Why Do Babies Die?Why Do Babies Die?Why Do Babies Die?Why Do Babies Die?

Elaine B. St. John, MDElaine B. St. John, MDDivision of NeonatologyDivision of NeonatologyUniversity of Alabama at University of Alabama at

BirminghamBirmingham

Mortality by CountryMortality by CountryMortality by CountryMortality by Country

Mortality by StateMortality by StateMortality by StateMortality by State

Mortality by Gestational Mortality by Gestational AgeAge

Mortality by Gestational Mortality by Gestational AgeAge

Causes of Death in Causes of Death in LivebornsLiveborns

Causes of Death in Causes of Death in LivebornsLiveborns

OtherInfection

Unexplained

Asphyxia/HIE

PPHN

Other Anomaly/Sequence

ChromosomalAbnormality

CHD

Extreme Prematurity

RDS

PDA

Pulmonary hemorrhage

CLD

NEC

MOSF

IVH

Termination/LAWR

Effect of Maternal Effect of Maternal SteroidsSteroids

Effect of Maternal Effect of Maternal SteroidsSteroids

0%0%

20%20%

40%40%

60%60%

80%80%

100%100%

1991-20011991-2001

25-26wks25-26wks1991-20011991-2001

27-28wks27-28wks

Home, No OHome, No O22 at 28d at 28d

Died PTDDied PTDOO22

Died <12 hrsDied <12 hrs

Effect of Consensus Statement on Prenatal Steroids

Alphabet Alphabet SoupSoup

Alphabet Alphabet SoupSoup

AOP AOP Apnea of Prematurity, A&BApnea of Prematurity, A&BBPD BPD Bronchopulmonary DysplasiaBronchopulmonary DysplasiaCLD CLD Chronic Lung DiseaseChronic Lung DiseaseHIEHIE Hypoxic Ischemic EncephalopathyHypoxic Ischemic EncephalopathyIVHIVH Intraventricular HemorrhageIntraventricular HemorrhageNECNEC Necrotizing EnterocolitisNecrotizing EnterocolitisPIEPIE Pulmonary Interstitial EmphysemaPulmonary Interstitial EmphysemaPPHNPPHN Persistent Pulm. Hypertension of the Persistent Pulm. Hypertension of the

Newborn, PFCNewborn, PFCRDSRDS Respiratory Distress Syndrome, HMDRespiratory Distress Syndrome, HMDROPROP Retinopathy of Prematurity, RLFRetinopathy of Prematurity, RLF

Alphabet Soup?Alphabet Soup?Alphabet Soup?Alphabet Soup?

Annual Rates of Low Birth Weight, Annual Rates of Low Birth Weight, Preterm and Neonatal Mortality Preterm and Neonatal Mortality

1981 – 19981981 – 1998Single Live Births to U.S. Resident Single Live Births to U.S. Resident

MothersMothers

Annual Rates of Low Birth Weight, Annual Rates of Low Birth Weight, Preterm and Neonatal Mortality Preterm and Neonatal Mortality

1981 – 19981981 – 1998Single Live Births to U.S. Resident Single Live Births to U.S. Resident

MothersMothers

0

2

4

6

8

10

12

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98

Neonatal Mort. Rate LBW Preterm

?

Survival & Births by Survival & Births by GAGA

Survival & Births by Survival & Births by GAGA

0%0%

10%10%

20%20%

30%30%

40%40%

50%50%

60%60%

70%70%

80%80%

90%90%

100%100%

2424 2525 2626 2727 2828 2929 3030 3131 3232 3333 3434 3535 3636 3737 3838 3939 4040 4141 4242

GA (wks)GA (wks)

SurvivalSurvival

0%

5%

10%

15%

20%

25%

30%

Distribution of Births

Distribution of Births

SurvivalSurvival

Distribution of BirthsDistribution of Births

Livebirth Causes of DeathLivebirth Causes of DeathLivebirth Causes of DeathLivebirth Causes of Death

Termination

Extrem. Prem.

IVH

CLD

OtherSepsis

CHD

Anomalies

PPHN

AsphyxiaUnknown

Pulm. Hemorr.

HMD

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

GA (wks)

Su

rviv

al

0%

5%

10%

15%

20%

25%

30%

Dis

trib

uti

on o

f B

irth

s

Survival

Distribution of Births