Abstract
Advances over the past decade have led to increased survival of infants born at 23-28 weeks gestational age (GA). Concurrently, more infants 24 hours. Mean birthweight was 318 ± 114 grams. Mean GA was 19.3 ± 2.4 weeks. Only 5/71 infants had either one or five minute apgars greater than 1. Of the live born, 66 (93%) were NW, and 5 (7%) were W. In the stillborn group, 101 (75%) were NW and 33 (25%) W. The 1992 Philadelphia infant mortality rate (IMR) was 13.8/1000, with rates of 18.6 for NW and 6.8 for W. Of 232 neonatal deaths, 71 (30.6%) were nonviable. The 66 NW deaths in the nonviable group accounted for 21% of NW infant deaths, while the 5 white nonviable infant deaths represented 6% of deaths in that group. If excluded from mortality statistics, as is the case in many developed nations, the NW infant mortality rate would drop from 18.6 to 14.5, and the IMR for white infants from 6.8 to 6.4. As 71 nonviable fetuses reported as live births come from only 60% of reported births in Philadelphia, the total in this group is likely higher, resulting in further reductions in the IMR. Variation among hospitals in the percentage of births under 23 weeks GA reported as live, (range 5-90%), and the fact that virtually no white infants< 23 weeks were classified as live born suggests a systematic bias in the reporting of live births.
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