Preventing and postponing death: trends in Tennessee infant mortality

Decreasing trend in postneonatal mortality

OBJECTIVE

The objective was to evaluate the postneonatal mortality rate at our institution from 1999 to 2006 as a follow-up to a previous report from our hospital covering 1993 to 1998 and to investigate the causes of death in infants dying in the postneonatal period.

STUDY DESIGN

We identified all infant deaths before discharge from the nursery aged > or =28 days. Clinical data for all cases and autopsy records where available were reviewed and the cause of death was determined for each infant.

RESULT

Total nursery deaths for the 7 years were 211, of which 14 (6.6%) occurred after the neonatal period. This represents a decreasing trend from the 12% reported in 1993 to 1998. Causes of death were the complications of prematurity and congenital defects. The five infants whose cause of death was the complications of prematurity had chronic lung disease, four had abdominal surgery for perforation and resection and two had intraventricular hemorrhage (IVH) Gr IV. All infants had multiple organ failure by the time of death and the final event was infection and/or renal failure. The nine congenital defects included two trisomy 21 with complications, one CHARGE association with heart defects, one hypertrophic cardiomyopathy and two others with multiple congenital heart defects. Of the three remaining infants, the anomalies included one with hydranencephaly, one with caudal regression and one with multiple vascular liver tumors.

CONCLUSION

Along with the general decrease in infant mortality, postneonatal mortality is decreasing as a percentage of nursery deaths. The causes of death include complications of prematurity and congenital defects.

Postneonatal mortality in Alabama: why no progress in the 90s?

PURPOSE

To examine the factors associated with postneonatal mortality.

METHODS

Logistic regression was used to examine the effects of various variables on postneonatal mortality in Alabama.

RESULTS

The most important predictor of postneonatal mortality was birth weight. Social and economic variables were also important in explaining postneonatal mortality.

CONCLUSIONS

Reductions in postneonatal mortality may require closer case management of low birth weight neonatal survivors. Survival of these infants creates a cohort at risk of postneonatal mortality. Many of these low birth weight infants are born into an environment where their mothers' parenting potential is compromised by youth and poverty. This may be responsible for the failure to reduce postneonatal mortality and explain its increasing proportion of infant deaths; deaths may be being postponed from the neonatal to the postneonatal period.

[Trends in infant mortality in France: frequency and causes from 1950 to 1997]

OBJECTIVES

To present an analysis of the infant mortality trends and causes of death in France from the beginning of the 1950s, neonatal (0-27 days) and post-neonatal mortality (27-364 days) being considered separately.

MATERIAL AND METHODS

We used the data from the national registries of births computed by INSEE (National Institute of Statistics and Economic Surveys) and of causes of deaths computed by Inserm (National Institute of Health and Medical Research). We analysed the evolution of the infant death rates from 1950 to 1997, the overall mortality for males and the percentages of causes of death at three different periods.

RESULTS

Mortality has changed according to neonatal or post-neonatal ages. A constant improvement was recorded for neonatal mortality up to 1995 (2.9 per 1,000), while there was a stagnation for post-neonatal mortality between 1979 and 1993, followed by a sharp decrease (2.0 per 1,000 in 1995). During the neonatal age the main causes of death are conditions generated in the neonatal period and congenital abnormalities, both decreasing regularly; during the post-neonatal age the main cause is sudden infant death syndrome, which fell dramatically during the last four years.

CONCLUSION

Several factors related to medical care, nursing and type of registration are contributing simultaneously to the important variations in mortality found in our results.

Impact of increased neonatal survival on postneonatal mortality in the United States

Neonatal intensive care has increased neonatal survival, but has also led to postponement of some of the neonatal deaths to the postneonatal period, particularly in very low birthweight (< 1.5 kg) infants. Our report assesses the impact of the increased neonatal survival and the accompanying delayed deaths on the crude postneonatal mortality rate of the US, using the national livebirth cohort data of 1960, 1980, and 1986. With increased neonatal survival, very low birthweight infants comprised 0.68% of all neonatal survivors in 1986, compared with only 0.31% in 1960. However, postneonatal mortality was increased in infants with birthweights < 1.0 kg from 69 per 1000 neonatal survivors in 1960 to 116 per 1000 in 1986. All other birthweight groups (> 1.0 kg) showed significant reductions in their postneonatal mortality, although the 1.0-1.5 kg group showed the least improvement. Thus, in 1986, 12.1% of all postneonatal deaths were from the very low birthweight neonatal survivors, as compared with 2.7% in 1960. If there had been no improvement in neonatal survival of very low birthweight infants since 1960, the crude postneonatal mortality rate of the US would have been 5.5% and 7.9% less than the actual rates of 3.65 and 3.45 per 1000 neonatal survivors in 1980 and 1986, respectively. However, the impact of these delayed deaths in very low birthweight infants was far less than the increase in their neonatal survival: an additional 416 per 1000 very low birthweight infants survived to 1 year of age in 1986 as compared with 1960. Delayed deaths in the 1.5-2.5 kg birthweight group had a very small effect on postneonatal mortality and there was no such effect of delayed deaths in the > 2.5 kg birthweight group.