Wise P H, First L R, Lamb G A, Kotelchuck M, Chen D W, Ewing A, Hersee H, Rideout J
Joint Program in Neonatology, Brigham and Women's Hospital; Boston, MA.
Pediatrics. 1988 Apr;81(4):542-8.
In this study, the determinants of an apparent increase in the infant mortality rate of an urban population with high access to tertiary neonatal care are reviewed. For a 4-year period (1980 to 1983), all infant deaths (n = 422) of the 32,329 births to residents of the City of Boston were analyzed through linked vital statistics data and a review of medical records. A significant increase in the infant mortality rate occurred in 1982 due to increases in three components of the infant mortality rate: the birth rate of very low birth weight infants (less than 1,500 g), the neonatal mortality rate of normal birth weight infants (greater than or equal to 2,500 g), and the mortality rate of infants dying during the postneonatal period (28 to 365 days). These increases were associated with inadequate levels of prenatal care. Although transient, the impact of the observed alterations in these infant mortality rate components was enhanced by a more long-standing phenomenon: the stabilization of mortality rates for low birth weight infants. This stabilization allowed the increases in other component rates to be expressed more fully than in previous years. In this report a mechanism is shown whereby fully regionalized neonatal care ultimately may confer to the infant mortality rate a heightened sensitivity to socioeconomic conditions and levels of adequate prenatal care.
在本研究中，我们回顾了在极易获得三级新生儿护理的城市人口中，婴儿死亡率明显上升的决定因素。在1980年至1983年的4年时间里，通过关联生命统计数据和病历审查，对波士顿市居民32329例出生中的所有婴儿死亡（n = 422）进行了分析。1982年婴儿死亡率显著上升，原因是婴儿死亡率的三个组成部分增加：极低出生体重婴儿（小于1500克）的出生率、正常出生体重婴儿（大于或等于2500克）的新生儿死亡率以及新生儿后期（28至365天）死亡婴儿的死亡率。这些增加与产前护理水平不足有关。尽管是短暂的，但这些婴儿死亡率组成部分的观察到的变化的影响因一个更长期的现象而增强：低出生体重婴儿死亡率的稳定。这种稳定使其他组成部分死亡率的增加比前几年更充分地显现出来。在本报告中，我们展示了一种机制，通过这种机制，完全区域化的新生儿护理最终可能使婴儿死亡率对社会经济状况和充分产前护理水平更加敏感。
