLP syndrome and the results were correlated with the parameters fetal outcome. For 74% of the patients this was the first pregnancy, in 93% of the cases a cesarean section was necessary; 66% of the newborn babies were dystrophic and 90% of them were born prematurely. The blood flow in one uterine artery was restricted in 95% of all 102 pregnant women, only 5% did not show any pathological findings. A pathological blood flow was observed on Doppler sonography in the umbilical artery in 70% of the group and 39% showed a pathologically increased perfusion of the fetal middle cerebral artery. The average birth weights and gestational ages in the study group were markedly reduced in comparison with healthy pregnant women (pregnancy induced hypertension: 1620 g/35 weeks; preeclampsia: 1660 g/34 weeks; HELLP syndrome: 1160 g/31 weeks, respectively). The lowest values for average birth weight and gestational age occurred when all four investigated blood vessels showed pathological Doppler findings: 1180 g/31 weeks (0 to 1 pathological vascular findings: 2780 g/38 weeks; 2 pathological vascular findings: 1845 g/34.5 weeks; 3 pathological vascular findings: 1330 g/31 weeks). This Doppler study underlines the importance of examining four blood vessels: the uterine, the umbilical, and the fetal middle cerebral arteries for a complete analysis of the fetoplacental hemodynamics. On account of the severely impaired hemodynamics observed in the placentas of our patients with hypertensive diseases in pregnancy or HELLP syndrome, we believe the early diagnosis of these disorders by Doppler sonography and an early start of therapy to be essential.     

Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit

OBJECTIVE: To determine risk factors and outcomes for women with severe preeclampsia and renal failure. STUDY DESIGN: Retrospective study from 1995 to 1998 of all women with renal failure who were admitted to the obstetric intensive care unit at Groote Schuur Hospital, South Africa. A total of 89 women were identified with severe preeclampsia defined as blood pressure > or = 160/110 mm Hg and > or = 2+ proteinuria, renal failure defined as a creatinine level of > or = 1.13 mg/dL, and oliguria defined as < 100 mL urine produced in 4 hours; 72 charts were available for analysis. A comparison was made between the 3 groups, which were defined by the maximum recorded creatinine levels. RESULTS: Of the 72 women, 31 women (43%) were primiparous and 41 (57%) were multiparous. Median gestation at delivery was 32 weeks (range, 21-40 weeks). The median maximum creatinine was 3.85 mg/dL (range, 1.13-12.50 mg/dL). Twelve women (16%) had a history of chronic renal disease or hypertension, and 36 women (50%) had HELLP syndrome and 23 (32%) abruptio placentae. All women with severe renal impairment had either abruptio placentae or hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Perinatal mortality was 38% (27/72). However, in this series only 7 women (10%) required dialysis in the short term and none required long-term dialysis or kidney transplant. There were no maternal deaths. CONCLUSIONS: In women with severe preeclampsia and renal failure, major obstetric complications were common and perinatal outcome was poor. However, the need for dialysis was infrequent, with only 10% women requiring transient dialysis, and there were no cases of chronic renal failure that required dialysis or kidney transplant.     

Maternally administered antenatal vitamin K1: effect on neonatal prothrombin activity, partial thromboplastin time, and intraventricular hemorrhage

Infants weighing 1500 g or less at birth are susceptible to intraventricular hemorrhage. This may be due in part to low concentrations of vitamin K-dependent clotting factors. Women in labor between 24-34 weeks' gestation were selected, according to their hospital registration number, to receive 10 mg vitamin K1 intramuscularly at least four hours before delivery. Control women received no vitamin K. The study included only infants born of mothers who were in hospital more than four hours before delivery, who weighed 1500 g or less at birth, and were less than 34 weeks' gestation. Twenty vitamin K1 and 33 control infants qualified for the study. Infants in both groups received routine postnatal vitamin K1. On admission, the infant's prothrombin activity and partial thromboplastin time (PTT) were measured. A head ultrasound was done between days 2 and 4 of life. Results demonstrated significantly improved prothrombin activity, a nonsignificant trend toward improved PTT, and a significantly decreased frequency of intraventricular hemorrhage in infants whose mothers had received vitamin K1. The effect of antenatal vitamin K1 on prothrombin activity and PTT appeared to be more pronounced in female infants.     

