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Some Facts about Infant Mortality and Neonatal Care chapter two Neonatal mortality is defined as death before 28 days of age. Postneonatal mortality is defined as death between 28 days and 1 year. Infant mortality is the sum of these two and is defined as death before 1 year of age. When these mortality rates are reported, they are usually offered for different groups of babies, classified by birthweight. Babies who weigh less than 2500 grams (5.5 pounds) at birth are classified as low birthweight. Babies who weigh less than 1500 grams (3.3 pounds) at birth are considered very low birthweight. In some reports , another category, extremely low birth weight, describes outcomes for babies who weigh less than 1000 grams (2.2 pounds) at birth. Infant mortality rates are generally reported not as percentages but as deaths per 1000 live births. Gestational maturity is highly correlated with birthweight, but some premature babies are larger than average and so fall within the range of normal for birthweight, while some full-term babies are smaller than average and hence of low birthweight. The numbers of babies in these two groups are relatively small, so, generally speaking , low birthweight means premature. In the United States, infant mortality has dropped from 55/1000 in 1900 to 9/1000 in 2000. Trends over the century reveal much about the reasons for the improvement . In the early part of the century, the improvement was in both neonatal and postneonatal mortality. Most epidemiologists attribute these improvements to public health measures, such as better nutrition and sanitation. In the mid-twentieth century, postneonatal mortality rates improved faster than neonatal mortality rates. 14 n e o n a t a l b i o e t h i c s This is usually attributed to medical interventions such as antibiotics and immunizations that had greater efficacy in older babies than in neonates. In 1960, the neonatal mortality rate in the United States was 19/1000. It steadily dropped over the next decades, to 16 in 1970, 13 in 1980, 9 in 1990, and 4 in 2000. Much of the recent drop is attributable to improvements in survival for low birthweight babies. These improvements in birthweight-specific neonatal mortality are generally attributed to improvements in neonatal intensive care and, in particular, in the care of tiny premature babies.1 Many of the patients in NICUs are premature babies, but there are two other groups of babies who are admitted to NICUs, full-term babies with acute illness and babies with congenital anomalies. These other groups of NICU patients are both medically and ethically distinct. three groups of babies who are admitted to nicus Overall, three relatively distinct groups of babies are admitted to neonatal intensive care units. The first group is full-term or near-term babies with acute illnesses such as pneumonia or sepsis or babies with surgically correctable anatomic abnormalities . The second group comprises babies with congenital anomalies that are not correctable at present. These include chromosomal anomalies such as Down syndrome . Many of these babies have problems that can be ameliorated but not fully corrected with surgical or medical treatment. The third group comprises those babies born prematurely who are otherwise physically normal; that is, they have no acute illness or congenital anomaly except prematurity. These groups of babies raise different clinical and ethical issues. It is important to recognize these three groups and to understand their differences because, to the extent that we think about all babies admitted to the NICU as relatively similar, we miss important differences that form the basis of our ethical responses. Full-term babies with acute illnesses are usually the least morally controversial. Most acute illnesses can be treated if they are accurately diagnosed. The problems that arise in decision making for such babies are similar to the problems related to other high-risk patients of any age—diagnoses must be made quickly and treatment initiated expeditiously. Time or need for discussion is limited. The medical indications for treatment define the moral obligations for treatment. These babies generally either get better quickly or die quickly. Ethical problems arise only when treatment is partially successful and the babies survive but with severe long-term complications of their acute illness. For example, full-term babies might develop meningitis, be diagnosed and treated, but then be left with a severe neurological impairment or [3.137.192.3] Project MUSE (2024-04-25 18:13 GMT...

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