Kerr G R, Ying J, Spears W
University of Texas at Houston, School of Public Health, Texas 77225, USA.
Tex Med. 1997 Jan;93(1):81-8.
Texas' health objectives include reducing the infant mortality rate from 8.1 per 1000 live births in 1990 to no more than 7 per 1000 by the year 2000. To help target potentially preventable causes of infant mortality, we examined the underlying cause of each of the 2545 infant deaths that occurred in Texas during 1990. Potential existed for primary prevention of the underlying cause of at least some of 778 infant deaths and for secondary prevention by treating the underlying causes of 1127. The following appear to be the most promising targets and strategies for prevention: causes of neonatal mortality by improving the clinical care of high-risk newborns; sudden infant death syndrome by having infants sleep in the supine position; respiratory complications of preterm birth by preventive and therapeutic surfactant; death from bacterial infections by optimal antibiotic therapy; injuries and accidents by optimal parental supervision; preterm birth and adverse pregnancy outcomes by optimal prenatal, obstetric, and neonatal care; and neural tube defects by adequate paraconceptual folic acid.
得克萨斯州的健康目标包括将婴儿死亡率从1990年的每1000例活产8.1例降至2000年时不超过每1000例7例。为了找出婴儿死亡中潜在可预防的原因，我们调查了1990年在得克萨斯州发生的2545例婴儿死亡事件中每一例的根本原因。对于778例婴儿死亡中的至少部分死亡的根本原因，存在一级预防的可能性；对于1127例死亡，存在通过治疗根本原因进行二级预防的可能性。以下似乎是最有前景的预防目标和策略：通过改善高危新生儿的临床护理来降低新生儿死亡率；让婴儿仰卧睡眠以预防婴儿猝死综合征；通过预防性和治疗性使用表面活性剂来预防早产引起的呼吸并发症；通过优化抗生素治疗来预防细菌感染导致的死亡；通过最佳的家长监督来预防伤害和事故；通过优化产前、产科和新生儿护理来预防早产和不良妊娠结局；以及通过孕前摄入足够的叶酸来预防神经管缺陷。
