Searching for preventable causes of infant mortality in Texas

Texas' health objectives include reducing the infant mortality rate from 8.1 per 1000 live births in 1990 to no more than 7 per 1000 by the year 2000. To help target potentially preventable causes of infant mortality, we examined the underlying cause of each of the 2545 infant deaths that occurred in Texas during 1990. Potential existed for primary prevention of the underlying cause of at least some of 778 infant deaths and for secondary prevention by treating the underlying causes of 1127. The following appear to be the most promising targets and strategies for prevention: causes of neonatal mortality by improving the clinical care of high-risk newborns; sudden infant death syndrome by having infants sleep in the supine position; respiratory complications of preterm birth by preventive and therapeutic surfactant; death from bacterial infections by optimal antibiotic therapy; injuries and accidents by optimal parental supervision; preterm birth and adverse pregnancy outcomes by optimal prenatal, obstetric, and neonatal care; and neural tube defects by adequate paraconceptual folic acid.