Abstract
BackgroundTo 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.MethodsA 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.ResultsAfter 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.ConclusionsValid 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.
Highlights
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 death using natality data from North Carolina for the years 1995–2000
During the six years of 1995–2000 in North Carolina, there were a total of 649,252 live births, with 5813 infant deaths (8.95 per 1000 live births), and 5311 fetal deaths
The population of pregnancies with outcomes classified as either fetal deaths or early neonatal deaths within the first 24 hours after birth consisted of 8044 such events
Summary
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. The definition of the infant mortality rate (IMR) as the number of deaths in the first year after birth per 1000 live births gained popular acceptance by the late 1800’s [1]. Disparities in the birth rates and newborn care of infants, especially preterm infants, may lead to incongruent comparisons. Very early preterm infants have much higher neonatal mortality rates than do term and nearterm live-born infants [5]. Approaches to birth classification, resuscitation, and care of the extremely preterm infant may alter outcome and influence the IMR [11]
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