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.     

Annual summary of vital statistics: 2005

The general fertility rate in 2005 was 66.7 births per 1000 women aged 15 to 44 years, the highest level since 1993. The birth rate for teen mothers (aged 15 to 19 years) declined by 2% between 2004 and 2005, falling to 40.4 births per 1000 women, the lowest ever recorded in the 65 years for which there are consistent data. The birth rates for women > or = 30 years of age rose in 2005 to levels not seen in almost 40 years. Childbearing by unmarried women also increased to historic record levels for the United States in 2005. The cesarean-delivery rate rose by 4% in 2005 to 30.2% of all births, another record high. The preterm birth rate continued to rise (to 12.7% in 2005), as did the rate for low birth weight births (8.2%). The infant mortality rate was 6.79 infant deaths per 1000 live births in 2004, not statistically different from the rate in 2003. Pronounced differences in infant mortality rates by race and Hispanic origin continue, with non-Hispanic black newborns more than twice as likely as non-Hispanic white and Hispanic infants to die within 1 year of birth. The expectation of life at birth reached a record high in 2004 of 77.8 years for all gender and race groups combined. Death rates in the United States continued to decline, with death rates decreasing for 9 of the 15 leading causes. The crude death rate for children aged 1 to 19 years did not decrease significantly between 2003 and 2004. Of the 10 leading causes of death for 2004 in this age group, only the rates for influenza and pneumonia showed a significant decrease. The death rates increased for intentional self-harm (suicide), whereas rates for other causes did not change significantly for children. A large proportion of childhood deaths continue to occur as a result of preventable injuries.     

Annual summary of vital statistics: 2009

The number of births in the United States decreased by 3% between 2008 and 2009 to 4?130?665 births. The general fertility rate also declined 3% to 66.7 per 1000 women. The teenage birth rate fell 6% to 39.1 per 1000. Birth rates also declined for women 20 to 39 years and for all 5-year groups, but the rate for women 40 to 44 years continued to rise. The percentage of all births to unmarried women increased to 41.0% in 2009, up from 40.6% in 2008. In 2009, 32.9% of all births occurred by cesarean delivery, continuing its rise. The 2009 preterm birth rate declined for the third year in a row to 12.18%. The low-birth-weight rate was unchanged in 2009 at 8.16%. Both twin and triplet and higher order birth rates increased. The infant mortality rate was 6.42 infant deaths per 1000 live births in 2009. The rate is significantly lower than the rate of 6.61 in 2008. Linked birth and infant death data from 2007 showed that non-Hispanic black infants continued to have much higher mortality rates than non-Hispanic white and Hispanic infants. Life expectancy at birth was 78.2 years in 2009. Crude death rates for children and adolescents aged 1 to 19 years decreased by 6.5% between 2008 and 2009. Unintentional injuries and homicide, the first and second leading causes of death jointly accounted for 48.6% of all deaths to children and adolescents in 2009.     

Causes of Perinatal Death at a Saudi Maternity Hospital

ABSTRACT. The time, cause and avoidahility of perinatal deaths were analyzed in infants who were delivered in the main Maternity hospital in Riyadh and who represented a large proportion of all births in the city. The crude perinatal mortality rate was 39.8 per 1000 births. Of all deaths 53 percent occurred either intrapartum or within 24 hours of birth. The mortality rate in this time period was 9 times higher, and the intrapartum mortality rate 16 times higher than the corresponding Swedish rates. The causes of death were classified according to Wigglesworth. Of all deaths, 37 percent were due to asphyxial conditions in labor, 32 percent to conditions associated with preterm birth, and 17 percent to malformations. The perinatal mortality rates caused by asphyxia, preterm birth and malformations were 14.7, 12.6 and 6.7 per 1000 births, respectively. 75 percent of infants who died from asphyxia were born at term, and nearly half of the preterm deaths were associated with severe asphyxia at birth. Avoidable factors were found in 74 percent of the deaths. The high rate of asphyxia indicated deficiences in the obstetric management and a high priority should be given to the strengthening of the obstetric service.     

