Chazalon S, Pilorget H, Fourmaintraux A
Unité de Néonatologie et Maternité, Centre Hospitalier Général de Saint-Pierre-Le Tampon, Saint-Pierre, Ile de la Réunion.
J Gynecol Obstet Biol Reprod (Paris). 1996;25(5):536-9.
The mortality rate is an indicator of public health related to social, economic and sanitary conditions. In 1990, the early neonatal and infant mortality rates published by the National Institute of Statistics and Economic Studies (INSEE) for Reunion Island were surprisingly lower than those published for continental France, in spite of a less favourable socio-economic status. Therefore, we considered is useful to try to re-establish the true rates by means of a retrospective survey based first on the vitality and maturité criteria of the French Register Office, then on those of the World Health Organisation (WHO).
Among all the childbirths registered in Reunion Island between January 1st and December 31st 1990, we collected the cases of stillbirths and neonatal deaths that occurred in hospital or at home. The vitality and maturity criteria were defined according to all clinical and para-clinical records available.
After an adjustment of the vitality criteria based on the medical files, the use of the French Register Office maturity criteria resulted in the following date: stillbirth rate 8.69% (versus 9.89), early neonatal mortality rate 3.88% (versus 2.65%), and infant mortality rate 8.12% (versus 6.7%). Then, using the WHO maturity criteria, we found the following rates: stillbirth 12.7%, early neonatal mortality 5.1%, perinatal mortality 17.74%, infant mortality 9.34%.
The non-observance of vitality criteria leads to a decrease of early neonatal mortality rate, and consequently of infant mortality rate. On the other hand, the WHO maturity criteria are either ignored or debated. Those two facts contribute to the publication of wrong still birth, early neonatal mortality and infant mortality rates. Therefore, the fetal-infant mortality rate seems to be more reliable than the infant mortality rate.
死亡率是一个与社会、经济和卫生条件相关的公共卫生指标。1990年,留尼汪岛国家统计与经济研究所(INSEE)公布的早期新生儿和婴儿死亡率,尽管社会经济状况较为不利,但令人惊讶地低于法国大陆公布的死亡率。因此,我们认为通过一项回顾性调查来重新确定真实死亡率是有用的,该调查首先基于法国户籍管理部门的生命体征和成熟度标准,然后基于世界卫生组织(WHO)的标准。
在1990年1月1日至12月31日留尼汪岛登记的所有分娩中,我们收集了在医院或家中发生的死产和新生儿死亡病例。根据所有可用的临床和辅助临床记录定义生命体征和成熟度标准。
根据医疗档案对生命体征标准进行调整后,采用法国户籍管理部门的成熟度标准得出以下数据:死产率8.69%(之前为9.89%),早期新生儿死亡率3.88%(之前为2.65%),婴儿死亡率8.12%(之前为6.7%)。然后,采用WHO的成熟度标准,我们得出以下比率:死产12.7%,早期新生儿死亡率5.1%,围产期死亡率17.74%,婴儿死亡率9.34%。
不遵守生命体征标准会导致早期新生儿死亡率降低,进而导致婴儿死亡率降低。另一方面,WHO的成熟度标准要么被忽视,要么存在争议。这两个事实导致公布的死产、早期新生儿死亡率和婴儿死亡率有误。因此,胎儿-婴儿死亡率似乎比婴儿死亡率更可靠。