Neonatal septicemia due to group B streptococci--perinatal risk factors and outcome of subsequent pregnancies

All cases of early onset group B streptococcal (GBS) septicemia in infants born at Karolinska Hospital 1975-1986 were reviewed. GBS-septicemia was diagnosed in 40 infants within the first five days of life. The incidence was 1.24 per 1000 births. Fifty-five percent of the infants were preterm and 48% were born more than or equal to 12 hours after rupture of membranes. Prematurity and/or prolonged rupture of membranes were present in 83% of all neonates with fatal outcome. Case fatality was 22%. Deliveries by both cesarean section (31%) and vacuum extraction (26%) were increased in the mothers when compared to an overall incidence of 14 and 12% (p less than 0.01). Twenty-four (89%) of 27 mothers had low type specific IgG antibodies against the infecting GBS-serotype. Late onset GBS-septicemia was diagnosed in only two infants during the period. Seventeen mothers went through 24 subsequent pregnancies. In 11 of those the mothers were colonized with GBS and 10 received penicillin prophylaxis during pregnancy and/or delivery. None of the infants born after prophylaxis were colonized with GBS. Two were born prematurely and all had an uneventful course; whereas one infant delivered at 26 weeks gestation of a colonized untreated mother died of GBS-septicemia. Screening of parturients at risk and selective antibiotic prophylaxis may help to prevent early onset GBS-septicemia.     

Morbidity and mortality of very low birth weight multiples compared with singletons

Background: Previous studies comparing the neonatal outcome of very low birth weight (VLBW) multiples and singletons have suggested a worse outcome for multiples at gestational ages on the limits of viability.

Objectives: The objective of this study is to determine the neonatal mortality and morbidity of VLBW multiples compared to singletons.

Methods: This is a retrospective study including all infants registered in the Spanish network for infants under 1500?g (SEN1500), over a 12-year period (from 2002 to 2013). Mortality and major morbidities were compared between singletons and multiples.

Results: About 32,770 infants were included: 21,123 singletons (64.5%) and 11,647 multiples (35.5%), with a mean gestational age of 29.5 weeks (22–38), and mean birth weight of 1115?g (340–1500). When adjusted by other perinatal factors, multiple pregnancy has a significantly higher risk of mortality than singleton pregnancy (odds ratio (OR) 1.15; IC 95% 1.05–1.26, p?=?.002), but not a higher risk of major morbidity or composite adverse outcome. In the subgroup of infants born before 26 weeks, multiples showed a higher risk of mortality (63.9% versus 51%, OR 1.7; 95% CI 1.47–1.96) and a higher risk of composite adverse outcome (88.9% versus 81.5%, OR 1.82, 95% CI 1.28–2.24).

Conclusions: In preterm infants born with less than 1500?g, multiple pregnancy is a prognostic factor that can slightly increase mortality. Extremely preterm infants born before 26 weeks have a greater risk of mortality and major morbidity if they come from a multiple pregnancy.     

Young maternal age associated with increased risk of postneonatal death

OBJECTIVE: To determine whether full-term, healthy infants born to early adolescent mothers (15 years old and younger) are at higher risk of postneonatal death compared with infants of adult mothers. METHODS: We combined the comprehensive 1996 and 1997 United States birth cohorts to compare postneonatal mortality rates among maternal age groups. With postneonatal death as our main outcome measure, we used multivariable logistic regression to model adjusted odds ratios. RESULTS: The postneonatal mortality rate for infants born to mothers 15 years old and younger was substantially higher (3.2 per 1000) than that of infants born to mothers 23-29 years old (0.8 per 1000) and remained substantially higher after adjusting for maternal race or ethnicity. Even after adjusting for maternal race or ethnicity, prenatal care utilization, and marital status, infants born to early adolescent mothers had a three-fold higher risk (odds ratio 3.0, 95% confidence interval 2.5, 3.6) of postneonatal death compared with adult mothers. CONCLUSION: Healthy infants born to early adolescent mothers are at increased risk of postneonatal death. Many of these deaths are potentially preventable; therefore, developing targeted postnatal support services specifically designed to address the needs of healthy infants born to adolescent mothers might have a positive effect on the lives of these children.