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Evaluation of the Nottingham birth scoring system
R J Madeley1, D Hull, J M Elwood
1Department of Community Medicine and Epidemiology, University of Nottingham Medical School, Queen's Medical Centre, England.
Annals of the New York Academy of Sciences
|January 1, 1988
Summary
Identifying high-risk infants for postneonatal deaths due to respiratory infections and SIDS did not accelerate mortality rate improvements. Resources should focus on general service enhancements and research into Sudden Infant Death Syndrome (SIDS) causes.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Postneonatal deaths in Nottingham (1974-1976) were mainly due to respiratory infections and Sudden Infant Death Syndrome (SIDS).
- Deaths predominantly occurred in winter, at home, and in deprived areas of Nottingham.
- A case-control study identified a high-risk infant group (9% of the population) where 53% of postneonatal deaths were concentrated.
Purpose of the Study:
- To assess the impact of intensive follow-up and early symptom recognition advice on postneonatal mortality rates.
- To evaluate the effectiveness of a high-risk infant identification system.
Main Methods:
- A case-control study was conducted to identify risk factors for postneonatal deaths.
- Step-wise discriminant analysis was used to define a high-risk infant group.
- Intensive follow-up by health visitors and general practitioners was implemented for the identified high-risk group from 1978.
Main Results:
- The postneonatal mortality rate decreased from 6.5 per 1,000 live births in 1977 to 5.2 per 1,000 in 1983.
- The study could not demonstrate a significantly faster rate of improvement after the intervention compared to the period before.
- The intervention system was discontinued in 1985.
Conclusions:
- Birth scoring systems are not recommended for reducing postneonatal mortality.
- Resources are better allocated to general improvements in healthcare services and early symptom recognition.
- Further basic research into the causes of Sudden Infant Death Syndrome (SIDS) is crucial.