Comparing Cause-Specific Infant Mortality in a West German State and the United States of America

ABSTRACT. The infant mortality rate in North Rhine Westphalia (NRW), the most populous West German state, has continuously been around 10 % higher than the German national average in the post-war period. Using white singleton data from the US 1980 National Infant Mortality Surveillance project (NIMS) and similar 1980/1981 data from NRW we compared infant mortality by birthweight and cause to describe the distribution of excess mortality in NRW. The US infant mortality rate was 8.7 deaths per 1000 live births, compared with 13.1/1000 for NRW (rate difference: 4.3/1000). Of the 4.3/1000 overall rate difference, 1.9/1000 was attributable to neonatal deaths, 2.4/1000 to postneonatal deaths. A major proportion, 2.0/1000, of the overall rate difference of 4.3/1000 was attributable to normal birthweight deaths postneonatally. 0.85/1000 of this 2.0/1000 rate difference was attributable to SIDS, 0.44/1000 to external causes and 0.42/1000 to infections.     

Sudden infant death syndrome and infant mortality in Aboriginal and non-Aboriginal infants

The aim of this study was to investigate sudden infant death syndrome (SIDS) in the context of total infant mortality for Aboriginal and non-Aboriginal infants. Deaths for infants born in Western Australia from 1980 to 1988 inclusive were ascertained from a total population data base. Infant mortality rates and rates by period and cause of death were calculated for both populations. Aboriginal infants had a mortality rate three times that for non-Aboriginal infants (23.6 cf. 7.9 per 1000 live births) and both populations showed a similar rate of decline in mortality over the study period. There were differences in the proportion of deaths occurring neonatally and postneonatally in the two populations. In terms of SIDS, 21% of the deaths in Aboriginal infants occurred neonatally compared with 7% for non-Aboriginal infants. The overall cause of infant death distribution differed significantly between the two populations ( P < 0.001). During the study period, Aboriginal infants showed a significant increase in deaths due to SIDS and a significant decrease in those due to birth defects and low birthweight. These results suggest it would be useful to review the pathology and diagnosis of sudden unexplained death in infancy.     

Infectious diseases: preventable causes of infant mortality

After almost a century of improvement, the rate of decrease in US infant mortality rates began to level off during the period of 1982 to 1984. Rates actually increased in some states. Because much of the decline in infant mortality in this century can be attributed to advances in infectious disease treatment and prevention programs, we evaluated the current impact of infectious diseases on infant mortality. The National Center for Health Statistics mortality data for 1980 contains information on as many as 20 causes of death for a given individual. Using these data, we found that infectious diseases contributed to 12.5% of all infant deaths and to almost 400,000 years of potential life lost because of infant deaths. Infectious diseases contributed to 9% of deaths of low birth weight infants and to more than 18% of all deaths in the postneonatal period. Compared with white infants, a higher proportion of nonwhite infants died of causes related to infectious diseases. For black infants, the mortality rate related to infectious diseases was twice that for white infants. These data indicate that infectious diseases still are a major contributor to infant mortality, one of the 15 areas targeted for prevention by the federal government, and the data suggest that programs for reducing infant mortality should place increased emphasis on preventing infectious diseases.     

Neonatologische Versorgung – Fallzahlregelung

Germany’s infant mortality rate is high compared with Scandinavian countries, for instance, despite relatively high expenditure on health care. Since the infant mortality rate is influenced mainly by the neonatal mortality rate, which in turn is strongly determined by premature infant mortality, the national discussion has been focusing on the improvement of very low birthweight (VLBW) infant care in Germany. In 2005, the Joint Federal Committee (Gemeinsamer Bundesausschuss), the legislative organ of self-governance in the German statutory health care system, after drawing up a list of structural requirements, agreed upon a minimum number of 14 VLBW babies below 1250 g birthweight or between 1250 and 1500 g birthweight, as well as publishing outcome quality. The pros and cons of such regulations to reduce infant mortality and improve the care of VLBW are discussed.     

