Neonatal mortality review: a basis for improving care.

Neonatal deaths in Iowa were reviewed to assess educational needs at each of the three levels of care. The review was oriented toward a clinical rather than a pathologic impression of cause of death. Five major categories of disease accounted for 90% of the deaths surveyed in the two years reported, 1978 and 1979. They were: congenital anomalies, birth weight less than or equal to 750 gm, respiratory distress syndrome, bacterial sepsis, and asphyxia. Defects in the care system were noted and remedial measures suggested. Based on the mortality data accumulated, an idealized neonatal death rate was calculated, and from this, an estimate of potentially salvageable deaths was offered. Small hospitals with low neonatal death rates were found to be an important source of potentially preventable deaths. Other states and regions interested in evaluating a regionalized system of perinatal health care may wish to consider a review of causes of neonatal deaths similar to the approach illustrated for Iowa.