In one of my first posts on preterm birth (PTB), Preterm Birth: An American Tragedy, it was mentioned that early delivery had surpassed birth defects and genetic abnormalities as the leading cause of death in the first year of life in the United States. A report published earlier this week in the journal Pediatrics indicates that we have grossly underestimated the contribution of PTB to neonatal mortality.
Callaghan and colleagues (Pediatrics 2006;118:1566-1573) sought to resolve the discrepancy that, although "two thirds of infant deaths occur among infants born preterm..., only 17% of infant deaths are classified as being attributable to preterm birth..." To accomplish this goal, they examined 27,970 neonatal death records from the year 2002 in the 'linked birth/infant death file,' looking not only for "preterm birth" as a listed cause of death, but complications (e.g., premature rupture of membranes; sepsis; respiratory distress syndrome; intraventricular hemorrhage) clearly related to PTB even if that was not actually recorded as an immediate cause. In their final analysis, they "classified 9,596 infant deaths (34.3% of all infant deaths) as attributable to preterm birth." Furthermore, "ninety-five percent of those deaths occurred among infants who were born at less than 32 weeks of gestation and weighed less than 1500 g, and two thirds of those deaths occurred during the first 24 hours of life." One frightening observation by the authors is that they still consider these estimates to be "conservative."
This study firmly establishes PTB as the irrefutable leading cause of neonatal mortality in the U.S. nearly doubling previous estimates. Let's just hope that convincing information like this helps to bolster support for the multidisciplinary programs that will be necessary if we ever hope to reverse the rising rates of PTB in this country. I look at any dollars spent as an investment in our future and the potential savings should far exceed the up-front costs.