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Premature Births Are Fueling Higher Rates of Infant Mortality in U.S., Report Says

Specializes in Critical care, tele, Medical-Surgical.

[color=#333333]high rates of premature birth are the main reason the united states has higher [color=#004276]infant mortality than do many other rich countries, government researchers reported tuesday in [color=#004276]their first detailed analysis of a longstanding problem.

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[color=#333333]in sweden, for instance, 6.3 percent of births were premature, compared with 12.4 percent in the united states in 2005, the latest year for which international rankings are available.

[color=#333333]infant mortality also differed markedly: for every 1,000 births in the united states, 6.9 infants died before they turned 1, compared with 2.4 in sweden. twenty-nine other countries also had lower rates.

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[color=#333333]if the united states could match sweden's prematurity rate, the new report said, "nearly 8,000 infant deaths would be averted each year, and the u.s. infant mortality rate would be one-third lower."...

[color=#333333]...dr. fleischman said the smallest, earliest and most fragile babies were often born to poor and minority women who lacked health care and social support....

[color=#333333]...[color=#333333]taking care of women's illnesses and problems like drinking, drug use and [color=#004276]smoking before and during pregnancy can help prevent prematurity, he said, adding that a state program in kentucky to provide home visits by nurses to poor women during pregnancy had decreased preterm births. ...

[color=#333333]http://www.nytimes.com/2009/11/04/health/04infant.html

canoehead, BSN, RN

Specializes in ER.

Probably some of those infants wouldn't survive as embryos in other countries too. Women who are medically fragile would not get pregnant without medical intervention, and multiple births of tiny babies certainly increases the American death rate.

Bree124, BSN, RN

Specializes in L&D.

In Sweden, for instance, 6.3 percent of births were premature, compared with 12.4 percent in the United States in 2005, the latest year for which international rankings are available.

Infant mortality also differed markedly: for every 1,000 births in the United States, 6.9 infants died before they turned 1, compared with 2.4 in Sweden. Twenty-nine other countries also had lower rates.

If the United States could match Sweden's prematurity rate, the new report said, "nearly 8,000 infant deaths would be averted each year, and the U.S. infant mortality rate would be one-third lower."

So we could be one-third lower, but we'd still be almost twice as high as Sweden... How does that work?

dancingdoula

Specializes in NICU.

"So we could be one-third lower, but we'd still be almost twice as high as Sweden... How does that work?"

Sweden also uses far fewer interventions (c-sections, vacuum extractions, etc...) which snowball into complications and most births are attended by Midwives. Docs in this country have a tendency to use techniques that aren't really necessary just to cover their butts. :angryfire

Bree124, BSN, RN

Specializes in L&D.

Sweden also uses far fewer interventions (c-sections, vacuum extractions, etc...) which snowball into complications and most births are attended by Midwives. Docs in this country have a tendency to use techniques that aren't really necessary just to cover their butts. :angryfire

I was making a poor attempt at sarcasm, and in retrospect I see that it did not translate well across a computer. :coollook:

Edited by Bree124

I wonder how the teenage pregnancies compare statistically between the US and other countries. I read a report that said the US has the highest rate of teen pregnancies among industrialized nations. About 745,000 teen pregnancies occur each year in the US. Teen mothers are more likely to receive inconsistent prenatal care, deliver preterm, and have low birth weights. This age group also participates in risk taking behaviors. This could be an important factor in the overall high premature births and mortality rates reported in the US.

TiffyRN, ADN, BSN, PhD

Specializes in NICU.

The report I read elaborated on how the US has many factors that increase their rate of prematurity. If we could reduce our risk factors for prematurity (induced labor, fertility with resultant multiple gestation, high rates of obesity, smoking, poor & no prenatal care), we would have a very comparable rate of infant mortality, but until we reduce our rate of prematurity, we will compare to 3rd world countries.

I believe it was also reported that we have a very superior rate of saving premature infants once they are born. Which I'm proud of because that's my field, however, hands down, no care we can provide compares to just staying a few more weeks inside mama.

Bree124, I totally understood what you were trying to say. But, I do also understand that the US as a whole probably has more teen pregnancy's than other countries. And yes I understand that it does happen in other countries but you also have to think about that in some of those other countries they can get married younger and that might give these women a (albeit maybe only slightly) better financial option than the single teen moms. And some of thses other countries probably have a religion where they can be punished for participating in premarital sex. Just so thoughts. Although I am totally glad that we have NICU nurses(that is what I would love to be) and I think that you do a fabolous job!

I may be wrong, been trying to find the info, but I believe in 2005 the resusutation guidlines in Sweden were less liberal than in the US. While we resusitate @ 23 weeks/400 gms, Sweden may label it as a "miscarrriage.

TiffyRN, ADN, BSN, PhD

Specializes in NICU.

I may be wrong, been trying to find the info, but I believe in 2005 the resusutation guidlines in Sweden were less liberal than in the US. While we resusitate @ 23 weeks/400 gms, Sweden may label it as a "miscarrriage.

I've always suspected that this unnaturally elevated our infant mortality rates. This latest CDC report counted all US infants born >22 weeks. I would say many if not most hospitals don't routinely attempt resuscitation until 23 weeks and I think I heard the survival to discharge rate of 22 weekers was

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

I think this is a state-by-state thing, but in my state, regardless of gestation, if the baby shows signs of life, it is counted as a live birth. Medically for the mother it is counted as a miscarriage but for statistical purposes if there is any movement at all, or a definite pulse, it is counted as a live birth and must have a birth and death certificate. So technically, I guess we have some 15 and 16 weekers figuring into our mortality stats as well. At least in my state.

