This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Richardson, D. K.
Right arrow Articles by McCormick, M. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Richardson, D. K.
Right arrow Articles by McCormick, M. C.
Related Collections
Right arrow Premature & Newborn

PEDIATRICS Vol. 102 No. 4 October 1998, pp. 893-899

Declining Severity Adjusted Mortality: Evidence of Improving Neonatal Intensive Care

Received Nov 19, 1997; accepted Apr 7, 1998.

Douglas K. Richardson*, Dagger , James E. Gray*, Steven L. Gortmaker§, Donald A. Goldmannparallel , DeWayne M. Pursley*, and Marie C. McCormick*, Dagger

From the * Joint Program in Neonatology (Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, and Children's Hospital and Harvard Medical School, Boston, Massachusetts; the Dagger  Department of Maternal and Child Health, Harvard School of Public Health, Boston, Massachusetts; the § Department of Health and Social Behavior, Harvard School of Public Health, Boston, Massachusetts; and the parallel  Department of Quality Improvement and Department of Infectious Diseases, Children's Hospital, Boston, Massachusetts.

Objectives.  Declines in neonatal mortality have been attributed to neonatal intensive care. An alternative to the "better care" hypothesis is the "better babies" hypothesis; ie, very low birth weight infants are delivered less ill and therefore have better survival.

Design.  We ascertained outcomes of all live births <1500 g in two prospective inception cohorts. We estimated mortality risk from birth weight and illness severity on admission and measured therapeutic intensity. We calculated logistic regression models to estimate the changing odds of mortality between cohorts.

Patients and Setting.  Two cohorts in the same two hospitals, 5 years apart (1989-1990 and 1994-1995) (total n = 739).

Results.  Neonatal intensive care unit mortality declined from 17.1% to 9.5%, and total mortality declined from 31.6% to 18.4%. Cohort 2 had lower risk (higher birth weight, gestational age, and Apgar scores and lower admission illness severity for newborns >= 750 g). Risk-adjusted mortality declined (odds ratio, 0.52; confidence interval, 0.29-0.96). One third of the decline was attributable to "better babies" and two thirds to "better care." Use of surfactant, mechanical ventilation, and pressors became more aggressive, but decreases in monitoring, procedures, and transfusions resulted in little change in therapeutic intensity.

Conclusions.  Mortality decreased nearly 50% for infants <1500 g in 5 years. One third of this decline is attributable to improved condition on admission that reflects improving obstetric and delivery room care. Two thirds of the decline is attributable to more effective newborn intensive care, which was associated with greater aggressiveness of respiratory and cardiovascular treatments. Attribution of improved birth weight specific mortality solely to neonatal intensive care may underestimate the contribution of high-risk obstetric care in providing "better babies."  Key words:  neonatal intensive care, neonatal mortality, low birth weight, illness severity, high-risk obstetric care.




This article has been cited by other articles:


Home page
 PediatricsHome page
E. A. Howell, P. Hebert, S. Chatterjee, L. C. Kleinman, and M. R. Chassin
Black/White Differences in Very Low Birth Weight Neonatal Mortality Rates Among New York City Hospitals
Pediatrics, March 1, 2008; 121(3): e407 - e415.
[Abstract] [Full Text] [PDF]

Home page
 J Trop PediatrHome page
F. B. de Mello, M. F. B. de Almeida, A. M. N. dos Santos, H. de Paula Fiod Costa, M. H. Miyoshi, and E. R. Amaro
Factors Associated with Survival of Very-low-birth-weight Infants in a Brazilian Fee-paying Maternity in the 1990s
J Trop Pediatr, June 1, 2007; 53(3): 153 - 157.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
K. E StC Hamilton, M. E Redshaw, and W. Tarnow-Mordi
Nurse staffing in relation to risk-adjusted mortality in neonatal care
Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2007; 92(2): F99 - F103.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
B. Luke and M. B. Brown
The Changing Risk of Infant Mortality by Gestation, Plurality, and Race: 1989-1991 Versus 1999-2001
Pediatrics, December 1, 2006; 118(6): 2488 - 2497.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
S A Reijneveld, M J K de Kleine, A L van Baar, L A A Kollee, C M Verhaak, F C Verhulst, and S P Verloove-Vanhorick
Behavioural and emotional problems in very preterm and very low birthweight infants at age 5 years
Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2006; 91(6): F423 - F428.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
D. M. Cutler, A. B. Rosen, and S. Vijan
The value of medical spending in the United States, 1960-2000.
N. Engl. J. Med., August 31, 2006; 355(9): 920 - 927.
[Abstract] [Full Text] [PDF]

