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Postponing or preventing deaths? Trends in infant survival, Georgia, 1974 through 1981
Insights
Infant survival improved across all birth weights, with newborn intensive care units significantly aiding survival for low birth weight infants. Advances in perinatal care prevented many deaths but sometimes postponed them, highlighting the need to assess both neonatal and postneonatal mortality.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Public Health
Background:
- Infant mortality remains a critical public health concern.
- Understanding survival trends across different birth weight categories is essential for evaluating healthcare interventions.
- Historical data from 1974-1981 in Georgia provides a valuable dataset for analyzing changes in infant survival.
Purpose of the Study:
- To examine trends in infant survival to the first birthday across five distinct birth weight groups.
- To investigate the relationship between neonatal and postneonatal survival improvements.
- To assess the impact of perinatal care advancements on infant mortality, particularly for very low birth weight infants.
Main Methods:
- Analysis of infant survival data for infants born in Georgia between 1974 and 1981.
- Stratification of infants into five birth weight groups: 500-999g, 1000-1499g, 1500-1999g, 2000-2499g, and >=2500g.
- Comparison of survival rates and causes of death between early (1974-1975) and later (1980-1981) periods within the study timeframe.
Main Results:
- Overall infant survival to the first birthday increased across all studied birth weight groups.
- Improvements in postneonatal survival generally paralleled neonatal survival, with notable exceptions for infants weighing 500-999g.
- A rise in deaths attributed to perinatal conditions but occurring postneonatally was observed (1.1% to 4.7%).
- Admission to newborn intensive care units was a key factor in improved survival for infants weighing less than 1500g.
Conclusions:
- Advances in perinatal care have contributed to a significant reduction in overall infant mortality.
- While many infant deaths were prevented, some may have been postponed, necessitating a comprehensive evaluation of both neonatal and postneonatal periods.
- Evaluating the effectiveness of perinatal care requires examining impacts on both neonatal and postneonatal mortality rates.
Abstract:
Trends in survival were examined for infants in five birth-weight groups (500 to 999 g, 1,000 to 1,499 g, 1,500 to 1,999 g, 2,000 to 2,499 g, and greater than or equal to 2,500 g). The study population consisted of infants born in Georgia from 1974 through 1981. Survival to the first birthday increased for all birthweight groups. Improvements in postneonatal survival occurred concurrently with improvements in neonatal survival, except for infants with birth weights of 500 to 999 g. Between 1974-1975 and 1980-1981, the proportion of deaths that were attributed to perinatal conditions but occurred during the postneonatal period increased from 1.1% to 4.7%. These observations suggest that advances in perinatal care have led to postponement rather than prevention of a few infant deaths, although overall many more deaths were prevented. For infants with birth weights of less than 1,500 g, lower mortality among those admitted to newborn intensive care units was the major contributor to improved survival. Our findings indicate that both neonatal and postneonatal mortality should be examined in evaluating the effects of perinatal care.