Birthweight‐specific infant mortality risks for native Americans and whites,United States, 1960 and 1984

Abstract

We used NCHS natality and linked‐birth/death certificate tapes to compare birthweight‐specific neonatal and postneonatal mortality risks for Native Americans and whites in 1960 and in 1984. The birthweight distributions for the two groups were similar both years. Native American neonatal mortality risk dropped from 20.2 in 1960 to 5.2 in 1984, and the relative risk for Native Americans with respect to whites fell from 1.31 in 1960 to a nonsignificant difference in 1984. Postneonatal mortality risks for Native Americans fell from 27.5 in 1960 to 6.2 in 1984, with a drop in the relative risk from 5.2 to 2.1. Although the relative improvements for Native Americans were highest in postneonatal survival, Native Americans still had over twice the level of white postneonatal mortality. Birthweight was positively associated with survival for both groups, but the odds of Native American neonatal death were affected less by low and very low birthweights. For both groups, improvements in neonatal mortality were highest at the lower birthweights, while the gains in postneonatal survival benefitted normal and high birthweight infants most.     

Invited review: Improving neonatal survival in small ruminants: science into practice

Neonatal mortality in small ruminant livestock has remained stubbornly unchanging over the past 40 years, and represents a significant loss of farm income, contributes to wastage and affects animal welfare. Scientific knowledge about the biology of neonatal adaptation after birth has been accumulating but does not appear to have had an impact in improving survival. In this paper, we ask what might be the reasons for the lack of impact of the scientific studies of lamb and kid mortality, and suggest strategies to move forward. Biologically, it is clear that achieving a good intake of colostrum, as soon as possible after birth, is crucial for neonatal survival. This provides fuel for thermoregulation, passive immunological protection and is involved in the development of attachment between the ewe and lamb. The behaviour of the lamb in finding the udder and sucking rapidly after birth is a key component in ensuring sufficient colostrum is ingested. In experimental studies, the main risk factors for lamb mortality are low birthweight, particularly owing to poor maternal nutrition during gestation, birth difficulty, litter size and genetics, which can all be partly attributed to their effect on the speed with which the lamb reaches the udder and sucks. Similarly, on commercial farms, low birthweight and issues with sucking were identified as important contributors to mortality. In epidemiological studies, management factors such as providing assistance with difficult births, were found to be more important than risk factors associated with housing. Social science studies suggest that farmers generally have a positive attitude to improving neonatal mortality but may differ in beliefs about how this can be achieved, with some farmers believing they had no control over early lamb mortality. Facilitative approaches, where farmers and advisors work together to develop neonatal survival strategies, have been shown to be effective in achieving management goals, such as optimising ewe nutrition, that lead to reductions in lamb mortality. We conclude that scientific research is providing useful information on the biology underpinning neonatal survival, such as optimal birthweights, lamb vigour and understanding the importance of sufficient colostrum intake, but the transfer of that knowledge would benefit from an improved understanding of the psychology of management change on farm. Developing tailored solutions, on the basis of adequate farm records, that make use of the now substantial body of scientific literature on neonatal mortality will help to achieve lower neonatal mortality.     

A Role for Biology in the Cultural Ecology of Ladakh

Human ecology research in the high-altitude region of Ladakh (northern India) has tended to focus on the adaptive significance of Ladakhi social institutions given a natural environment characterized by numerous challenges. This research appears to lead to the conclusion that traditionally-living Ladakhis are in a state of well-being and harmonious balance with their environment, as social institutions such as polyandry constrain fertility to keep the population size in check relative to constrained resources. There has been little research on biological adaptation in Ladakh, and the view from biology presents a very different picture of the relationship between Ladakhis and their environment. Data presented here show that the health of reproductive women and infants is compromised by both natural and social factors. Since reproductive health is crucial to the production of future generations, it is argued that mortality plays a major role in constraining population growth in Ladakh, and may be due to the limited biological history that Ladakhis have in this high-altitude region. This may also help us understand Ladakhi patterns in relation to those observed in the Andes.     

