Abstract
The role of improved neonatal care in the recent reduction in the U.S. NMR remains unclear. Although many socio-demographic factors affect the NMR, these appear to have little effect once birth weight (BW) is held constant, thus making BW-specific NMR's legitimate indicators of medical care and ideal for comparison. Most states, however, at present do not link infant birth and death records and thus cannot generate BW-specific NMR's.
We have found that a simple risk-adjusting index, the relationship between the NMR and the incidence of very-low-birth-weight infants (≤1500 grams, VLBW) has enabled us to assess the effectiveness of care at our institution during a period of fluctuating NMR's (AJDC 130:842, 1976). Annual changes in the NMR at our institution correlate strongly with annual variations in the incidence of VLBW newborns. Analysis of the relationship between these two variables, however, showed a decline over the past ten years toward a lower NMR for a given VLBW rate, indicating improving neonatal care.
This index has been applied to 1974 NMR and VLBW rate data from each of the 50 states and Washington, D.C.. Significant deviation of some states from the regression line linking the two variables is likely to be a better indicator of statewide neonatal care than the crude NMR.
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Lee, KS., Paneth, N., Pearlman, M. et al. 365 AN APPROACH TO THE EVALUATION OF NEONATAL MORTALITY RATES (NMR). Pediatr Res 12 (Suppl 4), 424 (1978). https://doi.org/10.1203/00006450-197804001-00370
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DOI: https://doi.org/10.1203/00006450-197804001-00370