Increased Infant Mortality Research Articles

Altitude, Low Birth Weight, and Infant Mortality in Colorado

A decrease in birth weight occurs at high altitude, but its relationship to infant mortality is unclear. We examined Colorado vital statistics recorded from 1979 through 1982 to determine whether high altitude increased infant mortality and whether decreased birth weight contributed to the mortality observed. Retardation of intrauterine growth reduced birth weight and doubled the frequency of low-birth-weight infants from the lowest (915 to 1523 m [3000 to 4999 ft]) to the highest (≥2744 m [≥9000 ft]) altitude in the state. Low birth weight increased mortality risk, but the mortality risk of low birth weight was decreased at high compared with low altitudes, resulting in similar infant mortality rates throughout the state. This finding differed from that of 1969 through 1973 when infant mortality doubled at high altitude. A 46% infant mortality reduction had occurred statewide over the ten years due chiefly to decreased mortality risk for preterm low-birth-weight infants. This reduction, particularly pronounced at high altitude, might have been due to better identification and transport of high-risk pregnancies to hospitals with tertiary neonatal treatment centers. (JAMA1988;259:3427-3432)

A Four-Week Observation of Maternity Care in Finland

The increasing infant mortality rate in the United States is of concern to all people, especially those involved in the care of mothers and infants. Of the 20 industrialized countries in the world, Finland, Sweden, and Japan rank first in lowest infant mortality rates. A four-week observational experience at a maternity and women's hospital in Helsinki, Finland, led to the identification of two contributing factors: 1) incentive for early antepartum care and 2) public education.

Altitude, Low Birth Weight, and Infant Mortality in Colorado

A decrease in birth weight occurs at high altitude, but its relationship to infant mortality is unclear. We examined Colorado vital statistics recorded from 1979 through 1982 to determine whether high altitude increased infant mortality and whether decreased birth weight contributed to the mortality observed. Retardation of intrauterine growth reduced birth weight and doubled the frequency of low-birth-weight infants from the lowest (915 to 1523 m [3000 to 4999 ft]) to the highest (greater than or equal to 2744 m [greater than or equal to 9000 ft]) altitude in the state. Low birth weight increased mortality risk, but the mortality risk of low birth weight was decreased at high compared with low altitudes, resulting in similar infant mortality rates throughout the state. This finding differed from that of 1969 through 1973 when infant mortality doubled at high altitude. A 46% infant mortality reduction had occurred statewide over the ten years due chiefly to decreased mortality risk for preterm low-birth-weight infants. This reduction, particularly pronounced at high altitude, might have been due to better identification and transport of high-risk pregnancies to hospitals with tertiary neonatal treatment centers.

Effects of prenatal exposure to tricyclic antidepressants on adrenergic responses in progeny.

Studies were undertaken to examine the effects on cardiovascular function in progeny of rats treated maternally with the tricyclic antidepressants, doxepin and imipramine. Doxepin was administered once daily during the first trimester (days 1-7), second trimester (days 8-14) or third trimester (days 15-21) of pregnancy, while imipramine was administered during the third trimester only. Exposure to doxepin during the first or second trimester increased infant mortality rate, while third trimester exposure to imipramine, but not doxepin, enhanced infant mortality. Additionally, third trimester imipramine, but not doxepin, exposure reduced birth weight and growth rate of progeny. Tests of cardiac and aortic response to adrenergic stimulation revealed that third trimester exposure to either of these tricyclic antidepressants enhance the responsiveness of the beta-adrenergic system in the aorta, while doxepin exposure during the other trimesters was without effect on aortic beta-response. Prenatal exposure to these antidepressants did not alter blood pressure or the contractile response of aortic tissues to alpha-receptor stimulation. Collectively, these studies reveal that at doses of tricyclic antidepressants which do not cause dysmorphic effects on the fetus, subtle alterations occur in selective adrenergic functions which can persist into adulthood in the rat.

Temperament and infant mortality among the Masai of East Africa.

On the basis of Western studies suggesting that infants with difficult temperaments are at greater risk for behavioral and physical disorders, the author postulated that Masai infants with difficult temperaments would be at greater risk in the harsh environment created by the sub-Saharan drought in 1974, which disrupted the life of the Masai people of East Africa and resulted in increased infant mortality. Two groups of infants with difficult and easy temperaments were defined and followed. Contrary to expectations, mortality was greater for the infants with easy temperaments. The infant's contribution, child-rearing orientation, and feeding practices were factors influencing survival.

