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The Changing Pattern of Neonatal Mortality in a Regionalized System of Perinatal Care

The Changing Pattern of Neonatal Mortality in a Regionalized System of Perinatal Care Abstract • Neonatal deaths in Iowa were reviewed for the years 1982 and 1983. As in a similar review of deaths in 1978 and 1979, respiratory distress syndrome, bacterial sepsis, asphyxia, lethal malformations, and extreme immaturity accounted for approximately 90% of deaths. Fewer deaths occurred in 1982 and 1983 and the causes of death shifted toward the nonpreventable. Lethal malformations became the leading cause of death and showed an increased incidence over the previous period. The greatest reduction of deaths was in level 1 hospitals. Ability to effect further reduction in neonatal deaths was estimated by calculation of an idealized neonatal mortality rate for the state and each level of care. These calculations suggest that future reduction in mortality must come primarily from improved care in level 2 and 3 centers rather than from further change in level 1 provider behavior. (AJDC 1986;140:989-993) References 1. Hein HA, Brown CJ: Neonatal mortality review: A basis for improving care . Pediatrics 1981;68:504-509. 2. Hein HA, Lathrop SS, Papke KR: Comparing perinatal mortality . Obstet Gynecol 1985;66: 346-349. 3. Hein HA, Christopher MC, Ferguson NN: Rural perinatology . Pediatrics 1975;55:769-773. 4. Hein HA: Regionalization of perinatal care in rural areas based on the Iowa experience . Semin Perinatol 1977;1:241-254. 5. Hirata T, Epcar JT, Walsh A, et al: Survival and outcome of infants 501 to 750 grams: A six-year experience . J Pediatr 1983;102:741-748.Crossref 6. Milunsky A: Lethal congenital anomalies . JAMA 1983;250:517-518.Crossref 7. Autio-Harmainen H, Rapola J, Hoppu K, et al: Causes of neonatal deaths in a pediatric hospital neonatal unit . Acta Paediatr Scand 1983;72:333-337.Crossref 8. Hein HA: The status and future of small maternity services in Iowa . JAMA 1986;255: 1899-1903.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

The Changing Pattern of Neonatal Mortality in a Regionalized System of Perinatal Care

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1986.02140240035021
Publisher site
See Article on Publisher Site

Abstract

Abstract • Neonatal deaths in Iowa were reviewed for the years 1982 and 1983. As in a similar review of deaths in 1978 and 1979, respiratory distress syndrome, bacterial sepsis, asphyxia, lethal malformations, and extreme immaturity accounted for approximately 90% of deaths. Fewer deaths occurred in 1982 and 1983 and the causes of death shifted toward the nonpreventable. Lethal malformations became the leading cause of death and showed an increased incidence over the previous period. The greatest reduction of deaths was in level 1 hospitals. Ability to effect further reduction in neonatal deaths was estimated by calculation of an idealized neonatal mortality rate for the state and each level of care. These calculations suggest that future reduction in mortality must come primarily from improved care in level 2 and 3 centers rather than from further change in level 1 provider behavior. (AJDC 1986;140:989-993) References 1. Hein HA, Brown CJ: Neonatal mortality review: A basis for improving care . Pediatrics 1981;68:504-509. 2. Hein HA, Lathrop SS, Papke KR: Comparing perinatal mortality . Obstet Gynecol 1985;66: 346-349. 3. Hein HA, Christopher MC, Ferguson NN: Rural perinatology . Pediatrics 1975;55:769-773. 4. Hein HA: Regionalization of perinatal care in rural areas based on the Iowa experience . Semin Perinatol 1977;1:241-254. 5. Hirata T, Epcar JT, Walsh A, et al: Survival and outcome of infants 501 to 750 grams: A six-year experience . J Pediatr 1983;102:741-748.Crossref 6. Milunsky A: Lethal congenital anomalies . JAMA 1983;250:517-518.Crossref 7. Autio-Harmainen H, Rapola J, Hoppu K, et al: Causes of neonatal deaths in a pediatric hospital neonatal unit . Acta Paediatr Scand 1983;72:333-337.Crossref 8. Hein HA: The status and future of small maternity services in Iowa . JAMA 1986;255: 1899-1903.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Oct 1, 1986

References