Symposium on synthetic surfactant. II: Perspective and commentary

Management of the surgical newborn: physiological foundations and practical considerations

The unique physiological changes that occur at birth and the adaptations that come in the first weeks of life profoundly affect the clinical management of the surgical newborn patient. The newborn has adaptive challenges that have to be met at birth: (a) establish a functional residual capacity and breathe; (b) change from a fetal to a newborn circulatory circuit; (c) change from fetal hemoglobin to hemoglobin A; (d) sustain a heart rate dependent cardiac output; (e) maintain normal body temperature; establish renal function and regulate postnatal body fluid composition; (f) establish hepatic function; and (g) maintain normal vital signs. Classical physiological studies of the last century describe the physiological basis of these adaptive tasks, and support practical considerations that we follow in clinical practice.

Cause-specific trends in neonatal mortality among black and white infants, United States, 1980-1995

OBJECTIVE

Although neonatal mortality has been declining more rapidly than postneonatal mortality in recent decades, neonatal mortality continues to account for close to two-thirds of all infant deaths. This report uses U.S. vital statistics data to describe national trends in the major causes of neonatal mortality among black and white infants from 1980 to 1995.

METHODS

Mortality rates were estimated as the number of deaths due to each cause (based on International Classification of Diseases, 9th Revision, codes) divided by the number of live births during the same time period. Linear regression models and smoothed rates were used to describe trends.

RESULTS

During the study period, neonatal mortality declined 4.0% per year for white infants and 2.2% per year for black infants, and the black-white gap increased from 2.0 to 2.4. By 1995, disorders relating to short gestation and low birth weight were the number one cause of neonatal death for black infants and the number two cause for white infants, had the highest black-white disparity (4.6, up from 3.3 in 1980), and accounted for almost 40% of excess deaths to black infants (up from 24% in 1980). Congenital anomalies were the number two cause of neonatal death for black infants and the highest ranked cause for white infants in 1995, and it is the only cause for which there was not a substantial excess risk to black infants.

CONCLUSIONS

Large declines in neonatal mortality have been achieved in recent years, but not in the black-white gap, which has increased. Declines were slower for black than white infants overall and for almost all causes. Prevention of preterm delivery and low birth weight continue to be a priority for reducing neonatal mortality, particularly among black infants. Although congenital anomalies do not contribute substantially to the black-white gap, their diagnosis, treatment, and prevention is critical to reducing overall neonatal mortality.