Low Birth Weight, Vital Records, and Infant Mortality

About one tenth of all infant deaths occur in babies weighing less than 500 g at birth, almost all of whom die very shortly thereafter. In 1983, when the United States reported 3,638,933 live births, 4,368 of them were less than 500 g; that year there were 26,507 neonatal deaths. This means that slightly more than 0.1% of all live births contributed to 17% of neonatal mortality. Given this order of magnitude, any change in the numbers relating to these tiny babies can have a disproportionate influence on reported infant mortality and on interstate comparisons. Two questions promptly arise. How accurate and meaningful are the data regarding babies born weighing less than 500 g? What can be done to decrease the deaths in this category? Wilson et al1 call attention to how the number of very low birth weight infants reported by a state may be affected by the state's definition of a live birth.

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Will Neonatology Vanish in 1995?

PEDIATRICS ◽

10.1542/peds.77.5.792 ◽

1986 ◽

Vol 77 (5) ◽

pp. 792-793

Author(s):

EMILE PAPIERNIK

Keyword(s):

United States ◽

Birth Weight ◽

Low Birth Weight ◽

Prevention Program ◽

Very Low Birth Weight ◽

The United States ◽

Low Birth Weight Infants

In Reply.— The interest of neonatologists in preventing preterm deliveries is remarkable in the United States. In France, where a policy of prevention was developed nationally in 1971, the first impulse also came from the neonatologists and specifically Alex Minkowski, who challenged the obstetricians to propose a real prevention program. The results of this program have now been published.1 incidence of very low birth weight infants in France in 1972 was 0.8 and in 1981 0.4.2

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Socioeconomic Disparities in Pregnancy Outcome and Infant Mortality: Extremely Low Birth Weight and Very Low Birth Weight Infants in Korea, 1995-2010

Health Policy and Management ◽

10.4332/kjhpa.2015.25.4.277 ◽

2015 ◽

Vol 25 (4) ◽

pp. 277-284

Author(s):

Hye-Jeong Park ◽

Mia Son

Keyword(s):

Birth Weight ◽

Infant Mortality ◽

Low Birth Weight ◽

Pregnancy Outcome ◽

Very Low Birth Weight ◽

Socioeconomic Disparities ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

In Pregnancy

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Changes in live births, preterm birth, low birth weight, and cesarean deliveries in the United States during the SARS-CoV-2 pandemic

10.1101/2021.03.20.21253990 ◽

2021 ◽

Author(s):

Alison Gemmill ◽

Joan A. Casey ◽

Ralph Catalano ◽

Deborah Karasek ◽

Tim-Allen Bruckner

Keyword(s):

Time Series ◽

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Cesarean Delivery ◽

Very Low Birth Weight ◽

National Level ◽

Health Indicators ◽

The United States ◽

Live Births

Background: The SARS-CoV-2 pandemic and associated social, economic, and clinical disruption have been widely speculated to affect pregnancy decision-making and outcomes. While a few US-based studies have examined subnational changes in fertility, preterm birth, and stillbirth, there remains limited knowledge of how the pandemic impacted childbearing and a broader set of perinatal health indicators at the national-level throughout 2020. Here, we use recently released national-level data to fill this gap. Importantly, we, unlike earlier work, use time-series methods to account for strong temporal patterning (e.g., seasonality, trend) that could otherwise lead to spurious findings. Methods: For the years 2015 to 2020, we obtained national monthly counts of births and rates (per 100 births) for six perinatal indicators: preterm birth (<37 weeks gestation), early preterm birth (<34 weeks gestation), late preterm birth (34-36 weeks gestation), low birth weight birth (<2500 g), very low birth weight birth (<1500 g), and cesarean delivery. We use an interrupted time-series approach to compare the outcomes observed after the pandemic began (March 2020) to those expected had the pandemic not occurred. Results: For total births as well as five of the six indicators (i.e., all but the rate of cesarean delivery), observed values fall well below expected levels (p<.0001 for each test) during the entire pandemic period. Declines in preterm birth and low birth weight were largest in magnitude in both early and later stages of the 2020 pandemic, while those for live births occurred at the end of the year. Discussion: Our findings provide some of the first national evidence of substantial reductions in live births and adverse perinatal outcomes during the SARS-CoV-2 pandemic. Only cesarean delivery appeared unaffected. These declines were not uniform across the pandemic, suggesting that several mechanisms, which require further study, may explain these patterns.

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Impact of Improved Survival of Very Low Birth Weight Infants on Recent Secular Trends in the Prevalence of Cerebral Palsy

PEDIATRICS ◽

10.1542/peds.91.6.1094 ◽

1993 ◽

Vol 91 (6) ◽

pp. 1094-1100

Author(s):

Vidya Bhushan ◽

Nigel Paneth ◽

John L. Kiely

Keyword(s):

United States ◽

Cerebral Palsy ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

The United States ◽

Epidemiologic Studies ◽

Secular Trends ◽

Industrialized Countries ◽

Low Birth Weight Infants

Objective. To review recent secular trends in the prevalence of cerebral palsy in industrialized countries that have population-based cerebral palsy registries and to estimate such time-trends for the United States, where until recently such registries were absent. Data sources. Recent epidemiologic studies of cerebral palsy published in peer-reviewed journals in English, and US vital data bearing on the principal demographic determinants of cerebral palsy—birth rates, the birth weight distributions, birth weight-specific mortality risk, and cerebral palsy risk among survivors. Results. Most epidemiologic studies from industrialized countries show a rise in the childhood prevalence of cerebral palsy in recent decades, largely because of the increasing contribution of children of low and very low birth weight to its prevalence. The only demographic determinant of cerebral palsy prevalence that is changing rapidly in the United States is survival of low birth weight and very low birth weight infants. Based on the magnitude of change in the survival of low and very low birth weight infants, it is estimated that childhood prevalence of cerebral palsy rose about 20% between 1960 and 1986 in the United States. Conclusion. An apparently unavoidable side effect of the increasing success of newborn intensive care is a moderate rise in the childhood prevalence of cerebral palsy.

