Variation in classification of live birth with newborn period death versus fetal death at the local level may impact reported infant mortality rate

BMC Pediatrics

Thomas Michael O’Shea²  John A Myers¹  Scott D Duncan¹  Deborah Winders Davis¹  Charles R Woods¹ 

[1] Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Suite 412, Louisville, KY, USA;Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA

关键词: Birth classification;    Perinatal death;    Infant mortality;    Fetal death;   

Others  :  1138886
DOI  :  10.1186/1471-2431-14-108

 received in 2013-10-09, accepted in 2014-04-11,  发布年份 2014

【 摘 要 】

Background

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.

Methods

A 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.

Results

After 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.

Conclusions

Valid 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.

【 授权许可】

   
2014 Woods et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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