Is Fetal Life Riskier than Neonatal life?
OBJECTIVE: The aim of this study is to compare risk for fetal death, greater than or equal to 20 weeks gestation, and neonatal death, less than 28 days, after each gestational age for the prevailing pregnancies.
DESIGN/METHODS: We used the NCHS linked birth and death files for 1999 and 2000. Variables used in the analysis were clinical gestational age, live births, Neonatal death at less than 27 days age of death (ND), and stillbirth (SB) more than and equal to 20 wks. SB risk (SBR) was calculated as SB for each gestational age per 1000 total births (TB) (total live births and total stillbirths) at risk. The neonatal mortality risk (NMR) was calculated as ND per 1000 TB at risk.
RESULTS: In 1999 and 2000, total pregnancies at risk were 8,076,923 comprising 8,025,028 live births and 51,895 stillbirths for GA 20-46wks. SBR was higher than NMR for every GA except for 23 thru 25 wks. There was no difference for mortality in GA from 41 thru 43; however, at 44 wks SBR becomes significantly higher. Analysis for GA > 44 wks was not possible due to very small numbers.
CONCLUSIONS: 1) Stillbirth rate is higher than neonatal mortality rate for every gestational age between 20 - 44 wks, with the exception of 23-25 wks. 2) Perinatal statistics should be presented as mortality, both intrauterine and extrauterine, for pregnancies at risk at each gestational age. The impact of stillbirth on potential life lost would be emphasized by this strategy. 3) Improvement of fetal life would impact the neonatal outcome also.
Provision of health care to the public
Define a new method of assessing pregnancy outcome as risk of fetal death or neonatal death for each week of gestation with respect to prevailing pregnancies at risk at the beginning of each. Compare stillbirth or neonatal mortality risk as pregnancies pass through each week of gestation.
Keyword(s): Epidemiology, Maternal and Child Health
Qualified on the content I am responsible for because: I have been taking care of sick newborns in the Neonatal intensive care unit, NICU for the last 30 years and assess neonatal mortality and still birth rates for perinatal statistics. After several years of experience I felt conventional method of calculation of still birth rate or neonatal mortality gives no assessment of pregnancy outcome of death as it passes through each week of pregnancy. A new method is presented for this assessment.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.