Neonatal mortality in normal birth weight babies: Does the level of hospital care make a difference?

Article Abstract:

The overall mortality rate for infants in the U.S. is 9 in 1000 live births, two thirds of which die within the first 28 days of life (neonatal mortality). Factors influencing mortality rates need to be assessed to effectively lower total infant mortality. Birth weights influence fetal outcome the most and are the greatest single contributor to infant death rates. Low birth weight infants, weighing less than 2,500 grams (5.5 pounds), are generally cared for in hospital intensive care units, which has been found to improve survival. Hospital levels of care are rated one through three, where level three facilities treat highest risk patients. If overall infant mortality rates are to be lowered, an evaluation of level of care for normal birth weight infants has to be made to determine if care level contributes to their death. Birth and death records over a three year period between Jan 1979 and Dec 1982 were examined in Georgia. The level of care was determined by fetal, mother, and infant risk before delivery. Low birth weight infants treated in level three facilities had lower mortality rates. Normal birth weight infants with high maternal pre-delivery risk had decreased chance of death as the level of care improved. Labor complications which developed in pregnant women, regardless of pre-delivery risk, were associated with increased neonatal mortality rates at level one hospitals. The study suggests pregnant women should be evaluated for risk status and referred to level two or three hospitals for delivery if appropriate.

Evaluation, Patient outcomes, Mortality, Statistics, Birth weight, Low, Low birth weight, Infants, Infant mortality, Hospitalization, Health status indicators, Hospital care

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The epidemiology of infantile hypertrophic pyloric stenosis in New York State: 1983 to 1990

Article Abstract:

Several factors appear to be associated with infantile hypertrophic pyloric stenosis (IHPS). IHPS is a muscular obstruction of the stomach's outlet to the intestine causing projectile vomiting beginning in infancy. Surgery is usually necessary. Researchers compared two sources of New York State data: a registry of malformations and a registry of hospitalizations. Overall, 3,742 cases were reported in one database and 4,063 in the other between 1983 and 1990. The overall rate fell from 2.36 cases per 1,000 live births in 1984 to 1.66 cases per 1,000 in 1990. The decrease was entirely due to a decrease in cases reported among upstate boys, suggesting that underreporting may play a role. White males were more likely to have IHPS. Decreased incidence was associated with not being the first or second child, greater maternal age, higher maternal education, and low birth weight. IHPS patients, especially girls, were more likely to have other digestive tract malformations than the general population.

Pyloric stenosis

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A descriptive study of prune belly in New York State, 1983 to 1989

Article Abstract:

A survey of prune belly syndrome in New York elicited information about incidence, associated malformations, and mortality. Prune belly syndrome, a congenital malformation, is characterized by abdominal wall muscle defects, urinary tract abnormalities, and undescended testes. Data came from the state health department's Congenital Malformations Registry. From 1983 to 1989, 50 males and 10 females with prune belly syndrome were born alive to New York State residents. The prevalence was 3.2 per 100,000 live births. In males it was 5.1 per 100,000 versus 1.1 per 100,000 in females. Among blacks it was 5.8 per 100,000 versus whites at 2.6 per 100,000. Among twins the prevalence was 12.2 per 100,000 versus 3.0 among singletons. Sixty percent of the infants died, usually in the first week after birth. Underdeveloped lungs was one of the most frequent causes of death.

Abnormalities, New York, Urinary organs, Urinary tract

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