Infectious disease-related deaths of low birth weight infants, United States, 1968 to 1982

Infant mortality rates in the United States are higher than in any other developed country. Low birth weight (LBW) is the primary determinant of infant mortality. Despite city, state, and federal programs to prevent LBW, decreases in infant mortality in the 1980s appear to be largely secondary to improved survival of LBW infants rather than to a decline in the rate of LBW births. Because prevention of mortality due to infectious disease is feasible, it was of interest to examine the role of infectious diseases in LBW infant mortality. US vital statistics mortality data for 1968 through 1982 were analyzed in terms of LBW infant mortality associated with infectious and noninfectious diseases. These analyses indicated that the rates of infectious disease-associated early neonatal and postneonatal LBW mortality increased during this time; late neonatal rates did not decline appreciably. Infectious diseases were associated with 4% of all LBW infant deaths in 1968; this had increased to 10% by 1982. Although LBW infant mortality rates associated with noninfectious diseases did not differ for white and black populations, infectious disease-associated mortality rates were consistently higher for blacks than whites in both metropolitan and nonmetropolitan areas. Chorioamnionitis was involved in 28% of infectious disease-associated early neonatal LBW deaths. Sepsis was an increasingly listed cause of death in all infant age periods, whereas respiratory tract infections were decreasingly listed. Necrotizing enterocolitis increased as a cause of late neonatal mortality. These data suggest that infectious diseases are an increasing cause of LBW infant mortality and these deaths occur more frequently in the black population targeted by prevention programs.(ABSTRACT TRUNCATED AT 250 WORDS)     

Trends of infant mortality in Hong Kong (1956–90) and evaluation of preventable infant deaths

Objective: This study describes the time trends for infant mortality in Hong Kong and aims to develop statistical models that can be used to predict changes of infant mortality in places already having low levels of infant mortality.
Methodology: Data on births and deaths of infants in Hong Kong during the years 1956–90 were analysed annually as well as by aggregating the data into seven consecutive quinquennia. To assess the contribution of preventable infant deaths, causes for infant deaths were classified into two broad categories: (i) congenital anomalies; and (ii) preventable diseases. A simple linear regression model was used to analyse the time trend of the mortality rate of the preventable diseases (PIMR) over the seven quinquennia.
Results: During the period 1956–90, the infant mortality rate fell from 60.9 in 1956–5.9 per 1000 in 1990 and the neonatal mortality rate fell from 24.2-3.8 per 1000. There was no clear time trend observed for infant mortality of congenital anomalies. However, the time trend for PIMR (log scale) was very close to a straight line and simple linear regression modelling showed a R² of 0.9970.
Conclusion: As the infant mortality rate (IMR) falls to below 30 per 1000, the further rate of decrease becomes less predictable from the regression model of the IMR. By removing the portion of deaths attributable to congenital anomalies, the further decrease in infant mortality became more predictable down to very low levels of IMR.     

Perinatal and infant mortality in urban slums under I.C.D.S. scheme

Perinatal and infant mortality during the year 1985 was analyzed through a prospective study conducted in 12 Anganwadis (total population of 13,054) located in slum areas of India's Jabalpur city. Overall, the infant mortality rate was 128.7/1000 live births and the perinatal mortality rate was 88.5/1000 live births. 58.5% of deaths occurred in the neonatal period. Causes of neonatal deaths included prematurity, respiratory distress syndrome, birth asphyxia, septicemia, and neonatal tetanus. Postneonatal deaths were largely attributable to dehydration from diarrhea, bronchopneumonia, malnutrition, and infectious diseases. All mortality rates were significantly higher in Muslims than among Hindus. Muslims accounted for 28% of the study population, but contributed 63% of stillbirths and 55% of total infant deaths. This phenomenon appears attributable to the large family size among Muslims coupled with inadequate maternal-child health care. The national neonatal and postneonatal mortality rates are 88/1000 and 52/1000, respectively. The fact that the neonatal mortality rate in the study area was slightly lower than the national average may reflect the impact of ICDS services.     

