This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Thompson, L. A. Articles by Little, G. A. Search for Related Content PubMed PubMed Citation Articles by Thompson, L. A. Articles by Little, G. A. Related Collections Premature & Newborn Social Bookmarking                         What's this?

PEDIATRICS Vol. 109 No. 6 June 2002, pp. 1036-1043

Is More Neonatal Intensive Care Always Better? Insights From a Cross-National Comparison of Reproductive Care

Lindsay A. Thompson, MD, MS^*,, David C. Goodman, MD, MS^*, and George A. Little, MD^*

^* Department of Pediatrics
Center for the Evaluative Clinical Sciences and Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire

--> Background. Despite high per capita health care expenditure, the United States has crude infant survival rates that are lower than similarly developed nations. Although differences in vital recording and socioeconomic risk have been studied, a systematic, cross-national comparison of perinatal health care systems is lacking.

Objective. To characterize systems of reproductive care for the United States, Australia, Canada, and the United Kingdom, including a detailed analysis of neonatal intensive care and mortality.

Design/Methods. Comparison of selected indicators of reproductive care and mortality from 1993–2000 through a systematic review of journal and government publications and structured interviews of leaders in perinatal and neonatal care.

Results. Compared with the other 3 countries, the United States has more neonatal intensive care resources yet provides proportionately less support for preconception and prenatal care. Unlike the United States, the other countries provided free family planning services and prenatal and perinatal physician care, and the United Kingdom and Australia paid for all contraception. The United States has high neonatal intensive care capacity, with 6.1 neonatologists per 10 000 live births; Australia, 3.7; Canada, 3.3; and the United Kingdom, 2.7. For intensive care beds, the United States has 3.3 per 10 000 live births; Australia and Canada, 2.6; and the United Kingdom, 0.67. Greater neonatal intensive care resources were not consistently associated with lower birth weight-specific mortality. The relative risk (United States as reference) of neonatal mortality for infants <1000 g was 0.84 for Australia, 1.12 for Canada, and 0.99 for the United Kingdom; for 1000 to 2499 g infants, the relative risk was 0.97 for Australia, 1.26 for Canada, and 0.95 for the United Kingdom. As reported elsewhere, low birth weight rates were notably higher in the United States, partially explaining the high crude mortality rates.

Conclusions. The United States has significantly greater neonatal intensive care resources per capita, compared with 3 other developed countries, without having consistently better birth weight-specific mortality. Despite low birth weight rates that exceed other countries, the United States has proportionately more providers per low birth weight infant, but offers less extensive preconception and prenatal services. This study questions the effectiveness of the current distribution of US reproductive care resources and its emphasis on neonatal intensive care.

Key Words: neonatal intensive care • infant mortality • health policy • international comparisons

Abbreviations: IMR, infant mortality rate • NMR, neonatal mortality rate • RR, relative risk • CI, confidence interval

---

Received for publication Dec 10, 2001; Accepted Jan 25, 2001.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				C. V Ananth, S. Liu, K. Joseph, M. S Kramer, and for the Fetal and Infant Health Study Group of the A comparison of foetal and infant mortality in the United States and Canada Int. J. Epidemiol., April 1, 2009; 38(2): 480 - 489. [Abstract] [Full Text] [PDF]

				R. David and J. Collins Jr Disparities in Infant Mortality: What's Genetics Got to Do With It? Am J Public Health, July 1, 2007; 97(7): 1191 - 1197. [Abstract] [Full Text] [PDF]

				J. M Cusack, D. J Field, and B. N Manktelow Impact of service changes on neonatal transfer patterns over 10 years Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2007; 92(3): F181 - F184. [Abstract] [Full Text] [PDF]

				M. L. Mayer Are We There Yet? Distance to Care and Relative Supply Among Pediatric Medical Subspecialties Pediatrics, December 1, 2006; 118(6): 2313 - 2321. [Abstract] [Full Text] [PDF]

				C. V. Ananth, S. Liu, W. L. Kinzler, and M. S. Kramer Stillbirths in the United States, 1981-2000: An Age, Period, and Cohort Analysis Am J Public Health, December 1, 2005; 95(12): 2213 - 2217. [Abstract] [Full Text] [PDF]

				E. A. Jewett, M. R. Anderson, and G. S. Gilchrist The Pediatric Subspecialty Workforce: Public Policy and Forces for Change Pediatrics, November 1, 2005; 116(5): 1192 - 1202. [Abstract] [Full Text] [PDF]

				A. Garland Improving the ICU: Part 1 Chest, June 1, 2005; 127(6): 2151 - 2164. [Abstract] [Full Text] [PDF]

				W. A. Silverman Restraining the Unsustainable Pediatrics, March 1, 2003; 111(3): 672 - 674. [Full Text] [PDF]

				R. A. Cooper, M. R. Goldstein, I. Hand, L. Noble, J. R. Milley, D. C. Goodman, E. S. Fisher, G. A. Little, and K. Grumbach Availability of Neonatal Intensive Care and Neonatal Mortality N. Engl. J. Med., December 5, 2002; 347(23): 1893 - 1895. [Full Text] [PDF]

				J. H. Tanne High level of resources for neonatal intensive care does not give US better outcomes BMJ, June 8, 2002; 324(7350): 1353 - 1353. [Full Text] [PDF]