Annual summary of vital statistics-1997

Many positive trends in the health of Americans continued into 1997. In 1997, the preliminary birth rate declined slightly to 14.6 births per 1000 population, and the fertility rate, births per 1000 women 15 to 44 years of age, was unchanged from the previous year (65.3). These indicators suggest that the downward trend in births observed since the early 1990s may have abated. Fertility rates for white, black, and Native American women were essentially unchanged between 1996 and 1997. Fertility among Hispanic women declined 2% in 1997 to 103.1, the lowest level reported since national data for this group have been available. For the sixth consecutive year, birth rates dropped for teens. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women (32.4%) was unchanged in 1997. The trend toward earlier utilization of prenatal care continued for 1997; 82.5% of women began prenatal care in the first trimester. There was no change in the percentage with late (third trimester) or no care in 1997. The cesarean delivery rate rose slightly to 20.8% in 1997, a reversal of the downward trend observed since 1989. The percentage of low birth weight (LBW) infants rose again in 1997 to 7.5%. The percentage of very low birth weight was up only slightly to 1.41%. Among births to white mothers, LBW increased for the fifth consecutive year, to 6.5%, whereas the rate for black mothers remained unchanged at 13%. Much, but not all, of the rise in LBW for white mothers during the 1990s can be attributed to an increase in multiple births. In 1996, the multiple birth rate rose again by 5%, and the higher-order multiple birth rate climbed by 20%. Infant mortality reached an all time low level of 7.1 deaths per 1000 births, based on preliminary 1997 data. Both neonatal and postneonatal mortality rates declined. In 1996, 64% of all infant deaths occurred to the 7.4% of infants born at LBW. Infant mortality rates continue to be more than two times greater for black than for white infants. Among all the states in 1996, Maine, Massachusetts, and New Hampshire had the lowest infant mortality rates. Despite declines in infant mortality, the United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a new high in 1997 of 76.5 years for all gender and race groups combined. Age-adjusted death rates declined in 1997 for diseases of the heart, accidents and adverse affects (unintentional injuries), homicide, suicide, malignant neoplasms, cerebrovascular disease, chronic liver disease and cirrhosis, and diabetes. In 1997, mortality due to HIV infection declined by 47%. Death rates for children from all major causes declined again in 1997. Motor vehicle traffic injuries and firearm injuries were the two major causes of traumatic death. A large proportion of childhood deaths continue to occur as a result of preventable injuries.     

Annual summary of vital statistics--1996

Several recent trends in the vital statistics of the United States continued in 1996, including an increase in life expectancy and declines in infant mortality, births to teenage mothers, age-adjusted death rates, and death rates for children and adolescents. In 1996, there were an estimated 3 914 953 births in the United States. The preliminary birth rate remained unchanged at 14.8 births per 1000 population, and the fertility rate, births per 1000 women 15 to 44 years of age, was essentially the same at 65.7. Fertility rates rose slightly for most racial and ethnic groups except black women, for whom the rate hit a historic low of 70.8. Overall, fertility remains particularly high for Hispanic women, although there is considerable variation within this heterogenous group. For the fifth consecutive year, birth rates dropped for teenagers. Birth rates for women >/=30 years of age continued to increase. The birth rate for unmarried women declined 1% in 1996 to 44.6 births per 1000 unmarried women, continuing the decline noted in 1995 for the first time in 2 decades. The percentage of women who began prenatal care in the first trimester rose in 1996 to 81.8%, whereas the percentage with late (third trimester) or no care dropped to 4.1%. The rise in timely prenatal care was greatest for black and Hispanic women. The percentage of low birth weight (LBW) infants reached 7.4% in 1996, its highest level since 1975. The very low birth weight rate remained unchanged at 1.4%. The rise in LBW occurred primarily among white women, whereas the LBW rate for black women dropped to 13.0%, the lowest rate reported since 1987. The rise among white women is only partially a result of increases in multiple births, because LBW rates have also risen among white singleton births. The multiple birth ratio rose again in 1996 by 2%, as it has since 1980. The rise was particularly large for higher-order multiple births. Infant mortality reached an all time low level of 7.2 deaths per 1000 births, based on preliminary 1996 data. Neonatal and postneonatal rates declined, as did rates for both black and white infants. National birth weight specific mortality rates are reported here for the first time. In 1995, 63% of infant deaths occurred to the 7.3% of the population that was born LBW. The four leading cause of infant death were congenital anomalies, disorders relating to short gestation and unspecified birth weight, sudden infant death syndrome, and respiratory distress syndrome, accounting for more than half of infant deaths in 1996. Despite the declines in infant mortality, the United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a new high in 1996 of 76.1 years for all gender and race groups combined. Age-adjusted mortality rates declined in 1996 for diseases of the heart, malignant neoplasms, cerebrovascular diseases, accidents and adverse effects, chronic liver disease and cirrhosis, and suicide. They rose, as in the past several years, for chronic obstructive pulmonary diseases, diabetes mellitus, and pneumonia and influenza. For the first time since human immunodeficiency virus infection was created as a special cause-of-death category in 1987, death rates for human immunodeficiency virus infection declined from 15.6 in 1995 to 11.6 in 1996. The homicide rate also declined, as it has since 1991. Death rates for children between 1 and 19 years of age declined in 1996, with an estimated 29 183 deaths to children. Unintentional injury mortality has dropped by approximately 50% among children and adolescents since 1979, although it remains the leading cause of death for all age groups of children from 1 to 19 years. Homicide was the fourth leading cause of death for children 1 to 4 and 5 to 9 years of age, the third leading cause for children 10 to 14, and the second leading cause for 15 to 19 year olds.     