Sudden infant death syndrome and unascertainable deaths: trends and disparities among Aboriginal and non-Aboriginal infants born in Western Australia from 1980 to 2001 inclusive

AIM: To analyse patterns and trends in mortality from unknown causes (sudden infant death syndrome and unascertainable deaths) for all Aboriginal and non-Aboriginal infants born in Western Australia, 1980-2001. METHODS: Using total population linked data, we reviewed all post-mortem reports, including death scene investigations and final causes of death as ascertained by the coroner. Neonatal, post-neonatal and infant mortality rates attributed to unknown causes were calculated and the latter were analysed according to maternal age, geographical location, gestational age, sex and birthweight. Relative risks (95% confidence interval) for Aboriginal infants (compared with non-Aboriginal) were calculated. RESULTS: The proportion of deaths considered to be of unascertainable cause has significantly increased in recent years. In contrast to the non-Aboriginal population, there has been no significant decrease in deaths in the Aboriginal population and the overall relative risk for Aboriginal infants for the most recent years studied was 7.9 (95% confidence interval 5.1-12.2). The relative risk was significantly increased for most categories analysed. CONCLUSION: Reviewing post-mortem reports enabled identification of changes in the classification of deaths due to unknown causes. This provided a more accurate picture of the patterns and long-term trends of such deaths so that programmes can be developed to specifically target those groups most at risk. Adequately funded and evaluated education campaigns aimed at reducing the risk of sudden infant death syndrome among Aboriginal infants are required, as well as sustaining the current efforts that have been so successful for non-Aboriginal infants.     

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.     

Low birth weight infants--study of mortality

Care of the low birthweight infant (LBW) in any neonatal unit calls for a large proportion of expenditure in terms of manpower and finances. Therefore, an analysis of 452 LBW infants at the IPGMER and SSKM Hospitals was made. The study reveals the highest mortality rates of 69.6% in the very LBW (1500 g) category compared to an overall mortality rate in LBW of 24.1%. The 1st 24 hour deaths accounted for 45 of the 109 (41.2%) deaths. In salvaging these 2 major groups of high mortality rates, trained personnel have only a minor influence. It is desirable to transfer these high risk infants to specialized neonatal centers which are equipped with adequate diagnostic and resuscitative facilities.     

Mortality from birth to adult life: a longitudinal study of twins

We have examined mortality from birth through adult life in a cohort of 2562 twins born in Birmingham, UK, between 1950 and 1954. Their birthweights and obstetric details had been recorded as part of a longitudinal study of births in Birmingham. There were a total of 151 perinatal deaths (perinatal mortality rate = 116 per 1000 births) and 227 infant deaths (infant mortality rate = 94 per 1000 live births). 70 deaths occurred after the age of one year. In comparison with national mortality rates in the UK, overall mortality in the twins was high (standard mortality rate, SMR = 259, 95% CI 221-300). Mortality was highest in the first year of life and, although it then declined progressively, it remained significantly higher that that of the general population until age 5 years. The excess mortality was largely due to conditions originating in the perinatal period but there were excess rates of congenital abnormalities, diseases of the respiratory system, digestive system and nervous and sensory organs. A Cox proportional Hazards analysis showed that the risk of death was related to low birthweight, prematurity and male sex. Death of the co-twin was highly predictive of mortality throughout the period of follow up. These studies not only underline the excess mortality associated with twin birth but show for the first time that this excess mortality extends into childhood.     

Socio-Economic Variables and Pregnancy Outcome

ABSTRACT. The effects of various social indicators on infant and child mortality were studied in Sweden with the use of a medical birth register to which census information was linked. Two years were studied: 1976 births linked to the 1975 census, and 1981 births linked to the 1980 census. Survival was followed to the age of 5 by linkage of the birth register with the death certificate register. The only statistically significant effect of a single socio-economic variable was that of housing conditions on perinatal death rate and postperinatal death rate up to the age of one. The family situation (e. g., cohabitation or not) had some effect, although it was not statistically significant. On the basis of cohabitation status and other social indicators, including housing conditions, we selected two groups: one privileged and the other underprivileged. Using crude mortality rates, we found no definite difference. There was evidence that the mortality rate had decreased more between 1976 and 1981 in the privileged than in the underprivileged group, but the difference may have been coincidental. After standardization for maternal age and parity, however, a difference appeared with a ratio of 1.14 between the underprivileged and the privileged groups, which was valid for deaths up to the age of one. After that age, no difference was seen. Following standardization for birthweight, the opposite was found: a higher weight-specific mortality rate in the privileged group than in the underprivileged group. The interpretation of these findings is discussed.     

