Page 441 |
Previous | 504 of 931 | Next |
|
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
|
Loading content ...
birth-weight categories, whereas in 1980 and 1981 all of the weight-specific nonwhite rates had been lower. The worsening of these nonwhite rates from 1981 to 1982 in comparison with the white rates was not associated with a relatively lower percent of nonwhite births in these weight categories occurring in Level III hospitals. These recent increases in nonwhite weight-specific neonatal death rates are cause for concern, particularly the increase in the over-2500-grams category (table 2). But there is still a critical need to reduce the high rate of low-weight births among nonwhites in North Carolina, and much room for improvement. "The intensive care approach alone will not suffice to close the racial gap in newborn mortality."'^ Williams and Chen'^ suggest that the most obvious target for sustaining the decrease in neonatal mortality rates is the reduction of low-weight births among blacks, and the data in the present study support this conclusion. Prenatal medical care strategies alone are not likely to solve this problem, since the weight distribution of live births in any population is closely linked to aspects of social class.Low birth weight is strongly associated with low socioeconomic status.-^ The application of neonatal intensive care technology has led to very rapid increases in neonatal survival rates, but strategies to increase birth weights may not show such rapid results. A number of interventions have been underway in North Carolina and are increasing, such as provision of prenatal care, nutritional supplementation and counseling, and health education. The overall low-birth-weight rate did decline from 8.3 percent in 1976 to 7.9 percent in 1981, and certainly efforts of this type must be continued. In addition, new medical care strategies such as early detection of incipient premature labor and treatment with tocolytic agents have shown some promise.'^ A large and sustained reduction of low-weight births is, however, also dependent upon the longer-term process of overall socioeconomic development and associated factors such as better education, employment opportunities, and incomes. Though these changes may be difficult to implement, they are nevertheless very important. Further improvements in neonatal mortality through postnatal medical interventions are not only limited, they are also very costly. Prevention of low-weight births will reduce not only the overall neonatal mortality rate but also neonatal intensive care costs. Sweden, which has about the same number of deliveries per year as North Carolina, has only about half as many low-weight births and neonatal deaths, and about half the number of ventilator-equipped neonatal intensive care beds as North Carolina.'^ While the outcome measure in this study was neonatal mortality, another result of increasing birth weights would be the reduction of neonatal morbidity. Low-weight babies are at higher risk for intracranial hemorrhage and birth asphyxia.'^ Without losing sight of the positive contribu- tion of intensive perinatal medical care in reducing morbidity,'^ "a strategy aimed at reducing the prematurity rate should be more effective in reducing morbidity in the population than a strategy focused primarily on helping premature babies survive, once factors have combined to cause a premature birth." In summary, this study has shown that North Carolina's higher neonatal mortality is due entirely to lower birth weights, when compared with the United States, and that little improvement in birth-weight distribution has occurred since at least 1976. Further, from 1981 to 1982 the percent of low-weight births actually increased. Clearly, a major part of our agenda for preventing future neonatal deaths in North Carolina should be the implementation of programs that reduce the number of low-birth-weight babies. Given the impact of low birth weight on morbidity and health care costs as well as on neonatal mortality, perhaps the low-birth-weight rate should become the major performance measure for maternal and child health programs. References 1. Guyer B, Wallach LA. Rosen SL: Birth-weighi-standardized neonatal mortalily rates and the prevention of low birth weight: How does Massachusetts compare with Sweden? N Engl J Med 1982;306:1230-1233, 2. National Center for Health Statistics: Annual summary of births, deaths, marriages and divorces: United States 1981. Monthly Vital Statistics Report vol 30. no 13, Dec. 20. 1982, 3. State Center for Health Statistics: North Carolina Viral Staiisiics 1980. Volume I. N.C. Division of Health Services, November 1981; other North Carolina data in this report are taken from other Volume 1 editions, the Basic AuiomaiedBirth Yearbook of the State Center for Health Statistics, and from special computer tabulations of the vital statistics files. 4. Ue K, Paneth N. Gartner LM. Pearlman M: The very low-birth weight rate; Principal predictor of neonatal mortality in industrialized populations, J Pediat 1980:97:759-764. 