Infant Mortality No Better in U.S. Despite Resources

Study finds similar rates in other English-speaking countries

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HealthDay Reporter

MONDAY, June 3, 2002 (HealthDayNews) -- The United States has unparalleled resources when it comes to the care of premature infants: more pediatricians to care for sick and premature infants; more infant intensive care units; and more health-care dollars.

However, more isn't always better, a new study shows.

Despite the availability of greater resources, the United States has higher infant mortality rates than three other developed countries, reports the study appearing in the June issue of Pediatrics.

"The U.S. spends more on sick babies, but still isn't improving its survival rates compared to other countries," says study author Dr. Lindsay Thompson, an instructor in pediatrics at Dartmouth Medical School.

This study only adds to concerns recently reported by another Dartmouth team in The New England Journal of Medicine that found many areas in the country have an abundance of neonatologists, yet don't have greatly increased survival rates.

In the current study, Thompson and her colleagues looked at how four different English-speaking countries cared for their infants. They gathered information on how the United States, the United Kingdom, Canada and Australia administered preconception care, prenatal care and hospital care after delivery. The researchers also compared mortality rates in babies from each country by their birth weight at one month and one year of age.

They found the United States had the greatest number of neonatologists: 6.1 per 10,000 live births. Australia had 3.7, Canada 3.3, and the United Kingdom had 2.7 per 10,000 live births. The United States also reported the highest number of neonatal intensive care units.

Canada, Australia and the United Kingdom all offer free family planning and prenatal care. Australia and the United Kingdom also pay for contraception.

The researchers found that even though the United States outperformed the other countries in some instances -- particularly with the smallest infants -- overall infant mortality was higher in America than it was for the other countries.

Neonatal mortality rates were 4.7 per 1,000 births in this country, 3.0 in Australia, 3.7 in Canada, and 3.8 in the United Kingdom.

The researchers suspect the United States has higher mortality rates because it had significantly more babies with low birth weights. "Low birth weight increases the risk of death," Thompson says.

For that reason, she suggests this country should allocate more of its resources to preconception and prenatal care.

While agreeing that spending more on care before birth should be a priority, Dr. Karen Hendricks-Munoz, director of neonatology at New York University Medical Center and Bellevue Hospital in New York City, says this study compared apples to oranges.

"Our system of health care is one that is very different," says Hendricks-Munoz. She points out the other three countries all have socialized medicine, which guarantees health care to everyone. Plus, she says she knows that, at least in the United Kingdom, they let medical residents perform significantly more of the hands-on work than is allowed in this country.

Also, even though the researchers compared babies by birth weight, there are many more factors -- including several neonatologists can't control -- that can affect mortality, Hendricks-Munoz notes.

Maternal age, smoking, nutrition during pregnancy and infant care for the year following delivery are some examples of things that are out of the hands of neonatologists. These are just some of the reasons why two babies born exactly the same weight can have very different health outcomes, Hendricks-Munoz explains.

Both Thompson and Hendricks-Munoz agree the United States needs to invest more in the mother and child before birth. Hendricks-Munoz adds that more needs to be done to support children after their birth as well.

What To Do

For more information on having a healthy baby, go to the March of Dimes or the U.S. Food and Drug Administration.

SOURCES: Lindsay Thompson, M.D., instructor, pediatrics, Dartmouth Medical School, Hanover, N.H.; Karen Hendricks-Munoz, M.D., director, neonatology, New York University Medical Center and Bellevue Hospital, and assistant professor, clinical pediatrics, New York University School of Medicine, New York City; June 2002 Pediatrics

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