OUTCOME OF TWIN BIRTH Review of 1636 Children Born in Twin Birth

Abstract. During the five-year period 1964–68 96733 births were registered in the 28 hospitals equipped with maternity facilities in the Uppsala hospital region. Of these babies, 1636 were born in 818 twin deliveries. Data on gestational age, sex, weight and length at birth, birth order, hospital type, congenital malformations and perinatal mortality are analysed. Altogether 17.3 per 1000 of the children born during this period were born in multiple births. The perinatal mortality for the twin babies was 64 per 1000 born, with the mortality higher in the less specialized hospitals than the others. Twin no. 1 suffered perinatal death in 67 cases per 1000 and twin no. 2 in 60 cases per 1000. For twins of primiparae the losses were 92 per 1000 children and for twins born to multiparae 51 per 1000. Altogether 72 per 1000 male twins died perinatally compared to 52 per 1000 female twins. The most heavy losses occurred among the low-weight premature twins and in these cases both twins often suffered perinatal death.     

Perinatal and postneonatal mortality in England and Wales among immigrants from the Indian subcontinent

Perinatal and postneonatal mortality among immigrants to England and Wales from India, Pakistan and Bangladesh (Asians) for the years 1982–85 showed significant differences not only between the immigrant and indigenous populations, but also among the different groups from the Indian subcontinent. Compared with the perinatal mortality rate of 10.1 per 1000 total births in UK born mothers, rates in infants of mothers born in India, Bangladesh, and Pakistan were 12.5, 14.3 and 18.8 respectively. In contrast, postneonatal mortality in infants of Indian and Bangladeshi origin (3.9 and 2.8 per 1000 live births respectively) was lower than in the indigenous population (4.1), with Pakistani infants experiencing the highest rate (6.4). Excess perinatal mortality in infants of Asian origin was apparent at most maternal ages and parities. Pakistani infants had the highest rates of perinatal and postneonatal mortality in all age, parity and birth weight groups. The Asian groups showed higher mortality from congenital anomalies in both the perinatal and the postneonatal period, the rates in Pakistani infants being almost double those in Indian and Bangaladeshi infants. A significant finding was the lower rates of sudden infant death in all the groups of Asian origin.     