5. Worid Health Organization: Social and Biological Effects on Perinatal Mortality, Report on an International Comparative Study, Budapest, 1978. 6. Clifford SH: High-Risk Pregnancy. N Engl J Med 1964;271:243-249. 7. National Center for Health Statistics: Adjusting neonatal monality rates for birth weight. Vital and Health Statistics. Data Evaluation and Methods Research, Series 2, No, 94. August 1982. 8. Wilcox AJ, Russell IT: Perinatal mortality: Standardizing for birth-weight is biased. Am J Epidemiol 1983;118:857-864. 9. National Center for Health Statistics: Advance report of final mortality statistics. 1980. Monthly Vital Statistics Report. Vol. 32. No, 4. Supplement. Aug. 11, 1983; all United States birth data in this paper are taken from Advance report of final natality statistics. 1980, Monthly Vital Statistics Report, Vol. 31. No. 8. Supplement. Nov, 30. 1982. 10. Goldenberg RL. Humphrey JL. Hale CB. Boyd BW. Wayne JB: Neonatal deaths in Alabama, 1970-1980: An analysis of birth weight- and race-specific neonatal mortality rates. Am J Obstet Gynecol 1980;145:545-552. 11. Alexander G, Altekruse JM: Correspondence on Birth-weight-standardized neonatal mortality rates, N Engl J Med 1982;307:1021-1022, 12. David RJ. Siegel E: Decline in neonatal mortality. 1968 to 1977: Better babies or better care? Pediatrics 1983;71:531-540, 13. Williams RL, Chen PM: Identifying the sources of the recent decline in perinatal mortality rates in California. N Engl J Med 1982;306:207-214. 14. Goldenberg RL, Humphrey JL. Hale CB. Boyd BW. Wayne JB: Neonatal deaths in Alabama. II. Policy and research implications derived from a comparison of birth weight-specific state and medical center neonatal mortality rates. Am J Obstet Gynecol 1983;146:450-455. 15. Herron MA, Katz M. Creasy RK: Evaluation of a preterm binh prevention program: Preliminary report, Obstet Gynecol 1982;59:452. 16. Shapiro S, McCormick MC, Starileld BH, Crawley B: Changes in infant morbidity associated with decreases in neonatal mortality. Pediatrics 1983;72:408-4J5. July 1984, NCMJ 441
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1984 |
Identifier | NCHH-17-045 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 45 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-045.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-045 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 441 |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1984 |
Identifier | NCHH-17-045-0025 |
Form General | Periodicals |
Page Type | all; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed45v21984medi_0025.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 45 |
Issue Number | 7 |
Page Number | 441 |
Health Discipline | Medicine |
Full Text | birth-weight categories, whereas in 1980 and 1981 all of the weight-specific nonwhite rates had been lower. The worsening of these nonwhite rates from 1981 to 1982 in comparison with the white rates was not associated with a relatively lower percent of nonwhite births in these weight categories occurring in Level III hospitals. These recent increases in nonwhite weight-specific neonatal death rates are cause for concern, particularly the increase in the over-2500-grams category (table 2). But there is still a critical need to reduce the high rate of low-weight births among nonwhites in North Carolina, and much room for improvement. "The intensive care approach alone will not suffice to close the racial gap in newborn mortality."'^ Williams and Chen'^ suggest that the most obvious target for sustaining the decrease in neonatal mortality rates is the reduction of low-weight births among blacks, and the data in the present study support this conclusion. Prenatal medical care strategies alone are not likely to solve this problem, since the weight distribution of live births in any population is closely linked to aspects of social class.Low birth weight is strongly associated with low socioeconomic status.-^ The application of neonatal intensive care technology has led to very rapid increases in neonatal survival rates, but strategies to increase birth weights may not show such rapid results. A number of interventions have been underway in North Carolina and are increasing, such as provision of prenatal care, nutritional supplementation and counseling, and health education. The overall low-birth-weight rate did decline from 8.3 percent in 1976 to 7.9 percent in 1981, and certainly efforts of this type must be continued. In addition, new medical care strategies such as early detection of incipient premature labor and treatment with tocolytic agents have shown some promise.'^ A large and sustained reduction of low-weight births is, however, also dependent upon the longer-term process of overall socioeconomic development and associated factors such as better education, employment opportunities, and incomes. Though these changes may be difficult to implement, they are nevertheless very important. Further improvements in neonatal mortality through postnatal medical interventions are not only limited, they are also very costly. Prevention of low-weight births will reduce not only the overall neonatal mortality rate but also neonatal intensive care costs. Sweden, which has about the same number of deliveries per year as North Carolina, has only about half as many low-weight births and neonatal deaths, and about half the number of ventilator-equipped neonatal intensive care beds as North Carolina.'