Using the 1990 Linked Infant Birth and Death data set (N= 2,915,889), we analyzed the effects of birth weight, Apgar score at 5 minutes, mode of delivery and maternal race/ethnicity on the risk of neonatal death among African Americans, Native Americans, Mexicans, Puerto Ricans and Non-Hispanic Whites in the Unite States. Data were analyzed using logistic regression. Maternal race/ethnicity, birth weight and Apgar scores at 5 minutes and mode of delivery were all strongly and independently associated with the risk for neonatal mortality. Apgar scores at 5 minutes remained a powerful predictor of the risk for neonatal death even after adjusting for the effects of birth weight, race and mode of delivery. For example, the risk of neonatal death associated with a low (0-3) Apgar score at 5 minutes was approximately 99 fold higher [Adjusted Odds Ratio (OR): 98.8, 95% C.I., 92.6 - 105.3] after controlling for birth weight, maternal race and mode of delivery. African Americans were at an approximately two-fold, Native Americans at 60% and Puerto Ricans at 50% higher risks for neonatal death as compared with Non-Hispanic Whites. However, the risk of neonatal death was 11% less for African Americans after controlling for birth weight and mode of delivery[Adjusted OR: 0.89, 95% C.I., 0.86 - 0.93], and 22% less after controlling for the effect of birth weight, mode of delivery and Apgar score at 5 minutes[Adjusted OR: 0.78, 95% C.I., 0.74 - 0.82]. In addition, the risk for neonatal death was not significantly different for Puerto Ricans [Adjusted OR: 1.01, 95% C.I., 0.86 - 1.17] as compared with Non-Hispanic Whites after controlling for the effects of birth weight and mode of delivery. On the other hand, the risk of neonatal death remained 43% higher for Native Americans [Adjusted OR: 1.43, 95% C.I., 1.17 - 1.74] as compared with Non-Hispanic Whites after controlling for the effects of birth weight, Apgar scores and mode of delivery.

Conclusions: 1. The increased risk of neonatal death among Puerto Ricans is entirely attributable to their distribution of birth weights. 2. African Americans have a lower risk of neonatal death after the effects of birth weight and Apgar scores are taken into account. 3. Native Americans have the highest risk of birth weight-specific, Apgar score-adjusted neonatal mortality in the United States.