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Ev8n4p325.Pdf (1.889Mb) UTILIZATION OF HOSPITAL BIRTH WEIGHTS AND MORTALITY AS INDICATORS OF HEALTH PROBLEMS IN INFANCY1 Carlos V. Serrano, M.D., Ph.D.,* and Ruth R. Puffer, Dr.P.H.3 The primary aim of this presentation is to encourage and facilitate routine employment of hospital data on the out- come of pregnancy in order to help meet basic health program needs. Such action would also lay a groundwork for collection and use of these data in a vital statistics system. Introduction pitals can also provide the basic data needed for study of mortality in the first day and the first In evaluating the state of health of a few days of life. newborn infant, weight at birth is a most With respect to pregnancy risk, a high-risk important variable. Birth weight is a condition- pregnancy is one in which there is an increased ing factor of survival and of future growth and overall hazard of fetal and neonatal death, or of development. It is also a clear reflection of disability to the offspring, due to complications factors and conditions responsible for the level of the maternal condition, or disease (current of reproductive and pregnancy risk in the or past), or treatment, or unfavorable reproduc- mother. Such factors and conditions may be tive characteristics. Many products of such present or acting even before the product is pregnancies have low or deficient birth weights; conceived. some have weights considered favorable, and a The Inter-American Investigation of Mortal- few are oversized. ity in Childhood4 has revealed the seriousness For actions leading to improvement of the of immaturity or low birth-weight in 13 Latin health of infants and young children in Latin American projects (I). Our analyses (2), as well American countries, knowledge is needed on as those of Legarreta and co-workers (3), have the distribution of live-born infants by birth also indicated that registration of infant deaths weight. A greater understanding is likewise in hospitals, particularly deaths occurring in the required of the causes and factors involved in neonatal period, is incomplete. Hospitals- low and deficient birth weights, of their in- especially in areas where a high proportion of volvement in neonatal mortality, and of their births occur in these institutions-constitute the role in mortality due to nutritional deficiency source of valuable data needed to evaluate the in the post-neonatal period and early life. This problems of immaturity and low birth-weight, knowledge is needed because adequate weight and to learn more about the proportion of at birth appears to be an outstanding deter- babies born with deficient birth weights. Hos- minant of survival and normal development. The evidence from the Investigation indi- 1Also appearingin Spanishin Boletin de la Oficina cates that immaturity has played an excessive Sanitaria Panamericana, Volume LXXVIII, 1975. *Medical Officer, Pan American Health Organiza- role in mortality in the Latin American areas. tion. In Santiago, for example, immaturity was an 3Principal Investigator, Inter-American Investiga- tion of Mortality in Childhood. underlying or associated cause of 19.7 neonatal 4A collaborativeresearch effort coordinatedby the deaths per 1,000 live births-nearly twice the Pan American Health Organization on a continental rate of 10.0 found in the City of San Francisco scale in order to explore in depth the causes of excessive mortality in infancy and early childhood in (2). Such a difference might be explained by a the Americas (I). The investigation was made possible higher frequency of low-weight births or by by a contract between the Agency for International Development of the United States and the Pan variations in the quality and availability of American Health Organization. services to care for these highly vulnerable 325 326 PAHO BULLETIN . Vol. VIII, No. 4, 1974 infants. Thus information for preventive pro- measure would be facilitated if hospitals would grams is urgently needed regarding distribution assume the role of initiating birth certificates of birth weights in the cities, states or prov- and assisting with development of satisfactory inces, and countries of Latin America. In order registration systems. However, the development to extend and apply our knowledge of low and of complete and accurate data will take several deficient birth weights and the effect of birth years, and a satisfactory system will depend on weight on health and survival, utilization of obstetricians, pediatricians, and other hospital indicators of these problems is proposed. staff taking the lead in showing the value of the Research (5) is being carried out in New data involved. York City The large maternity hospitals and the mater- . to identify the antecedents as well as the nities of general hospitals can provide two types consequences of low birth-weight, in an effort of urgently needed basic data: fist, the dis- first to establish, and then to plan strategies to tribution of live births by birth weight; and prevent, its