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Feeding the Very Low-Birth-Weight Infant

Pediatrics in Review ◽

10.1542/pir.14.4.123 ◽

1993 ◽

Vol 14 (4) ◽

pp. 123-132

Author(s):

Rene Romero ◽

Ronald E. Kleinman

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

The United States ◽

Full Term ◽

Nutrition Support ◽

Low Birth Weight Infants ◽

Term Infants ◽

Stage Of Development ◽

Organ Systems

Unfortunately, premature birth occurs commonly in the United States. Improving the survival of very low-birth-weight (VLBW) infants depends in large part upon understanding the physiologic capabilities of their immature organ systems and providing appropriate support as they mature. Advances in the nutritional support of these infants have contributed to the better outcomes we have come to expect today, even for the smallest infants. In this review, we will discuss the limitations of gastrointestinal function and the unique nutritional requirements of very low-birth-weight infants and describe the current methods of enteral and parenteral nutrition support used to meet these requirements. Developmental Physiology By 24 to 26 weeks of gestation, the fetal gastrointestinal tract is morphologically similar to that of the full-term infant; however, functional development is far from complete. Maturation of gastrointestinal motility, digestion, and absorption continues through much of the first year of life, even in full-term infants, as a result of an interplay between the preprogrammed "biological clock" and environmental influences. The decision to feed the VLBW infant must take into account the developmental limitations as well as the potential for enhancing intestinal maturation at each stage of development (Table 1). Fetal swallowing is evident at the beginning of the second trimester.

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Infant mortality in a very low birth weight cohort from a public hospital in Rio de Janeiro, RJ, Brazil

Revista Brasileira de Saúde Materno Infantil ◽

10.1590/s1519-38292013000300005 ◽

2013 ◽

Vol 13 (3) ◽

pp. 237-246 ◽

Cited By ~ 3

Author(s):

Regina Coeli Azeredo Cardoso ◽

Patrícia Viana Guimarães Flores ◽

Cláudia Lima Vieira ◽

Kátia Vergetti Bloch ◽

Rejane Sobrino Pinheiro ◽

...

Keyword(s):

Birth Weight ◽

Infant Mortality ◽

Low Birth Weight ◽

Low Income ◽

Rio De Janeiro ◽

Public Hospital ◽

Very Low Birth Weight ◽

Low Birth Weight Infants ◽

Risk Of Death ◽

Years Of Schooling

OBJECTIVES: to evaluate infant mortality in very low birth weight newborns from a public hospital in Rio de Janeiro, Brazil (2002-2006). METHODS: a retrospective cohort study was performed using the probabilistic linkage method to identify infant mortality. Mortality proportions were calculated according to birth weight intervals and period of death. The Kaplan-Meier method was used to estimate overall cumulative survival probability. The association between maternal schooling and survival of very low birth weight infants was evaluated by means of Cox proportional hazard models adjusted for: prenatal care, birth weight, and gestational age. RESULTS: the study included 782 very low birth weight newborns. Of these, (28.6%) died before one year of age. Neonatal mortality was 19.5%, and earlyneonatal mortality was 14.9%. Mortality was highest in the lowest weight group (71.6%). Newborns whose mothers had less than four years of schooling had 2.5 times higher risk of death than those whose mothers had eight years of schooling or more, even after adjusting for intermediate factors. CONCLUSIONS: the results showed higher mortality among very low birth weight infants. Low schooling was an independent predictor of infant death in this low-income population sample.

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Preterm Infant Care After Hospital Discharge

Pediatrics in Review ◽

10.1542/pir.10.7.195 ◽

1989 ◽

Vol 10 (7) ◽

pp. 195-206

Author(s):

Judy C. Bernbaum ◽

Susan Friedman ◽

Marsha Hoffman Williamson ◽

JoAnn D'Agostino ◽

Anne Farran

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Pediatric Population ◽

The United States ◽

Low Birth Weight Infants ◽

Developmental Problems ◽

Developmental Progress ◽

Neurologic Disorders ◽

Physical Examinations

The survival of low birth weight infants has been markedly altered by the improvements in neonatal care. Despite these advances, little progress has been made in reducing the incidence of prematurity and low birth weight. Recently available statistics from 1983 indicate that, of all live births, 9.2% were premature (<37 weeks' gestation) and 1.8% were very premature (<32 weeks's gestation). Approximately 6% of infants are born weighing <2,500 g and 1.1% are very low birth weight (<1500 g). Approximately 3.6% of babies born in the United States are both premature and of low birth weight, and 0.8% are VLBW and very premature. Despite these relatively small numbers, this population comprises a disproportionately high percentage of children with medical, neurologic, and developmental problems. It is clear that, as more infants with low birth weights enter the pediatric population, pediatricians must become more expert in managing the medical conditions of these infants, recognizing early signs of neurologic disorders and monitoring their developmental progress. Routine physical examinations are usually not sufficient for such children. More time is generally needed to assess them and to discuss them with their parents than the typical well child. Physicians can play a major role in the identification of problems early in their evolution.

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