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Reducing postneonatal mortality in West Virginia: a statewide intervention program targeting risk identified at and
D Z Myerberg1, R G Carpenter, C F Myerberg
1Department of Pediatrics, West Virginia University, Morgantown 26506-9218, USA.
Insights
Two interventions targeting high-risk infants in West Virginia significantly reduced postneonatal mortality. This initiative improved infant survival rates by ensuring access to essential healthcare services for vulnerable newborns.
Area of Science:
- Public Health
- Pediatrics
- Healthcare Management
Background:
- West Virginia experienced excessive postneonatal mortality linked to inadequate healthcare access.
- A significant proportion of infant deaths were concentrated among a small group of high-risk infants.
Purpose of the Study:
- To describe two interventions designed to reduce postneonatal mortality in West Virginia.
- To identify and provide care for infants at the greatest risk of death.
Main Methods:
- Two risk-related intervention systems were implemented statewide from 1985-1987.
- Infant risk was assessed using the Sheffield Birth Score and clinical factors.
- At-risk infants were connected with physicians for specific care plans and followed for one year.
Main Results:
- Interventions reached 45% of high Sheffield Birth Score infants and 1003 infants with clinical risk factors.
- High-risk infants faced significantly higher odds of postneonatal mortality and sudden infant death syndrome.
- A 21.4% reduction in the trend of yearly standardized mortality ratios was observed during the program.
Conclusions:
- Affordable, accessible, and acceptable healthcare for at-risk infants was associated with a substantial decrease in postneonatal mortality.
- The program potentially saved 33 infant lives.
- The findings highlight the effectiveness of targeted interventions in improving infant survival rates.
Objectives:
Excessive postneonatal mortality in West Virginia has been associated with inadequate health care. This paper describes two interventions aimed at those infants at greatest risk of dying.
Methods:
Two systems of risk-related intervention were simultaneously introduced and funded statewide from 1985 through 1987. Risk status was determined by a multifactorial score at birth or clinical risk factors later. At-risk infants were linked with physicians who provided specified care plans. All infants were followed for 1 year for mortality.
Results:
Of 4570 infants with a high Sheffield Birth Score, 45%, together with 1003 infants with clinical risk factors, received specified care plans. High-risk infants constituted 7.6% of total resident births. Odds ratios for overall postneonatal mortality and sudden infant death syndrome in high-birth-score infants compared with low-birth-score infants were 6.2 (95% confidence interval [CI] = 4.2, 9.3) and 11.2 (95% CI = 5.4, 23.2), respectively. The relative risks of postneonatal mortality were similarly significant for infants with most clinical risk factors. During the program there was a 21.4% reduction in the trend of yearly standardized mortality ratios, which differed markedly from the trend in surrounding states. The data suggest that 33 lives were saved at a cost of $36,363 per infant.
Conclusion:
Ensuring affordable, available, accessible, and acceptable care for a small group of at-risk infants was associated with a dramatic drop in overall postneonatal mortality in West Virginia.