Annual summary of vital statistics--1998

Most vital statistics indicators of the health of Americans were stable or showed modest improvements between 1997 and 1998. The preliminary birth rate in 1998 was 14.6 births per 1000 population, up slightly from the record low reported for 1997 (14.5). The fertility rate, births per 1000 women aged 15 to 44 years, increased 1% to 65.6 in 1998, compared with 65.0 in 1997. The 1998 increases, although modest, were the first since 1990, halting the steady decline in the number of births and birth and fertility rates in the 1990s. Fertility rates for total white, non-Hispanic white, and Native American women each increased from 1% to 2% in 1998. The fertility rate for black women declined 19% from 1990 to 1996, but has changed little since 1996. The rate for Hispanic women, which dropped 2%, was lower than in any year for which national data have been available. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women remained about the same at one third. The birth rate for teen mothers declined again for the seventh consecutive year, and the use of timely prenatal care (82.8%) improved for the ninth consecutive year, especially for black (73.3%) and Hispanic (74.3%) mothers. The number and rate of multiple births continued their dramatic rise; the number of triplet and higher-order multiple births jumped 16% between 1996 and 1997, accounting, in part, for the slight increase in the percentage of low birth weight (LBW) births. LBW continued to increase from 1997 to 1998 to 7.6%. The infant mortality rate (IMR) was unchanged from 1997 to 1998 (7.2 per 1000 live births). The ratio of the IMR among black infants to that for white infants (2.4) remained the same in 1998 as in 1997. Racial differences in infant mortality remain a major public health concern. In 1997, 65% of all infant deaths occurred to the 7.5% of infants born LBW. Among all of the states, Maine, Massachusetts, and New Hampshire had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage LBW, and birth weight-specific neonatal mortality rate for each state. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth increased slightly to 76.7 years for all gender and race groups combined. Death rates in the United States continue to decline, including a drop in mortality from human immunodeficiency virus. The age-adjusted death rate for suicide declined 6% in 1998; homicide declined 14%. Death rates for children from all major causes declined again in 1998. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.     

A study of perinatal mortality rate from rural based Medical College Hospital

The present study conducted in a rural medical college aimed at analysing the perinatal mortality and its determinants in a rural set up. Fiftyeight still births and sixty two early neonatal deaths among 1107 consecutive deliveries gave a perinatal mortality rate of 108.4 per 1000 deliveries. Fifty percent of the total deliveries were unbooked. The perinatal mortality was higher in unbooked cases (16.3%), twins (33.2%) and preterms (33.9%) as compared to that in booked cases (5.3%), singletons (9.6%) and term deliveries (6.7%). Sixty nine percent of the still births were due to causes like obstructed labour, toxemia of pregnancy, antepartum hemorrhage, hand prolapse, and cord prolapse where timely intervention would have reduced the perinatal mortality significantly. Early neonatal deaths were mainly associated with prematurity and were largely due to birth anoxia, intraventricular hemorrhage, aspiration and infections.     

Annual summary of vital statistics: 2006

US births increased 3% between 2005 and 2006 to 4,265,996, the largest number since 1961. The crude birth rate rose 1%, to 14.2 per 1000 population, and the general fertility rate increased 3%, to 68.5 per 1000 women 15 to 44 years. Births and birth rates increased among all race and Hispanic-origin groups. Teen childbearing rose 3% in 2006, to 41.9 per 1000 females aged 15 to 19 years, the first increase after 14 years of steady decline. Birth rates rose 2% to 4% for women aged 20 to 44; rates for the youngest (10-14 years) and oldest (45-49) women were unchanged. Childbearing by unmarried women increased steeply in 2006 and set new historic highs. The cesarean-delivery rate rose by 3% in 2006 to 31.1% of all births; this figure has been up 50% over the last decade. Preterm and low birth weight rates also increased for 2006 to 12.8% and 8.3%, respectively. The 2005 infant mortality rate was 6.89 infant deaths per 1000 live births, not statistically higher than the 2004 level. Non-Hispanic black newborns continued to be more than twice as likely as non-Hispanic white and Hispanic infants to die in the first year of life in 2004. For all gender and race groups combined, expectation of life at birth reached a record high of 77.9 years in 2005. Age-adjusted death rates in the United States continue to decline. The crude death rate for children aged 1 to 19 years decreased significantly between 2000 and 2005. Of the 10 leading causes of death for children in 2005, only the death rate for cerebrovascular disease was up slightly from 2000, whereas accident and chronic lower respiratory disease death rates decreased. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.     

Race- and rank-specific infant mortality in a US military population.

Mortality among black infants in the United States is approximately twice that among white infants. The disparity has been attributed in large part to the higher incidence of poverty and limited access to health care among black Americans. We investigated race- and rank-specific infant mortality rates among dependents of military officers and soldiers at Madigan Army Medical Center, Tacoma, Wash, between 1985 and 1990. The overall infant mortality rate was 9.3 deaths per 1000 live births compared with 10.1 deaths per 1000 live births in the United States in 1987. Mortality rates for infants born to families of junior enlisted soldiers were similar to those for infants born to families of noncommissioned and commissioned officers. The mortality rate among black infants was 11.1 deaths per 1000 live births compared with 17.9 deaths per 1000 live births among all black Americans in 1987. These lower rates of mortality among black infants may be due to guaranteed access to health care and higher levels of family education and income in the multiracial subpopulation served by our medical center compared with the nation as a whole.     