Socio-economic variables and pregnancy outcome. 2. Infant and child survival

The effects of various social indicators on infant and child mortality were studied in Sweden with the use of a medical birth register to which census information was linked. Two years were studied: 1976 births linked to the 1975 census, and 1981 births linked to the 1980 census. Survival was followed to the age of 5 by linkage of the birth register with the death certificate register. The only statistically significant effect of a single socio-economic variable was that of housing conditions on perinatal death rate and postperinatal death rate up to the age of one. The family situation (e.g., cohabitation or not) had some effect, although it was not statistically significant. On the basis of cohabitation status and other social indicators, including housing conditions, we selected two groups: one privileged and the other underprivileged. Using crude mortality rates, we found no definite difference. There was evidence that the mortality rate had decreased more between 1976 and 1981 in the privileged than in the underprivileged group, but the difference may have been coincidental. After standardization for maternal age and parity, however, a difference appeared with a ratio of 1.14 between the underprivileged and the privileged groups, which was valid for deaths up to the age of one. After that age, no difference was seen. Following standardization for birthweight, the opposite was found: a higher weight-specific mortality rate in the privileged group than in the underprivileged group. The interpretation of these findings is discussed.     

Bronchiolitis-associated hospitalizations among American Indian and Alaska Native children

BACKGROUND: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract illness among infants and young children. Respiratory system diseases account for a large proportion of hospitalizations in American Indian and Alaska Native (AI/AN) children; however, aggregate estimates of RSV-associated hospitalizations among AI/AN children have not been made. METHODS: We used Indian Health Service hospitalization data from 1990 through 1995 to describe hospitalizations associated with bronchiolitis, the most characteristic clinical manifestation of RSV infection, among AI/AN children <5 years old. RESULTS: The overall bronchiolitis-associated hospitalization rate among AI/AN infants < 1 year old was considerably higher (61.8 per 1,000) than the 1995 estimated bronchiolitis hospitalization rate among all US infants (34.2 per 1,000). Hospitalization rates were higher among male infants (72.2 per 1,000) than among females infants (51.1 per 1,000). The highest infant hospitalization rate was noted in the Navajo Area (96.3 per 1,000). Hospitalizations peaked annually in January or February, consistent with national peaks for RSV detection. Bronchiolitis hospitalizations accounted for an increasing proportion of hospitalizations for lower respiratory tract illnesses. CONCLUSIONS: Bronchiolitis-associated hospitalization rates are substantially greater for AI/AN infants than those for all US infants. This difference may reflect an increased likelihood of severe RSV-associated disease or a decreased threshold for hospitalization among AI/AN infants with bronchiolitis compared with all US infants. AI/AN children would receive considerable benefit from lower respiratory tract illness prevention programs, including an RSV vaccine, if and when one becomes available.     

Birthweight specific perinatal mortality in Greece

Data from the Greek Perinatal Study in April 1983 revealed an excessively high perinatal mortality rate of 21.6 per 1,000 total births among singletons despite a low birthweight rate of only 4.5%. Comparison of perinatal mortality rates with Danish mortality rates in 1983, revealed the Greek rates to be three times higher than those in Denmark. When divided by time of death, the Greek stillbirth rates were two times higher and the early neonatal mortality rates were four times higher than the corresponding Danish rates. Subdivision of the Greek perinatal deaths using the Wigglesworth classification showed that the biggest group (40%) consisted of deaths associated with intrapartum asphyxia. The incidence of such deaths was 10 times higher than that found in Denmark. We conclude that in reducing the excessively high perinatal mortality rate in Greece special attention should be made to improve intrapartum and resuscitation techniques.     

Infant Mortality in Belfast

Data on all livebirths and infant deaths occurring to residents in Belfast 1963-5 and in Birmingham 1964 were analysed in order to examine possible reasons why the infant mortality rate in Belfast (29·4 per 1000 livebirths) was higher than in Birmingham (21·4).The hypothesis that the excess infant mortality in Belfast was mainly due to a higher proportion of infants born to high parity Belfast mothers was tested and found to be untenable. Though significant differences between the distributions of livebirths by parity in the two cities were demonstrated, they could have accounted for only about 12% of the excess. Differences between the two livebirth distributions by birthweight were more important and accounted for 40% of the excess infant mortality in Belfast. A high mortality rate attributed to postnatal asphyxia and atelectasis (I.C.D. No. 762) was noted in this city.     