^ While the outcome measure in this study was neonatal mortality, another result of increasing birth weights would be the reduction of neonatal morbidity. Low-weight babies are at higher risk for intracranial hemorrhage and birth asphyxia.'^ Without losing sight of the positive contribu- tion of intensive perinatal medical care in reducing morbidity,'^ "a strategy aimed at reducing the prematurity rate should be more effective in reducing morbidity in the population than a strategy focused primarily on helping premature babies survive, once factors have combined to cause a premature birth." In summary, this study has shown that North Carolina's higher neonatal mortality is due entirely to lower birth weights, when compared with the United States, and that little improvement in birth-weight distribution has occurred since at least 1976. Further, from 1981 to 1982 the percent of low-weight births actually increased. Clearly, a major part of our agenda for preventing future neonatal deaths in North Carolina should be the implementation of programs that reduce the number of low-birth-weight babies. Given the impact of low birth weight on morbidity and health care costs as well as on neonatal mortality, perhaps the low-birth-weight rate should become the major performance measure for maternal and child health programs. References 1. Guyer B, Wallach LA. Rosen SL: Birth-weighi-standardized neonatal mortalily rates and the prevention of low birth weight: How does Massachusetts compare with Sweden? N Engl J Med 1982;306:1230-1233, 2. National Center for Health Statistics: Annual summary of births, deaths, marriages and divorces: United States 1981. Monthly Vital Statistics Report vol 30. no 13, Dec. 20. 1982, 3. State Center for Health Statistics: North Carolina Viral Staiisiics 1980. Volume I. N.C. Division of Health Services, November 1981; other North Carolina data in this report are taken from other Volume 1 editions, the Basic AuiomaiedBirth Yearbook of the State Center for Health Statistics, and from special computer tabulations of the vital statistics files. 4. Ue K, Paneth N. Gartner LM. Pearlman M: The very low-birth weight rate; Principal predictor of neonatal mortality in industrialized populations, J Pediat 1980:97:759-764. 5. Worid Health Organization: Social and Biological Effects on Perinatal Mortality, Report on an International Comparative Study, Budapest, 1978. 6. Clifford SH: High-Risk Pregnancy. N Engl J Med 1964;271:243-249. 7. National Center for Health Statistics: Adjusting neonatal monality rates for birth weight. Vital and Health Statistics. Data Evaluation and Methods Research, Series 2, No, 94. August 1982. 8. Wilcox AJ, Russell IT: Perinatal mortality: Standardizing for birth-weight is biased. Am J Epidemiol 1983;118:857-864. 9. National Center for Health Statistics: Advance report of final mortality statistics. 1980. Monthly Vital Statistics Report. Vol. 32. No, 4. Supplement. Aug. 11, 1983; all United States birth data in this paper are taken from Advance report of final natality statistics. 1980, Monthly Vital Statistics Report, Vol. 31. No. 8. Supplement. Nov, 30. 1982. 10. Goldenberg RL. Humphrey JL. Hale CB. Boyd BW. Wayne JB: Neonatal deaths in Alabama, 1970-1980: An analysis of birth weight- and race-specific neonatal mortality rates. Am J Obstet Gynecol 1980;145:545-552. 11. Alexander G, Altekruse JM: Correspondence on Birth-weight-standardized neonatal mortality rates, N Engl J Med 1982;307:1021-1022, 12. David RJ. Siegel E: Decline in neonatal mortality. 1968 to 1977: Better babies or better care? Pediatrics 1983;71:531-540, 13. Williams RL, Chen PM: Identifying the sources of the recent decline in perinatal mortality rates in California. N Engl J Med 1982;306:207-214. 14. Goldenberg RL, Humphrey JL. Hale CB. Boyd BW. Wayne JB: Neonatal deaths in Alabama. II. Policy and research implications derived from a comparison of birth weight-specific state and medical center neonatal mortality rates. Am J Obstet Gynecol 1983;146:450-455. 15. Herron MA, Katz M. Creasy RK: Evaluation of a preterm binh prevention program: Preliminary report, Obstet Gynecol 1982;59:452. 16. Shapiro S, McCormick MC, Starileld BH, Crawley B: Changes in infant morbidity associated with decreases in neonatal mortality. Pediatrics 1983;72:408-4J5. July 1984, NCMJ 441 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-045.pdf |
Document Sort | all; nchh-17 |
Article Title | The Impact Of Low Birth Weight On North Carolina Neonatal Mortality 1976-1982 |
Article Author | Paul A. Buescher; Richard R. Nugent; Ronald H. Levine |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-045 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Tags
Comments
Post a Comment for Page 441