Disparate black and white neonatal mortality rates among infants of normal birth weight in Chicago: a population study.

To determine the extent to which disparities in risk status and access to tertiary care affect racial differences in neonatal mortality rates among normal birth weight infants, we conducted a vital records study concerning normal weight black (N = 44,399) and white (N = 48,146) singleton births in Chicago. Neonatal mortality rate among black infants was twice that among white infants (3.3 deaths per 1000 births vs 1.5 deaths per 1000 births); the unadjusted black relative risk equaled 2.2 (95% confidence interval, 1.7 to 2.9). Because prematurity, growth retardation, congenital anomalies, low Apgar scores at 5 minutes, teenage mothers, and poverty were more common among black infants, multivariate analyses were performed. The disparity in mortality rate was greatest between black and white infants with none of these risk factors; relative risk for black infants equaled 3.6 (95% confidence interval, 2.0 to 6.7). Approximately 30% of all deaths of black infants were attributable to birth in nontertiary hospitals. When the confounding variables, including hospital of birth, were put into a multivariate logistic-regression model, the adjusted relative risk estimate (odds ratio) for black infants equaled 1.5 (95% confidence interval, 1.1 to 2.0). Traditional risk factors fail to explain the racial disparity in neonatal mortality rate among normal birth weight infants. Level of perinatal care available, or some factor closely related to this level, is an important determinant of neonatal chance of survival for normal birth weight urban black infants.     

Changing patterns of childhood mortality in Wolverhampton.

OBJECTIVES: To review the incidence and characteristics of preventable childhood deaths in an urban population in the UK and to determine whether the excess of preventable deaths seen previously in Asian girls still exists. DESIGN: A retrospective survey of childhood deaths from 1996-2002 classified in terms of preventability and compared with a previous study conducted 20 years earlier from 1976-82. SETTING: The city of Wolverhampton in the UK. MAIN OUTCOME MEASURES: Deaths from all causes in children under the age of 5 years. RESULTS: There has been a reduction in the number of deaths in all age groups and from all causes. The postneonatal mortality rate fell from 6.5/1000 in 1976 to 3.1/1000 live births in 2002 largely because of the fall in the numbers of deaths caused by sudden infant death syndrome (SIDS). Preventable deaths are still associated with low birth weight (p<0.001) and poverty (unemployment and overcrowding in the earlier study (p<0.05) and with the Townsend score in this study (p<0.02)). There were fewer deaths among Asians and no female excess. There was a new category not seen in the previous study, deaths caused by homicide. The death rate for homicide in the first year of life was much higher in Wolverhampton (18.7/100,000) than in England and Wales (4.6/100,000). CONCLUSIONS: Low birth weight and adverse socioeconomic conditions remain important factors associated with preventable deaths. There is no longer an increased risk of preventable death in Asian girls. The number of non-accidental deaths is a major cause for concern.     

Cerebral palsy in the surviving twin associated with infant death of the co-twin

BACKGROUND: Monozygotic twins are at greater risk of dying and of serious morbidity than dizygotic twins, and both are at greater risk than singletons. This is only partly explained by the higher proportion of low birthweight infants among twins. AIM: To compare, in same sex and different sex twins, birth weight specific neonatal death rates and cerebral palsy prevalence rates in the surviving twin when the co-twin has died in infancy. METHODS: Analysis of birth and death registration data for same sex and different sex twins for England and Wales 1993-1995 where both were live births. Death certificates of all liveborn twins who died were obtained from the Office for National Statistics. A questionnaire was sent to the general practitioners of all surviving co-twins to determine if the child had any disability. RESULTS: The neonatal death rate in same sex twins was 25.4 and in different sex twins 18.0 per 1000 live births (death rate difference 7.4; 95% confidence interval 4.7 to 10.1; p < 0.001). The higher neonatal death rate in same sex compared with different sex twins is attributable to the higher proportion of same sex twins with low birth weight. Prevalence of cerebral palsy in the low birthweight group (< 1000 g) was marginally higher in same sex (224 per 1000) than different sex (200 per 1000) twin survivors. In the birth weight group 1000-1999 g, same sex twin survivors were at a significantly higher risk of cerebral palsy than those of different sex: 167 v 21 per 1000; difference 145 (95% confidence interval 44 to 231; p < 0.01) per 1000 infant survivors. CONCLUSION: There are two components to the cause of cerebral palsy in twins. Immaturity per se predisposes to cerebral damage. Also, same sex twins may sustain cerebral damage that is in excess of that due to immaturity.     

