title: Variation in classification of live birth with newborn period death versus fetal death at the local level may impact reported infant mortality rate.
abstract: BACKGROUND
  To better understand factors that may impact infant mortality rates (IMR), we evaluated the consistency across birth hospitals in the classification of a birth event as either a fetal death or an early neonatal (infant) death using natality data from North Carolina for the years 1995-2000.
  
  
  METHODS
  A database consisting of fetal deaths and infant deaths occurring within the first 24 hours after birth was constructed. Bivariate, followed by multivariable regression, analyses were used to control for relevant maternal and infant factors. Based upon hospital variances, adjustments were made to evaluate the impact of the classification on statewide infant mortality rate.
  
  
  RESULTS
  After controlling for multiple maternal and infant factors, birth hospital remained a factor related to the classification of early neonatal versus fetal death. Reporting of early neonatal deaths versus fetal deaths consistent with the lowest or highest hospital strata would have resulted in an adjusted IMR varying from 7.5 to 10.64 compared with the actual rate of 8.95.
  
  
  CONCLUSIONS
  Valid comparisons of IMR among geographic regions within and between countries require consistent classification of perinatal deaths. This study demonstrates that local variation in categorization of death events as fetal death versus neonatal death within the first 24 hours after delivery may impact a state-level IMR in a meaningful magnitude. The potential impact of this issue on IMRs should be examined in other state and national populations.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Woods
authors.affiliation: Department of Pediatrics, University of Louisville School of Medicine, 571 S, Floyd Street, Suite 412, Louisville, KY, USA. deborah.davis@louisville.edu.
authors.forename: Deborah Winders
authors.initials: DW
authors.lastname: Davis
authors.forename: Scott D
authors.initials: SD
authors.lastname: Duncan
authors.forename: John A
authors.initials: JA
authors.lastname: Myers
authors.forename: Thomas Michael
authors.initials: TM
authors.lastname: O'Shea
mesh_terms: D001724:Birth Weight; D019992:Databases as Topic; D004522:Educational Status; D005260:Female; D005313:Fetal Death / Q000145:classification*; D046689:Fetal Mortality; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth; D008423:Maternal Age; D009657:North Carolina / Q000453:epidemiology; D054238:Perinatal Mortality
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