Home page
 Health Aff (Millwood)Home page
J. A. Rogowski, D. O. Staiger, and J. D. Horbar
Variations In The Quality Of Care For Very-Low-Birthweight Infants: Implications For Policy
Health Aff., September 1, 2004; 23(5): 88 - 97.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
S. Hakansson, A. Farooqi, P. A. Holmgren, F. Serenius, and U. Hogberg
Proactive Management Promotes Outcome in Extremely Preterm Infants: A Population-Based Comparison of Two Perinatal Management Strategies
Pediatrics, July 1, 2004; 114(1): 58 - 64.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
B. Holler, S. A. Omar, M. D. Farid, and M. J. Patterson
Effects of Fluid and Electrolyte Management on Amphotericin B-Induced Nephrotoxicity Among Extremely Low Birth Weight Infants
Pediatrics, June 1, 2004; 113(6): e608 - e616.
[Abstract] [Full Text]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
R Joyce, R Webb, and J L Peacock
Associations between perinatal interventions and hospital stillbirth rates and neonatal mortality
Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2004; 89(1): F51 - F56.
[Abstract] [Full Text] [PDF]

Home page
 Ann. N. Y. Acad. Sci.Home page
B. S. PETERSON
Brain Imaging Studies of the Anatomical and Functional Consequences of Preterm Birth for Human Brain Development
Ann. N.Y. Acad. Sci., December 1, 2003; 1008(1): 219 - 237.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
M J K de Kleine, A L den Ouden, L A A Kollee, M W G N. van der Sanden, M Sondaar, B J M van Kessel-Feddema, S Knuijt, A L van Baar, A Ilsen, R Breur-Pieterse, et al.
Development and evaluation of a follow up assessment of preterm infants at 5 years of age
Arch. Dis. Child., October 1, 2003; 88(10): 870 - 875.
[Abstract] [Full Text] [PDF]

Home page
 NeoReviewsHome page
L. R. Blackmon
The Role of the Hospital of Birth on Survival of Extremely Low-birthweight, Extremely Preterm Infants
NeoReviews, June 1, 2003; 4(6): e147 - 152.
[Full Text] [PDF]

Home page
 BrainHome page
A. M. Santhouse, D. H. ffytche, R. J. Howard, S. C. R. Williams, A. L. Stewart, M. Rooney, J. S. Wyatt, L. Rifkin, and R. M. Murray
The functional significance of perinatal corpus callosum damage: an fMRI study in young adults
Brain, August 1, 2002; 125(8): 1782 - 1792.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
J. D. Horbar, G. J. Badger, J. H. Carpenter, A. A. Fanaroff, S. Kilpatrick, M. LaCorte, R. Phibbs, and R. F. Soll
Trends in Mortality and Morbidity for Very Low Birth Weight Infants, 1991-1999
Pediatrics, July 1, 2002; 110(1): 143 - 151.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
D. C. Goodman, E. S. Fisher, G. A. Little, T. A. Stukel, C.-h. Chang, and K. S. Schoendorf
The Relation between the Availability of Neonatal Intensive Care and Neonatal Mortality
N. Engl. J. Med., May 16, 2002; 346(20): 1538 - 1544.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
M. C. McCormick and D. K. Richardson
Premature Infants Grow Up
N. Engl. J. Med., January 17, 2002; 346(3): 197 - 198.
[Full Text] [PDF]

Home page
 PediatricsHome page
D. C. Goodman, E. S. Fisher, G. A. Little, T. A. Stukel, and C.-h. Chang
Are Neonatal Intensive Care Resources Located According to Need? Regional Variation in Neonatologists, Beds, and Low Birth Weight Newborns
Pediatrics, August 1, 2001; 108(2): 426 - 431.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
A.-M. Brooks, R. S. Byrd, M. Weitzman, P. Auinger, and J. T. McBride
Impact of Low Birth Weight on Early Childhood Asthma in the United States
Arch Pediatr Adolesc Med, March 1, 2001; 155(3): 401 - 406.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. Hack, H. G. Taylor, N. Klein, and N. Mercuri-Minich
Functional Limitations and Special Health Care Needs of 10- to 14-Year-Old Children Weighing Less Than 750 Grams at Birth
Pediatrics, September 1, 2000; 106(3): 554 - 560.
[Abstract] [Full Text]

Home page
 JAMAHome page
M. S. Kramer, K. Demissie, H. Yang, R. W. Platt, R. Sauve, R. Liston, and for the Fetal and Infant Health Study Group of the
The Contribution of Mild and Moderate Preterm Birth to Infant Mortality
JAMA, August 16, 2000; 284(7): 843 - 849.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
S. B. Morse, J. L. Haywood, R. L. Goldenberg, J. Bronstein, K. G. Nelson, and W. A. Carlo
Estimation of Neonatal Outcome and Perinatal Therapy Use
Pediatrics, May 1, 2000; 105(5): 1046 - 1050.
[Abstract] [Full Text]

Home page
 PediatricsHome page
L. R. Ment, B. Vohr, W. Allan, M. Westerveld, S. S. Sparrow, K. C. Schneider, K. H. Katz, C. C. Duncan, and R. W. Makuch
Outcome of Children in the Indomethacin Intraventricular Hemorrhage Prevention Trial
Pediatrics, March 1, 2000; 105(3): 485 - 491.
[Abstract] [Full Text]

Home page
 PediatricsHome page
M. Perlman
Neonatal Intensive Care Unit Report Cards
Pediatrics, October 1, 1998; 102(4): 975 - 976.
[Full Text] [PDF]