Changing patterns of childhood mortality in Wolverhampton

Objectives: To review the incidence and characteristics of preventable childhood deaths in an urban population in the UK and to determine whether the excess of preventable deaths seen previously in Asian girls still exists. Design: A retrospective survey of childhood deaths from 1996–2002 classified in terms of preventability and compared with a previous study conducted 20 years earlier from 1976–82. Setting: The city of Wolverhampton in the UK. Main outcome measures: Deaths from all causes in children under the age of 5 years. Results: There has been a reduction in the number of deaths in all age groups and from all causes. The postneonatal mortality rate fell from 6.5/1000 in 1976 to 3.1/1000 live births in 2002 largely because of the fall in the numbers of deaths caused by sudden infant death syndrome (SIDS). Preventable deaths are still associated with low birth weight (p<0.001) and poverty (unemployment and overcrowding in the earlier study (p<0.05) and with the Townsend score in this study (p<0.02)). There were fewer deaths among Asians and no female excess. There was a new category not seen in the previous study, deaths caused by homicide. The death rate for homicide in the first year of life was much higher in Wolverhampton (18.7/100 000) than in England and Wales (4.6/100 000). Conclusions: Low birth weight and adverse socioeconomic conditions remain important factors associated with preventable deaths. There is no longer an increased risk of preventable death in Asian girls. The number of non-accidental deaths is a major cause for concern.     

Ethnic differences in incidence of sudden infant death syndrome in Birmingham.

Among the 45,204 live births in Birmingham in the three calendar years 1981-3, there were 218 postneonatal deaths, giving a postneonatal mortality rate of 4.82 per 1000 live births. Postneonatal mortality rates were 4.22 for whites, 5.91 for Asians (relative risk 1.26, 95% confidence interval (CI) 1.04 to 1.53) and 8.20 for Afro-Caribbeans (relative risk 1.78, 95% CI 1.25 to 2.55). Among Asians malformations were common (3.36) and sudden infant death syndrome rare (1.18), in contrast to Afro-Caribbeans among whom the rates were 0.66 and 5.25, respectively. Logistic regression analysis demonstrated a significantly lower risk of sudden infant death syndrome (SIDS) in Asians and significantly raised risks of SIDS in very low birthweight babies and those with unemployed parent(s). Ethnic differences persisted after controlling for maternal age, social class, and birth weight. Studies of sociocultural differences in child rearing practices are needed and may uncover important aetiological factors of sudden infant death syndrome.     

Neonatal mortality patterns in an urban hospital.

Neonatal mortality rate is perhaps the most reliable indicator of the perinatal outcome. An assessment of perinatal outcome can be made through knowledge of causes of death. This study was carried out to evaluate the neonatal deaths in our hospital. Live births (n = 7309) and deaths (n = 328) during a 6 months period were retrospectively analyzed. These were grouped into non-preventable and potentially preventable causes of death. The single most important factor contributing to the mortality was respiratory distress (29.3%) followed by sepsis (24.4%) and birth asphyxia (16.2%). The non-preventable causes of mortality (e.g., lethal congenital malformations, extremely low birth weight) accounted for 10.4% of the total mortality. The idealized neonatal mortality rate was 4.6/1000 live births, while the salvageable death rate was 40.2/1000 live births. The mortality increased significantly if the birth weight fell below 2 kg. The salvageable deaths could perhaps be prevented through better antenatal and intranatal care, ventilatory support and prevention of sepsis.     

