U.S. has high rate of newborn deaths

Kristen Gerencher, "U.S. has high rate of newborn deaths", Market
Watch, May 10, 2006,
Link:
http://www.marke****ch.com/News/Stor...F8%7D&keyword=

Newborns in the United States have the second lowest survival rate in
the industrialized world, according to a report released this week.

Babies in their first month of life have the best odds in Japan, which
boasts the lowest newborn mortality rate of 1.8 deaths per 1,000 live
births, according to a report from the nonprofit group Save the
Children. Latvia had the highest mortality rate among the 33
industrialized nations surveyed, at six newborn deaths per 1,000 live
births.

The U.S. ranked next to last and tied with Hungary, Malta, Poland and
Slovakia, which all averaged five deaths per 1,000 live births. The
U.S. newborn mortality rate is nearly three times higher than that of
Finland, Iceland, Norway and Japan, the study found. Minorities had
disproportionately high rates. Black Americans had a newborn mortality
rate nearly twice the national average, at 9.3 deaths per 1,000 live
births. African American babies are twice as likely as white babies to
be born prematurely, have low-birth weight and to die at birth,
according to Save the Children.

A growing number of people without health insurance, a lack of
education in some areas and underlying factors such as poor maternal
nutrition, uncontrolled chronic conditions and risky behaviors all play
a role in the low U.S. standing, said David Oot, director of the office
of health for Save the Children U.S., a member of the global Save the
Children Alliance.

"There are real issues around access and use of health services," Oot
said.

Education and access to universal health care contribute to the success
of nations such as Norway and Finland that ranked near the top for
newborn survival, he said.

"There are high levels of education pretty uniformly across the
populations of those countries," Oot said. "That has a lot to do with
whether mothers seek and use care before, during and after pregnancy.
It also has to do with how they care for themselves with nutritional
and other practices that might otherwise put them at risk."

Broader focus on maternal health

The study may overstate the problem in the U.S. because what's counted
as a newborn death here -- such as a baby born 23 weeks into pregnancy
who dies soon thereafter -- may be counted as a fetal death in other
nations, said Dr. Nancy Green, medical director for the March of Dimes.

"We are not as good as we should be, but maybe we're not as bad as the
numbers would suggest," she said.

Still, the U.S. should be doing more to help women take care of their
health before they start families, Green said. Increased attention to
family planning and maintaining adequate time between births also
reduces the risk of newborn deaths, she said. "We have not as a nation
reached a point of optimizing maternal health, and that's what you're
seeing with these sort of mediocre standings in terms of neonatal
mortality," Green said.

Maternal health shouldn't focus exclusively on prenatal care but health
care in general, she said. "For example, women who are extremely
underweight or extremely obese have higher rates of prematurity/low
birth weight. There is some rough correlation with overall health and
well-being in those issues."

Last month, the Centers for Disease Control and Prevention released
recommendations for improving women's health before conception. Among
the highlights, the CDC recommends women who want to get pregnant stop
smoking and drinking alcohol and take daily supplements of folic acid,
which reduces the risk of neural tube defects by two-thirds.

The infant mortality rate, defined as death before the first birthday,
was flat in 2003, with 6.8 deaths for every 1,000 live births,
according to data from the National Center for Health Statistics.
Two-thirds of all infant deaths occurred within the first month of
life.

In 2002, about 25% of U.S. newborn deaths were caused by prematurity
and low birth weight, and 20% were caused by birth defects, Green said.
The rest were due to other problems such as maternal, placental and
umbilical cord complications.

Even the lowest-ranking industrialized nations have substantially
better infant mortality rates than in sub-Saharan Africa, which has the
highest newborn death rates, the report said. One in five mothers there
has lost at least one baby in childbirth, and Liberia had the highest
mortality rate of all surveyed nations at 65 deaths per 1,000 live
births.

Western countries, including the U.S., account for only about 1% of the
annual 4 million newborn deaths worldwide, according to Save the
Children.

"It's important to remember, while it is an issue certainly in the U.S.
and in certain groups in the U.S., globally 99% of deaths in the first
month of life occur in the developing world," Oot said. "The tragedy
.... is that 70% of those deaths could be prevented with low-cost,
low-tech interventions if they were made more available."

Routine childhood vaccines, promotion of immediate and exclusive
breastfeeding, warming of the infant and care of a newborn by a skilled
birth attendant would raise the survival rate considerably, he said.

"It's important to remember, while it is an issue certainly in the U.S.
and in certain groups in the U.S., globally 99% of deaths in the first
month of life occur in the developing world," Oot said. "The tragedy
.... is that 70% of those deaths could be prevented with low-cost,
low-tech interventions if they were made more available."

That makes it OK, what comes from vaccinating too soon, especially hep b at
birth, and what part does cord cutting play