Search

Better prenatal care may partly explain the drop in neonatal mortality rates among premature infants in the 1990s. Researchers compared the outcomes of 379 low-birth-weight infants born between 1989-1990 and 365 similar infants born between 1994-1995. During the five-year period, total mortality rates dropped from 32% to 18%. Mortality rates in the neonatal intensive care unit similarly dropped about 50%. Only two-thirds of the decrease could be attributed to better postnatal care. The remainder was attributed to better prenatal care, such as better ultrasound imaging and other fetal assessment tools., Objectives. Declines in neonatal mortality have been attributed to neonatal intensive care. An alternative to the "better care" hypothesis is the "better babies" hypothesis; ie, very low birth weight infants are delivered less ill and therefore have better survival. Design. We ascertained outcomes of all live births [is less than] 1500 g in two prospective inception cohorts. We estimated mortality risk from birth weight and illness severity on admission and measured therapeutic intensity. We calculated logistic regression models to estimate the changing odds of mortality between cohorts. Patients and Setting. Two cohorts in the same two hospitals, 5 years apart (1989-1990 and 1994-1995) (total n = 739). Results. Neonatal intensive care unit mortality declined from 17.1% to 9.5%, and total mortality declined from 31.6% to 18.4%. Cohort 2 had lower risk (higher birth weight, gestational age, and Apgar scores and lower admission illness severity for newborns [is greater than or equal to] 750 g). Risk-adjusted mortality declined (odds ratio, 0.52; confidence interval, 0.29-0.96). One third of the decline was attributable to "better babies" and two thirds to "better care." Use of surfactant, mechanical ventilation, and pressors became more aggressive, but decreases in monitoring, procedures, and transfusions resulted in little change in therapeutic intensity. Conclusions. Mortality decreased nearly 50% for infants [is less than] 1500 g in 5 years. One third of this decline is attributable to improved condition on admission that reflects improving obstetric and delivery room care. Two thirds of the decline is attributable to more effective newborn intensive care, which was associated with greater aggressiveness of respiratory and cardiovascular treatments. Attribution of improved birth weight specific mortality solely to neonatal intensive care may underestimate the contribution of high-risk obstetric care in providing "better babies." Pediatrics 1998;102:893-899; neonatal intensive care, neonatal mortality, low birth weight, illness severity, high-risk obstetric care., ABBREVIATIONS. VLBW, very low birth weight; NICU, neonatal intensive care unit; SNAP, Score for Neonatal Acute Physiology; NTISS, Neonatal Therapeutic Intervention Scoring System. The rapid decline in neonatal mortality during [...]

The infant mortality rate in the US has declined since the 1960s, but large differences in infant mortality still exist between different racial groups. A research study found that among infants born to college-educated parents, the mortality rate was higher among black infants than among white infants. Higher mortality among black infants was caused by higher rates of low and very low birth weight. Social variables used by health researchers to assess racial differences in infant mortality may not fully reflect differences between racial groups in the US. Although parent income and education may be the same, middle-class white families may still have more economic resources than black families. Social differences between races are complex, and are difficult to characterize. An interdisciplinary approach and more communication between medical researchers and health care workers is needed to more fully understand differences in infant mortality between different racial groups.