The changing nature of the link between infant mortality and fertility in Finland 1776-1978

Short-term and long-term variations in data from the long Finnish time series were exploited for possible information on the nature of the relationship between child mortality and fertility. Various statistical models were applied to estimate the importance of different paths of causation between infant mortality and from short-term variations in those time series. All models of analysis--cross-lagged correlational analysis for absolute values and for annual percentage changes distributed lag regressions for total and for age-specific rates and the consideration of child mortality age 1-2 -- gave essentially the same result. In premodern (before 1917) Finland high tends to increase infant mortality in the following year; the infant mortality experience of the previous years does not appear to be an important determinant of current fertility. In the modern period (after 1917) the structure of determination seems to be reversed and high infant mortality experience in a certain year tends to increase in the following years. In terms of the interpretative model given it can be concluded that there is no evidence for a replacement strategy or for a strong lactational effect in premodern Finland. Evidence for a significant effect of fertility stress and possible direct or indirect infanticide appears. Once the practice of family limitation became accepted there was no more need for reducing the number of living children but still some less effective involuntary factors could have been present. The most significant change is that in modern Finland where fertility is within the calculus of conscious choice there seems to be clear evidence for a replacement strategy. To check the plausibility of the assumptions made and to shed more light on the determining influence of long-term development focuse moves to the impact of the secular infant mortality decline. It seems reasonable to see 1860-70 as a threshold since infant mortality enters its steep decline which continues almost linearly until 1960 when the curve which approaches zero levels off. Thus the steep and unreversed decline in infant mortality started in Finland 40-50 years before that of fertility. 40-50 years seems to quite long for the assumed perception lag which should link directly to infant mortality. The development of 5-year averages from 1751-1857 reveals significant declines even before 1880. A regression line drawn through the plot gives a slope coefficient of - .462 implying a decline in the infant mortality rate by 23.1 points in 50 years. Comparing this pattern of early decline in infant mortality to the time series of no effect of that early decline on was found. In fact even increased during the 2nd half of the 19th century.

Fertility effects of isolated spouse separations in relation to their timing.

The primary determinant of natural fecundability is coital frequency. Temporary spousal separation reduces coital frequency and may act as a contraceptive. Spousal separation can be 1) seasonal or cyclic, which is often linked with fishing or farming occupations, or 2) isolated, which is often associated with military service or migration from one community to another when the husband precedes the rest of the family. 1) Length, 2) completeness, and 3) timing of the separation determine fertility impact. This paper asks which reproductive state should begin the seperation in order to minimize the delay of the next conception. The investigation narrows the reproduction states under consideration to the 9 successive months of pregnancy and the month of postpartum anovulation. Using a simple model, the authors hypothesize that the minimum fertility impact for spousal separation coincides with a later gestational month, so that the average length of postpartum anovulation is longer, and the overall risk of pregnancy loss is higher. Longer separation should start at earlier gestational states to minimize net delay to the next conception since most women wil have a live birth and will be less fecund throughout much of the separation. Separations beginning at later gestational ages, such as 5 months, minimuze fercundability for shorter (6 month) periods. Spousal separation is a significant variable affecting fertility when the separation is short and is highly significant when the the separation is long. The authors also find that increased infant mortality decreases postpartum anovulation.

Crime and deviance : by Graeme R. Newman. Sage Publications, Inc. (275 South Beverly Drive, Beverly Hills, California 90212), 1980, 335 pp., hardcover, $20.00, softcover, $9.95.

This paper conducts the first analysis of the effect of armed conflict on progress in meeting the United Nation’s Millennium Development Goals. We also examine the effect of conflict on economic growth. Conflict has clear detrimental effects on the reduction of poverty and hunger, on primary education, on the reduction of child mortality, and on access to potable water. A medium-sized conflict with 2500 battle deaths is estimated to increase undernourishment an additional 3.3%, reduce life expectancy by about 1 year, increases infant mortality by 10%, and deprives an additional 1.8% of the population from access to potable water.

ESTIMATING THE RISKS FOR OFFSPRING OF FIRST-COUSIN MATINGS. AN APPROACH

Effects of parental consanguinity on morbidity and mortality can be estimated from observations on families ascertained through a child with a disease or defect, provided that appropriate corrections are made for the ascertainment bias. The risk of first-cousin parents having a child with a recessively inherited disease appears to be low (less than 1%). Data obtained by this approach suggest that the increased infant mortality associated with inbreeding (upon which calculations of lethal equivalents are based) may result in part from environmental differences between consanguineous and nonconsanguineous matings, which may be changing. Thus estimates of the number of lethal equivalents in a population can change as the environment changes.

The world food prospect

The global supply of food is now acting as a constraint on both population and economic growth. The worldwide scarcity of food in recent years has ked to soaring food prices. These in turn have contributed to rising death rates in the lowest income countries and, through efforts to check inflation, a global slowdown in economic growth. Thus, food has become not only a limit to future world growth but a very visible indicator of declining human welfare. In this paper the author demonstrates how the agricultural and nutritional advances of the last quarter century have ended on a resounding downbeat characterized by a falling fish catch, falling grain yields, increased infant mortality, falling food reserves, and price instability. Then he examines the way in which overpopulation, affluence inefficiency and political expediency have led virtually the entire world to heavy dependence on the North American breadbasket. Faced as we are with restraints on increased production—limited land, water, fuel, fertilizer, technology, capital, as well as ecological deterioration—one can only conclude that a vigorous global effort will be required to reverse the troublesome trends emerging during the seventies.