But without knowing exactly how other countries define this same thing, it's hard to tell whether it actually confounds our statistics or not. I've heard some of the same things already posted in this thread but it would be interesting to find out at what gestation countries like the UK, the Netherlands, Sweden, or heck, even Argentina (just to name a few) resuscitate aggresively or count as a 'live birth.' Interesting topic.

Edited by ElvishDNP

BabyCatchr, ADN, ASN, RN

Specializes in OB/Gyn, L&D, NICU.

We need to know where these statistics are coming from: the WHO? If so, wouldn't they have standardized the definition of "stillbirth" vs "live birth"? Worth checking into. However, the U.S. mortality rate is still increased by unnecessary intervention: c-sections, vacuum, induction. Even putting in an IV has serious consequences at the cellular level, which is evidenced in studies & outcomes as well. IVs should not be routine in a normal birth. Hep lock/saline lock at most. Moms need to eat and drink to keep up their blood sugar levels in labor.

Poor nutrition, smoking, and & multiple births also contribute to our higher mortality rate. I would have to say that those having multiple births are probably not cross-tabulated with the poor, as they don't have the finances/insurance to cover infertility treatments. Overall, I hope that we, as nurses (me still a student but am currently a certified childbirth educator, labor assistant, & doula) can affect change for the better! We have come a long way: dads in the delivery room (introduced by Dr. Robert Bradley), mom being awake during the birth, and dramatic decrease in the number of episiotomies & forceps deliveries. Yay!!

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

Oh, I agree with you, BabyCatchr. I am no proponent of the US system of giving birth. I'm just saying, I wonder how each country reports their own stats, because I think that is what the WHO goes by.

I did some research last night and found some interesting things about how Scandinavia reports their birth stats.

Here:

http://www.stakes.fi/EN/tilastot/statisticsbytopic/reproduction/perinatalreproductionsummary.htm

i did some research last night and found some interesting things about how scandinavia reports their birth stats.

here:

http://www.stakes.fi/en/tilastot/statisticsbytopic/reproduction/perinatalreproductionsummary.htm

stillbirth: birth of a foetus or a child that shows no evidence of life typical of a live birth, but complying with the definition of a birth. the registration criterion is 12 gestational weeks in norway, 22 weeks in denmark, finland and iceland, and 28 weeks in sweden. finland uses the birth weight limit of 500 g as a parallel registration criterion.

this is exactly what i am looking for! 28 weeks?! 28 weekers have a 90% (guesstimation)survival rate on my unit. even with a one minute apgar of 0.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

I still find it interesting that they use other criteria in other countries and beat us all hollow - 22 weeks in Finland/Denmark/Iceland and 12 weeks in Norway. 28 weeks in Sweden seems to be an outlier.

This is exactly what I am looking for! 28 weeks?! 28 weekers have a 90% (guesstimation)survival rate on my unit. Even with a one minute apgar of 0.

No wonder Sweden has such good numbers. Their cost savings is also remarkable I bet, a very sick less than 28 weeker can be very expensive all their life.

Tons of people are falling through the cracks in American healthcare. And our obstetric care is outrageous. We're sectioning at very dangerous rates. This headline seems to me like an attempt to justify or explain away our stats. We will do much better if we face what's really going on and start making changes.

HeartsOpenWide, RN

Specializes in Ante-Intra-Postpartum, Post Gyne.

a lot of these pre-mature births are caused by doctors doing inductions too early. there is a new word they are using to try and discourage this: "late pre-term" for babies that are 37 weeks. A lot of docs will induce the second a woman turns 37 weeks. A lot of people in this country have "fast-food" and "microwave oven" mentalities and need to just learn to wait.

lamazeteacher

Specializes in OB, HH, ADMIN, IC, ED, QI.

"So we could be one-third lower, but we'd still be almost twice as high as Sweden... How does that work?"

Sweden also uses far fewer interventions (c-sections, vacuum extractions, etc...) which snowball into complications and most births are attended by Midwives. Docs in this country have a tendency to use techniques that aren't really necessary just to cover their butts. :angryfire

Thank you, dancing doula for using your math well, to show that the USA is still having far more infant mortality than occurs elsewhere. We can't pin it all on the increase in c/s rate. H1N1 will show a greater increase in premature c/s. I sure hope we'll focus on assisting the greater number of motherless children as a result of the tragic It's especially interesting to see that money spent on doctors, hospitals, etc. isn't a deciding factor.

Intervention by doing C/S upon request, and justifying it incorrectly is increasing. It would be very interesting (you know where I'm coming from) to keep stats on the number of premies, early and later, that occur among class prepared expectant mothers, and the amount of fluids they drink daily.

We need to study what other countries do that keeps their prematurity and infant mortality rates lower than ours. Diets need to be analyzed, water contents, medication/street drug use in pregnancy, exercise, family histories, and health attitudes, etc. I somehow doubt that resistance to physician, nurse and informed family recommendations, aka noncompliance occurs as much as it does here, elsewhere. :imbar

CLC172

Specializes in Pediatrics.

"So we could be one-third lower, but we'd still be almost twice as high as Sweden... How does that work?"

Sweden also uses far fewer interventions (c-sections, vacuum extractions, etc...) which snowball into complications and most births are attended by Midwives. Docs in this country have a tendency to use techniques that aren't really necessary just to cover their butts. :angryfire

I know, it drives me crazy and that's the reason I want to become a midwife. I believe that the reason I ended up with a C-section, due to my daughter being in fetal distress, was because of the medical interventions like breaking my water and use of pitocin. I'll obviously never know for sure, but it is something that's always bothered me. I'm thinking of getting pregnant again but the statistics of our country worries me!:twocents:

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