occurrence and sequelae.5 second, mortality in the first day of life. Such Kessner, et al. (6) stated in the recommenda- data may also be analyzed according to other tions from their study of 142,017 live births in variables, among them the age of the mother the same city that more detailed studies of the and birth order. relationship between infant survival and mater- The purpose of this paper is to encourage nal characteristics are required and that routine use of hospital data on the outcome of From such new analyses, providers of obstetric pregnancy in order to increase knowledge of services would be able to determine the risk these important problems. Data obtained faced by an individual female and direct her to during the Investigation or as a result, through appropriate services that decrease her chances special tabulations, are included to show the of producing a low-birth-weight or nonviable infant.6 value of such information and to serve as a basis for comparisons in new studies. The frequencies Official birth certificates were utilized in the of low and deficient birth weights and of death New York City study (6). The frequency of rates in the first day of life are termed low-weight births can be obtained in this indicators of specific problems. Since all mem- manner through the official registration system bers of the teams responsible for delivery and if weight at birth is included on the birth care of the newborn may contribute to the certificate, and if procedures are established for recording of vital information, educational pro- babies delivered in hospitals to be weighed in grams are proposed and exercises have been the delivery room, and for those delivered at designed for use in courses of preventive home to be weighed by the midwife. In areas medicine, nursing, midwifery, and medical where many births occur at home, midwives records. and empirical personnel attending deliveries can be provided with scales for recording birth weight. The data they can provide would be a very beneficial by-product of educational and Frequency of Low and Deficient Birth Weights control programs for midwives and auxiliaries An important indicator of immaturity-the participating in programs of simplified delivery percentage of live births weighing 2,500 grams of health care. or less-may be readily obtained from birth The inclusion of weight at birth on birth weights recorded in large maternities or in certificates in all countries of the Americas is maternity services of hospitals. Each product of highly recommended. Implementation of this pregnancy should be weighed in the delivery room immediately after birth and the weight 5D. Rush, et al. (5), International Journal of Epidemiology 1 (4): 375, 1972. should be recorded in grams or in pounds and 6D. M. Kessner, et al. (6), p. 11. ounces. Serrano and Puffer . INDICATORS OF HEALTH PROBLEMS IN INFANCY 327 Definition of Live Birth and Fetal Death only one of the 2,565 live births during the first two minutes of life. The birth attendant, by observing vital signs This study demonstrates the feasibility of present at birth, determines whether the prod- conducting such studies of routine hospital uct should be classed as a live birth or a fetal services and emphasizes the importance of death. The definitions of live birth and fetal acquiring accurate basic information regarding death which the World Health Organization (7) live births and fetal deaths. The value of studies recommends for use in member countries are as of this kind extends beyond internal hospital follows: procedures, also affecting registration practices Live birth is the complete expulsion or and the comparability of statistics 09 birth and extraction from its mother of a product of death. conception, irrespective of the duration of the pregnancy, which, after such separation, In order to obtain both accurate hospital breathes or shows any other evidence of life, data and accurate official statistics, all those such as beating of the heart, pulsation of the responsible for recording live births and fetal umbilical cord, or definite movement of volun- deaths must be fully aware of the four signs of tary muscles, whether or not the umbilical cord life cited above and must clearly distinguish live has been cut or the placenta is attached; each births from fetal deaths. product of such a birth is considered live-born.7 Some of the babies classed as live births die Fetal death is death prior to the complete in the frost hour or first few hours of life. III expulsion or extraction from its mother of a product of conception, irrespective of the fact, within the live-birth cohort of 1960 in the duration of pregnancy; the death is indicated United States (9), nearly one-fifth of those by the fact that after such separation the fetus dying in the first day of life did so within the does not breathe or show any other evidence of first hour-7,811 deaths in the first hour out of life, such as beating of the heart, pulsation of 43,317 in the first day.
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