Fetal growth retardation and increased infant mortality at high altitide.

An examination of recent Colorado vital statistics records was performed. The records included 194,526 live births and 3,100 infant deaths occurring during the years 1969-73, and some 466,000 live births and 71,000 infant deaths occurring during 1960-71. Birth weights at high altitude (2,744 to 3,100 m) were found to be reduced owing to retardation of intrauterine growth rather than preterm delivery. Despite decreased infant mortality at all altitudes in Colorado during the last 20 years, the infant mortality rate at high altitude remains almost twice that seen in Denver. The elevated mortaltiy at high altitude occurred within 28 days after birth, primarily in preterm (less than 38 weeks) infants. It appears that high altitude, possibly throuth the mechansif of exaggerated fetal hypoxia, retards fetal growth and increases the mortality rate of preterm infants.

Effects of chronic morphine administration on pregnant rats and their offspring.

The effect of chronic maternal morphine exposure on conception, pregnancy, and perinatal development was studied in rat. Beginning 5 days prior to mating and continuing through gestation and lactation, female Sprague-Dawley albino rats received twice daily intraperitoneal (i.p.) injections of morphine sulfate; drug dosages were gradually increased from 10 mg/kg/injection to a maintenance level of 40 mg/kg/injection. Throughout gestation, drug-treated mothers weighed less than saline-injected controls. Control females displayed progressive weight loss during lactation; morphine-injected females showed marked weight gain in the 2nd and 3rd weeks of this period. Morphine administered during pregnancy produced decreased litter size, increased number of stillborns, increased infant mortality, and retardation of body growth in drug-exposed offspring. Weight deficits persisted in young rats observed 5 1/2 weeks after cessation of drug exposure as well as in animals continuing to receive twice daily i.p. injections of 20 mg/kg.

The World Food Prospect

Abstract The global supply of food is now acting as a constraint on both population and economic growth. The worldwide scarcity of food in recent years has ked to soaring food prices. These in turn have contributed to rising death rates in the lowest income countries and, through efforts to check inflation, a global slowdown in economic growth. Thus, food has become not only a limit to future world growth but a very visible indicator of declining human welfare. In this paper the author demonstrates how the agricultural and nutritional advances of the last quarter century have ended on a resounding downbeat characterized by a falling fish catch, falling grain yields, increased infant mortality, falling food reserves, and price instability. Then he examines the way in which overpopulation, affluence inefficiency and political expediency have led virtually the entire world to heavy dependence on the North American breadbasket. Faced as we are with restraints on increased production—limited land, water, fuel, fertilizer, technology, capital, as well as ecological deterioration—one can only conclude that a vigorous global effort will be required to reverse the troublesome trends emerging during the seventies.

Mother-infant interaction in lymphocytic choriomeningitis virus infection of the newborn mouse: the effect of maternal health on mortality of offspring.

Extract: The health of mothers was found to influence mortality of infant mice inoculated at 2 days of age with lymphocytic choriomeningitis (LCM) virus. When a normal mother (not exposed to LCM) was exchanged on day 9 after infection of the offspring with the original mother of LCM-inoculated mice a 20% decrease in mortality was observed, and when two mothers per litter were used the mortality dropped by 32%. Substitution of the original mother of uninoculated 9-day-old infant mice with a mother from LCM-infected mice induced a 15% greater mortality above the control level. Daily exchange (rotation) of mothers increased mortality of LCM-inoculated mice to 100% from the usual value of 71%, but only induced 11% mortality in uninoculated controls. Weight, and immunity tests, of mothers of infected mice showed that they received contact infection that caused mild illness, but in increased infant mortality (IM). Speculation: Lymphocytic choriomeningitis virus used as an infectious agent in mice indicate that sick infant mice are very susceptible to minor changes in maternal care, consequent upon mild or subclinical infection. Illness of both mother and offspring apparently results in a synergistic lethal effect resulting in exaggerated IM. Although it appears likely that IM arises from poor maternal care, other factors such as milk composition, including antibody content, may be involved, and may be relevent to comparable situations in man.

Protein and Calorie Malnutrition Among Preschool Navajo Indian Children

The hospital charts of children, under 5 years of age, admitted with malnutrition to the Public Health Service Indian Hospital in Tuba City, Arizona, were reviewed for the 5-year period of 1963-1967 inclusive. There were 616 children with diagnoses of malnutrition. Five hundred and eighty-seven had heights and weights below the norms for their chronological ages. Fifteen had kwashiorkor and 29 had marasmus. Total serum protein and serum albumin were reduced in the cases of kwashiorkor. The occurrence of these calorie- and protein-deficiency diseases constitute a major public health problem on the western half of the Navajo Reservation. The heights and weights of Head Start children, from all over the reservation, were below the Iowa-Boston norms. This is probably the end result of chronic calorie and protein malnutrition acting in synergism with repeated bacterial and viral infections, causing repeated episodes of gastroenteritis and respiratory infections and contributing to increased infant mortality.