A base-line survey on birth defects in Gansu province,West China

We report a study to determine the incidence, types and rank order of congenital anomalies and related fetal and infant mortality in Gansu province in China to provide a base-line for an intervention project directed at reducing birth defects in Gansu. Forty-two communities in four counties of Gansu were randomly selected by cluster sampling, based on economic and geographical features of the province. All infants born between 1 January 2001 and 1 January 2002 (live and stillborn) were investigated in departments of gynaecology and obstetrics, in birth control centres and in facilities for women and children in county and community hospitals. The types of birth defect were classified by the diagnostic standardisation ICD-9. The overall incidence of birth defects in Gansu was 15.4/1000 births (102/6621): 6.7/1000 (44) neural tube defects, 4.7/1000 (31) low birthweight infants, 2/1000 (13) limb defects, 0.8/1000 (five) cleft lip and palate and 0.5/1000 (three) Down's syndrome. The infant mortality rate was 14.8/1000 (98), to which birth defects contributed 7.3/1000 (48). We conclude that the incidence of birth defects in Gansu is one of the highest in China, that birth defects are the leading cause of infant mortality and that neural tube defects cause most deaths.     

Risk factors for SIDS in Japan: A record-linkage study based on vital statistics

This study examines the effect of items as reported on birth certificates on sudden infant death. We linked infant death certificates with birth certificates for the infants born in 1989 to residents of the Tohoku, Tokai and Kyushu regions in Japan (n = 409 679), that is, about one-third of the infants born in Japan that year. The mortality rate from sudden infant death, including 88 deaths from sudden infant death syndrome (SIDS) and 17 deaths from instantaneous death, was 25.6 per 100 000 live births. Elevated risk of sudden infant death was associated with low birthweight, late birth order, illegitimacy, male gender and young maternal age. These results correspond to previous studies from Western countries, suggesting a similar pattern for SIDS in Japan.     

Neonatal morbidity and mortality in a Tanzanian tertiary care referral hospital

In developing countries, neonatal mortality accounts for 50-70% of infant mortality. The purpose of this study was to describe morbidity and mortality patterns, with a focus on neonatal infections, in a Tanzanian special care baby unit (SCBU). During a 3-month period, 246 consecutive admissions to the SCBU at Kilimanjaro Christian Medical Centre were audited. Prematurity, low birthweight and suspected infection accounted for 61% of all admissions. The overall mortality rate was 19%, but varied considerably according to gestational age, birthweight and diagnosis. Thirty-one neonates (two-thirds of all deaths) died during the 1st 24 hours of life. Of 27 infants admitted on grounds of perinatal asphyxia, 11 (41%) died, and, of 19 infants with a gestational age <31 weeks, 13 (68%) died. More than two-thirds of all infants were treated with antibiotics. Septicaemia confirmed by blood culture was found in 16 cases. The susceptibility pattern of bacterial isolates did not indicate high rates of resistance to commonly used antibacterial agents. A reduction in the number of preterm deliveries and improved perinatal care to avoid and treat perinatal asphyxia would be the two most important measures in reducing neonatal mortality in this setting.     

Infant Outcome, Fetal Growth, and Pregnancy Care: Relationships in Indonesian University Obstetrics

ABSTRACT. The risk of perinatal death is displayed for'56 growth combinations', then contracted into 16 gestational age/birthweight categories (GA/BW) with additional control for antenatal visits (AV; CARE) for 36000 singleton birth deliveries monitored in Indonesia from 1978-1980. For virtually all GA/BW combinations, the risk of perinatal death (PD) drops impressively with pregnancy care (Care effect on PD). Fetal growth curves are then displayed by infant outcome, the BW difference being the deficit birthweight (DBW) that may serve as a specific life-death growth standard (LDGS)—a reference system in relation to which fetal growth curves, to be controlled for factors other than infant outcome, may be studied. By controlling for maternal education and pregnancy care, the fetal growth curve associated with high pregnancy care and low education (HIAV/LOED) is more favorable than that for low pregnancy care and high education (LOAV/HIED). In Indonesia then, pregnancy care is more important than formal education in the reduction of not only perinatal mortality but also low birthweight (Care effect on fetal growth).