Neonatal deaths in Alabama. II. Policy and research implications derived from a comparison of birth weight-specific state and medical center neonatal mortality rates.
An analysis of Alabama's recent neonatal mortality rate was performed to answer questions pertaining to projected changes in the neonatal mortality rate in the next decade. With current technology these questions include: (1) Can the current decline in the neonatal mortality rate continue? (2) Which infants not now surviving are potentially able to be saved? (3) What types of new programs may further reduce the neonatal mortality rate? (4) For which infants may research provide technology leading to further reductions in the neonatal mortality rate? In this analysis, birth weight-specific neonatal mortality rates for Alabama were compared with the lowest birth rate-specific neonatal mortality rates achieved in perinatal centers. Specific causes of neonatal death for each birth weight group were determined. Data suggest that 20% of current neonatal deaths would be preventable with available technology through expanded regionalization of perinatal care for infants born weighing less than 2,500 gm. Since lethal congenital anomalies cause the majority of neonatal deaths in infants born weighing greater than 2,499 gm, there is apparently little room for an improved neonatal mortality rate in this group. Without successful research leading to a reduction in preterm delivery rates, a reduction in lethal congenital anomalies or better survival of low-birth weight infants. Alabama's neonatal mortality rate is likely to level off at five to six per 1,000.
D000407:Alabama; D001724:Birth Weight; D000013:Congenital Abnormalities / Q000401:mortality / Q000517:prevention & control; D006291:Health Policy; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D009359:Neonatology / Q000592:standards* / Q000639:trends; D011295:Prenatal Care; D012040:Regional Health Planning