The changing pattern of neonatal mortality in a regionalized system of perinatal care: A current update

Our earlier studies about the changing pattern of neonatal mortality were based on data from 1978-1979 and 1982-1983. In this report, we provide a modern update of the causes of neonatal deaths to help focus prevention measures.

We reviewed neonatal deaths for the years 1995 and 1996 and assigned a clinical cause of death. Deaths were reviewed and analyzed by place of birth and death, according to level of care. We provided an estimate of the change in causes of death between 1982-1983 and 1995-1996 and calculated an idealized neonatal mortality rate for each level of care and for the entire state.

The major changes in causes of death occurred in the respiratory distress syndrome (RDS) and extremely low birth weight (ELBW) categories. RDS showed a substantial decline, but ELBW deaths increased by nearly the same amount that RDS declined. The idealized neonatal mortality rate calculations suggest that fewer potentially medically preventable deaths occur now than in 1982-1983. Currently, more neonatal deaths of level I births occur in level III facilities than in 1982-1983. However, at that time, Iowa had only one tertiary facility, and the level II regional hospitals were the site of more deaths.

We believe that assigning deaths to a clinical category rather than to a catastrophic final event helps focus on sources of preventable death in the medical care system. To reduce neonatal mortality, the incidence of lethal congenital malformations and ELBW infants must be impacted.