 |
Questions? Call 888-624-8373 |
|
|
|
|
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 2
2
fives for the nation for 1990.* But much more needs to be done. Congress,
state governments, professional groups, business and labor organizations,
church and women's groups, schools, and the media all have a role to play in
improving the health of the nation's infants. The committee recommends
that leadership in the effort to reduce the occurrence of Tow birthweight be
assumed by the executive branch of the federal government, especially the
~. , .
tJ ' 1 ~
Department or Realty and Human Services. Such leadership should include
an increased commitment of resources to a range of activities likely to
decrease low birthweight.
The committee's conclusions and recommendations, and the data
supporting them, have been published in a comprehensive report available
from the National Academy Press. This summary volume is intended to
provide a brief overview of the issues covered in the full report and is cTirected
to health care practitioners, legislators and their staffs, government aciminis-
trators, and all others interested in the prevention of low birthweight in
infants.
Support for the Committee to Study the Prevention of Low Birthweight
was proviclecT principally by the Commonwealth Fund, with additional
support from the Ford Foundation, the March of Dimes Birth Defects
Foundation, the National Institute of Child Health and Human Develop-
ment, and the National Research Council Fund.
THE LOW BIRTHWEIGHT PROBLEM
In 1982, 6. ~ percent of newborns in the United States were Tow birthweight
(2,500 grams or less), and slightly more than ~ percent were very low
birthweight (1,500 grams or less). Low birthweight is an indicator of inade-
quate fetal growth, resulting from premature birth Duration of pregnancy
less than 37 weeks from the last menstrual period), poor weight gain for a
given duration of gestation (intrauterine growth retarclation), or both.
To determine the consequences for child health of being born at Tow
birthweight, the committee reviewed the literature on the relationships
between low birthweight and both mortality and morbidity. Two-thircis of
deaths in the neonatal period (the first 28 days of life) occur among infants
born at 2,500 grams or less. The risk of mortality increases with decreasing
birthweight the risk of neonatal death is 200 times greater for the very Tow
birthweight infant than for the normal birthweight infant.
The link between birthweight and death in the postneonatal period (be-
tween 28 days and ~ year of age) is less pronounced, but still significant. Low
birthweight infants are five times more likely than normal birthweight in-
fants to die later in the first year and account for 20 percent of postneonatal
deaths.
High rates of low-weight births also contribute to differences in infant
mortality found among particular groups of the population in the Unitecl
States. For example, the higher neonatal mortality rates observed for non
*"By 1990, low birthweight babies . . . should constitute no more than 5 percent of all live
births . . . (and) no county and no racial or ethnic group of the population (e.g.. black,
Hispanic, American Indian) should have a rate of low birth weight infants . . . that exceeds 9
percent of all live births."
OCR for page 3
3
white mothers, adolescent mothers, and mothers with less than a high
school education are largely explainecl by higher proportions of low birth-
weight infants in these groups.
For postneonatal mortality, the association is somewhat different. Even
after controlling statistically for birthweight, postneonatal mortality rates
remain higher for nonwhite infants, infants of teenage mothers, and infants
of mothers of low educational attainment. Thus, factors typical of socioeco-
nomic disadvantage are linked to increased infant mortality through both
higher Tow birthweight rates and a birthweight-indepenclent risk of post-
neonatal death.
Current Trends
Between 1965 and 19SO, the infant mortality rate in the United States
dropped by almost 50 percent, from 24.7 to 13.] per 1,000 live births. This
decrease has not been matched by a comparable clecline in the rate of Tow
birthweight. Between 1971 and 1982, Tow-weight births declined moderately
from 76 to 68 per 1,000 live births. Analysis of national and state data shows
that the decline in low birthweight has been confined to the group weighing
between 1,501 grams and 2,500 grams. No decline has been observed in the
proportion of very low birthweight infants.
Evidence from a variety of sources indicates that the recent decline in
infant mortality, especially neonatal mortality, can be attributed largely to
improved survival of low birthweight infants, resulting primarily from more
speciaTizecl hospital-based management through neonatal intensive care
programs. The moderate improvement in the Tow birthweight rate has
played a relatively small role. Sustaining the decline in infant mortality will
require major new actions to prevent Tow birthweight an approach that
may well prove to be considerably less costly, both socially and economical-
ly, than additional investments in neonatal intensive care.
Low Birthweight and Morbidity
Low birthweight infants appear to be at increased risk of a variety of health
problems, although the impact of low birthweight on morbidity is less well
established than its contribution to mortality.
The association between low birthweight and neurodevelopmental prob-
lems, such as cerebral palsy and seizure disorders, was first documented in
the 1950s. Low birthweight infants are three times as likely as normal birth-
weight infants to have neurodevelopmental handicaps, and the risk in-
creases with decreasing birthweight ~ to 19 percent of very low birthweight
infants may be severely affected.
The risk of other developmental problems, especially those related to
success in school, is more difficult to evaluate. it appears that these problems
are more common among children whose birthweights were low for gesta-
tional age, but the evidence is not conclusive.
Low birthweight infants also are more likely to have significant congenital
anomalies than normal birthweight infants and are more susceptible to
conditions such as lower respiratory tract infections. They are also vuIner-
able to the potential sicle effects of neonatal intensive care interventions. In
Representative terms from entire chapter:
birthweight infants
Items in cart [1]