Annual summary of vital statistics--2001

The number of births, the crude birth rate (14.5 in 2001), and the fertility rate (67.2 in 2001) all declined slightly (by 1% or less) from 2000 to 2001. Fertility rates were highest for Hispanic women (107.4), followed by Native American (70.7), Asian or Pacific Islander (69.4), black (69.3), and non-Hispanic white women (58.0). During the early to mid 1990s, fertility declined for non-Hispanic white, black, and American Indian women. Rates for these population groups have changed relatively little since 1995; however, fertility has increased for Asian or Pacific Islander and Hispanic women. The birth rate for teen mothers continued to fall, dropping 5% from 2000 to 2001 to 45.9 births per 1000 females aged 15 to 19 years, another record low. The teen birth rate has fallen 26% since 1991; declines were more rapid (35%) for younger teens aged 15 to 17 years than for older teens aged 18 to 19 years (20%). The proportion of all births to unmarried women remained about the same at one-third. Smoking during pregnancy continued to decline; smoking rates were highest among teen mothers. The use of timely prenatal care increased slightly to 83.4% in 2001. From 1990 to 2001, the use of timely prenatal care increased by 6% (to 88.5%) for non-Hispanic white women, by 23% (to 74.5%) for black women, and by 26% (to 75.7%) for Hispanic women. The number and rate of twin births continued to rise, but the triplet/+ birth rate declined for the second year in a row. For the first year in almost a decade, the preterm birth rate declined (to 11.6%); however, the low birth weight rate was unchanged at 7.6%. The total cesarean delivery rate jumped 7% from 2000 to 2001 to 24.4% of all births, the highest level reported since these data became available on birth certificates (1989). The primary cesarean rate rose 5%, whereas the rate of vaginal birth after a previous cesarean delivery tumbled 20%. In 2001, the provisional infant mortality rate was 6.9 per 1000 live births, the same as in 2000. Racial differences in infant mortality remain a major public health concern, with the rate for infants of black mothers 2.5 times those for infants of non-Hispanic white or Hispanic mothers. In 2000, 66% of all infant deaths occurred among the 7.6% of infants born low birth weight. Among all states, Maine and Massachusetts had the lowest infant mortality rates. The United States continues to rank poorly in international comparisons of infant mortality. The provisional death rate in 2001 was 8.7 deaths per 1000 population, the same as the 2000 final rate. In 2000, unintentional injuries and homicide remained the leading and second-leading causes of death for children 1 to 19 years of age, although the death rate for homicide decreased by 10% from 1999 to 2000. Among unintentional injuries to children, two-thirds were motor vehicle-related; among homicides, two-thirds were firearm-related.     

Annual summary of vital statistics: 2004

The crude birth rate in 2004 was 14.0 births per 1000 population, the second lowest ever reported for the United States. The number of births and the fertility rate (66.3) increased slightly (by <1%) from 2003 to 2004. Fertility rates were highest for Hispanic women (97.7), followed by Asian or Pacific Islander (67.2), non-Hispanic black (66.7), Native American (58.9), and non-Hispanic white (58.5) women. The birth rate for teen mothers continued to fall, dropping 1% from 2003 to 2004 to 41.2 births per 1000 women aged 15 to 19 years, which is another record low. The teen birth rate has fallen 33% since 1991; declines were more rapid for younger teens aged 15 to 17 (43%) than for older teens aged 18 to 19 (26%). The proportion of all births to unmarried women is now slightly higher than one third. Smoking during pregnancy declined slightly from 2003 to 2004. In 2004, 29.1% of births were delivered by cesarean delivery, up 6% since 2003 and 41% since 1996 (20.7%). The primary cesarean delivery rate has risen 41% since 1996, whereas the rate of vaginal birth after a previous cesarean delivery has fallen 67%. The use of timely prenatal care was 84.0% in both 2003 and 2004. The percentage of preterm births rose to 12.5% in 2004 from 10.6% in 1990 and 9.4% in 1981. The percentage of low birth weight births also increased to 8.1% in 2004, up from 6.7% in 1984. Twin birth rate and triplet/+ birth rates increased by 1% and <1%, respectively, from 2002 to 2003. Multiple births accounted for 3.3% of all births in 2003. The infant mortality rate was 7.0 per 1000 live births in 2002 compared with 6.8 in 2001. The ratio of the infant mortality rate among non-Hispanic black infants to that for non-Hispanic white infants was 2.4 in 2002, the same as in 2001. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a record high of 77.6 years for all gender and race groups combined. Death rates in the United States continue to decline, with death rates decreasing for 8 of the 15 leading causes. Death rates for children < or =19 years of age declined for 7 of the 10 leading causes in 2003. The death rates did not increase for any cause, and rates for heart disease, influenza, and pneumonia and septicemia did not change significantly for children as a group. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.