No improvement in neonatal death rate

Despite significant developments in neonatal medicine over the past decade or two there has been no overall reduction in the number of neonatal deaths according to the results of a recently published US study. 

Researchers at the University of Colorado in Denver performed a retrospective study of all 779,385 live births in Colorado during the period 1991–2003 and compared neonatal mortality rate (NMR) for the six year period 1991–1996 with that for the following six year period 1997–2003. During the whole twelve-year study period there were 3398 neonatal deaths, defined as death within 28 days of birth. 

The NMR during the period 1997–2003 was 4.4 per 1000 live births, which was in fact slightly higher than the 4.3 per 1000 live births during the earlier period, although this difference did not reach statistical significance. Of particular note was the revelation that death rates actually increased between the two time periods for the most vulnerable group of babies with birth weight at the threshold of viability (< 750 g). 

These babies accounted for 45 % of all neonatal deaths in the first period and 54.5 % of all deaths in the second and the odds of death for these babies increased between the time periods (odds ratio 1.3). This increase in death rates was offset by slight reduction in death rates between the two periods for babies whose birth weight was in the range 750–2500 g. 

NMR for babies of normal birth weight (> 2500 g) was the same (0.9 per 1000 live births) in both periods. The vast majority of neonatal deaths (85 % in the first period, 81 % in the second) occurred within the first 24 hours of birth. The study provided clear evidence that birth in a hospital where there was a level III (tertiary referral) neonatal intensive care facility was associated with decreased risk of death.