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TIME
Unlocking
The Mystery of
Infant Mortality
When a baby is born too soon, it’s hard to
imagine that the infant would do better anywhere
else in the world than in America. The most
fragile preterm infants are housed in specialized
intensive-care units and cared for by world-class
experts. Prematurity costs the country some $26
billion in 2005, according to the U.S. Institute of
Medicine. And yet for all the technology and
expense, roughly 30,000 American babies under
age 1 die each year. They die at a rate three
times as high as in Singapore, which has the
world’s best infant survival – long considered a
key indicator of a nation’s overall level of health.
In fact, the U.S. – ranked No. 30 in 2005 – lags
behind almost every other industrialized nation,
behind Cuba, Hungary, and Poland.
What explains such dismal figures? The math is
fairly simple. Babies born preterm – before 37
weeks of gestation – account for two thirds of all
infant deaths and the number of preemies in the
U.S. is growing.
Comparison USA vs Parkland
Limited to:
• Singleton, ≥ 500 g
• Liveborn
• Prenatal care
• Hispanic origin = Mexico
Parkland 1988-2007
• Singletons
• ≥ 500g livebirths
• Prenatal care
N = 260,197 Women Studied
BIRTHS < 37 WEEKS USA vs Parkland
1995 United States 2002
1988
Parkland
2006
4
5
6
7
8
9
10
11
12
1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007
Year
Pe
rce
nt
< 3
7 w
eek
s
BIRTHS < 37 WEEKS White Women
1995
United States
2002
1988
Parkland
2006
5
6
7
8
9
10
11
12
1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007
Year
Pe
rce
nt
< 3
7 w
eek
s
BIRTHS < 37 WEEKS African-American Women
1995 United States 2002
1988
Parkland
2006
6
8
10
12
14
16
18
1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007
Year
Pe
rce
nt
< 3
7 w
eek
s
BIRTHS < 37 WEEKS Hispanic Women
1995
United States
2002 1988
Parkland
2006
3
4
5
6
7
8
9
10
11
1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007
Year
Pe
rce
nt
< 3
7 w
eek
s
FINDINGS
#1. Unlike the United States data preterm
birth decreased at Parkland between
1988-2006
#2. Disparity decreased for African-American
and Hispanic women compared to white
women.
WHY ? HOW ?
PARKLAND OBSTETRICS
SERVICE
―Re-engineering‖
Births < 37 weeks
6
8
10
12
1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007
Year
Perc
en
t <
37 W
eeks
Perc
en
t P
rete
rm B
irth
4
5
6
7
8
9
10
11
12 Pe
rce
nt w
ith P
ren
ata
l Ca
re 86
88
90
92
94
96
98
100
Preterm Birth
Prenatal care
―Re-engineering‖
Comprehensive and highly orchestrated
public health care system
• Geographic in scope
• Neighborhood based
• Community awareness that
access is not denied
• Access (appointments) under neighborhood
control.
• No turn-aways!
• Patient education.
• Pregnancy record availability — a must!
• Patient centered care.
• Single administration for women
and infant’s services.
• Physician champions.
• Protocol (practice) guidelines for
physicians, nurses, nurse practitioners,
and CNM’s.
• Health care outcomes research.
• Evidence based healthcare.
Is preterm birth preventable?
Is disparity preventable?
