Grand Rounds has eaten up most of my blog time for today, but I do want to direct you to this article on neonatal mortality in the United States and globally. Not good news for the U.S. and the UK--we're tied for the bottom of industrialized countries. The numbers, overally, are terrible:
Each year, according to the report, more than a half-million women die as a result of pregnancy and childbirth difficulties, 2 million babies die within their first 24 hours -- more than 5,000 deaths a day -- 2 million more die within their first month and 3 million are stillborn.
It's a brief article, but they highlight some of the good and some of the bad. Clearly, we all have much room for improvement.
Image from http://www.pregnancy-leads-to-new-babies.com/images/newborn-baby-pictur…
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Before folks start jumping on the U.S.-bashing bandwagon that's painted "Infant Mortality", let's take a closer look at the numbers.
The top 5 leading causes of infant death in 2002 were as follows:
Congenital Malformations (20%)
Disorders relating short gestation and unspecified low birth weight (17%)
Sudden Infant Death Syndrome (8%)
Newborns affected by maternal complications of pregnancy (6%)
Newborns affected by complications of placenta, cord, and membranes (4%)
Source: Pediatrics 117(1):168-183)
The top two causes can be accounted for entirely by the usual custom and practice in the U.S. to deliver fetuses with obvious congenital anomalies and extremely low birth weights and to count them as live births. In other countries this is often neither usual nor customary.
The third cause, SIDS, is at least partially preventable via back-to-sleep (and maybe pacifiers). It is not yet known what the "background" rate of SIDS is, if there is one.
The last two are obstetrical causes. Word to the wise for the home-birth crowd.
This remains the best country in the world if you want to be born.
best,
Flea
Very good points, and the article does (albeit very briefly) mention the differences cultural practices play in the determination of rankings and statistics, which would include the definition of what constitutes a live birth. Have a question for you--do you know what they use to define "unspecified low birth weight"? I don't see it in the Peds article on brief glance. "Short gestation and low birth weight" seems to me an awful broad category.
Tara,
It's a way of saying "we know the baby is a premie and low-birth weight but we have no record of gestational age or birth weight".
Flea
Hey you. Drop me an email. I wanted to write you, but your address is in some laptop I used 3 laptops ago.
Go see Scanner Darkly when it comes out:
http://en.wikipedia.org/wiki/Scanner_darkly
http://wip.warnerbros.com/ascannerdarkly
oooh look comment spam! I want to kill whoever invented that.
Here's a skeptic's thought. The UK with their abysmal healthcare this probably does not apply to, but here in the US those who would A. not survive, B. be infertile, or C. just in general be unhealthy are much better taken care of than many other places around the world.
This is pure speculation, but the fact that people with already 'weak constitutions' (being intentionally vague here) not only can live full adult lives (or at least into adulthood) but are able to conceive, may play a role here.
There is plenty of evidence for increased infant mortality in women with any number of conditions which are nuisances with modern medical care but life-threatening without it.
I've heard that couples who are unable to conceive without medical intervention are more likely to have babies with various problems once they seek infertility, for instance. Never seen a paper on it, but seen a few news releases about it, and had it mentioned to me by a couple of OB/GYN's
Sorry, that was formless and ill-stated, but hopefully someone can pick up on what I was saying and actually make the coherent statement that I intended to make.
IndianCowboy,
I'm guessing your are a ranch hand at Brokeback Mountain. That was not comment spam you dork.
Sorry, Noble, didn't mean to cast aspersions on your character. I saw what looked like an advert for something and jumped to a conclusion (i get over 150 comment spams per day...and only 70 visitors! wtf? So I really hate comment spam).
And no, I am not a ranch hand at Brokeback Mountain. I was chief monkey wrangler at an animal sanctuary for a while.
But yes, I am indeed a dork.
I think low birth weight is an infant <2500 g and short gestation is <37 weeks. CDC describes <2500 g as "low birth weight" and <1500 g as "very low birth weight." I'm not positive about how short "short gestation" is.
I think low birth weight is an infant under 2500 g and short gestation is less than 37 weeks. CDC uses less than 2500 g as "low birth weight" and less than 1500 g as "very low birth weight." I'm not positive about how short "short gestation" is.
This is pure speculation, but the fact that people with already 'weak constitutions' (being intentionally vague here) not only can live full adult lives (or at least into adulthood) but are able to conceive, may play a role here.
I doubt that people with 'weak constitutions' are significantly more likely to survive and conceive in the US than list-topping Scandinavia, for example.
like I said, pure speculation. And honestly probably applies more to developed vs. 3rd world, rather than developed vs. developed.
I have heard what Windy posted, too. Some countries do not count as live births babies under a certain weight OR length...! So they are documented stillborn. Sp because we do more with premies and very sick babies and document them "properly" our stats appear even highter.
Additionally, I am sure as I read that stats in (especially so-called Third World countries, and perhaps others) these stats are under-reported, but a HUGE number.
Hh