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High level of resources for neonatal intensive care does not give US better outcomes

Janice Hopkins Tanne, New York

The United States has more neonatologists and neonatal intensive care beds per person than the United Kingdom, Canada, or Australia but higher rates of low birth weight and death among neonates, says a study from Dartmouth Medical School's Center for the Evaluative Clinical Sciences in Pediatrics (2002;109:1036-43)[Abstract/Free Full Text].

The study compared neonatal intensive care resources, preconception care and prenatal care, rates of low birth weight and neonatal deaths (deaths within the first month), and infant mortality (deaths within the first year).

The United States has 6.1 neonatologists per 10000 live births, compared with 3.7 in Australia, 3.3 in Canada, and 2.7 in the United Kingdom. The United States has 3.3 neonatal intensive care beds per 10000 live births, while Australia and Canada have 2.6 and the United Kingdom has 0.67. Of all neonates in the United States, 1.45% had a very low birth weight (<1500 g), compared with about 1% in the other countries, and infants weighing <2500 g were also more common in the United States.

The crude neonatal mortality rate was 4.7 deaths per 1000 births in the United States, compared with 3.0 in Australia, 3.7 in Canada, and 3.8 in England and Wales.

For infants weighing <1000 g the death rates were 396.7 per 1000 live births in the United States, 330.4 in Australia, 444.9 in Canada, and 391.4 in England and Wales. For infants weighing between 1000 g and 2499 g the rates were 13.2 per 1000 births in the United States, 12.8 in Australia, 16.9 in Canada, and 12.4 in England and Wales. For infants weighing >2500 g, infant mortality rates were higher in the United States. If the United States achieved Canada's survival rate, almost 3000 more babies would survive each year.

Lead author Dr Lindsay Thompson pointed out that Australia, Canada, and the United Kingdom provide health insurance for all children under 18 and all women aged 18-44. In the United States, however, only 86% of children and 78% of women had health insurance. Australia, Canada, and the United Kingdom provide free family planning advice and prenatal and perinatal care.

"Low birth weight is the number one predictor of neonatal mortality," Dr Thompson said, because of factors during pregnancy, delivery, and birth. The United States has high rates of teenage pregnancy and unintended pregnancy, and teenagers are often poor and uninsured.

She recommended maintaining the current level of neonatal care in the United States but giving more attention to preconception care and prenatal care.

(Credit: AP PHOTO/CHARLES REX ARBOGAST) Nurse Jeana Jackson handles a premature baby at a hospital in Illinoiswould her salary be better spent on antenatal care?