Optimal birthweights in Peruvian populations at high and low altitudes

This study tests the hypothesis that optimum birthweight for survival is lower among hospital-born infants in Puno, Peru (altitude 3860 m) than that among their counterparts at low altitude in Tacna, Peru (altitude 600 m). The data are derived from hospital birth records for 1971 and 1972 and municipal death records for 1971 through 1973. Linking these records permits analysis of the patterns of mortality in relation to birthweight. Stabilizing selection upon birthweight is operating in both populations. The high altitude population has a lower mean birthweight and a lower optimal birthweight. The Puno population is closer to its optimal birthweight distribution and, as a result of mortality during infancy, is approaching its optimum birthweight distribution for survival more rapidly than the Tacna population. It appears that the high altitude Puno population may well be adapted to its environment in the sense that there is less selective mortality on birthweight phenotypes.     

Survival analysis of mortality in pre-weaning kids of Sirohi goat

Pre-weaning animals exit a flock through death induced by various reasons, causing significant economic losses to the goat producers. In this study, we investigated the survival from birth to weaning of Sirohi goat kids within framework of the survival analysis. Kid records were accessed from 1997 to 2017, with the information on 4417 pre-weaning animals of farmed Sirohi goat native to the Rajasthan State of India. A multivariable Cox regression was fitted to the data after checking the assumptions of regression. The explanatory variables were sex, type of birth, season of birth, birthweight, doe weight at kidding and year of birth. Model selection eliminated doe weight from the model, and sex, type of birth, season of birth, birthweight and year of birth were retained in the model. With model calibration also, these five covariates were retained in the model. The mortality on the first day after birth was 0.3%, constituting 3.5% of all pre-weaning mortality. The mortality until the end of weaning period was 7.8%. Regression analysis revealed that the higher birthweight at kidding was associated with reduced hazard of death among the kids. Male kids had higher hazards of death compared with female kids. The single-born kids had lower risks of death compared with twin-born kids after accounting for heterogeneity. The winter season had a very high adverse effect on the survival of the kids. With each passing year, risks of death decreased. The results of this study indicate that better survival of kids can be achieved by controlling both environmental and animal-related factors.     

Influence of birth weight on differences in infant mortality by social class and legitimacy.

OBJECTIVE--To investigate the influence of birth weight on the pronounced social class differences in infant mortality in Britain. DESIGN--Analysis of routine data on births and infant deaths. SETTING--England and Wales. SUBJECTS--All live births and infant deaths, 1983-5. MAIN OUTCOME MEASURE--Mortality in infants by social class, birth weight, and legitimacy according to birth and death certificates. RESULTS--Neonatal and postneonatal mortality (deaths/1000 births) increased with social class. Neonatal and postneonatal mortality was 4.2/1000 and 2.3/1000 respectively for social class I and 6.8/1000 and 5.6/1000 respectively for social class V. Mortality was lower among births registered within marriage (postneonatal 3.5/1000; neonatal 5.2/1000) than among those jointly registered outside marriage (5.1/1000; 6.4/1000); mortality was highest in those solely registered outside marriage (7.2/1000; 7.0/1000). For neonatal mortality the effect of social class varied with birth weight. Social class had little effect on neonatal mortality in low birthweight babies and increasing effect in heavier babies. For postneonatal mortality the effect of social class was similar for all birth weights and was almost as steep as for all birth weights combined. CONCLUSION--Birth weight mediates little of the effect of social class on postneonatal mortality.     

Predicting death from initial disease severity in very low birthweight infants: a method for comparing the performance of neonatal units.

OBJECTIVES--To investigate (a) which clinical variables and physiological measures of disease severity best predict death in very low birthweight infants and (b) their use in comparing mortality between two neonatal units. DESIGN--Retrospective study of two cohorts of very low birthweight infants from overlapping time periods who received mechanical ventilation. SETTING--Two neonatal intensive care units (hospitals A and B). SUBJECTS--262 Very low birthweight infants, 130 in hospital A, 132 in hospital B. MAIN OUTCOME MEASURE--Death in hospital. RESULTS--In hospital A the mean level of oxygenation in the first 12 hours of life, whether measured as inspired oxygen requirement (FIO2), arterial/alveolar oxygen (a/AO2) ratio, or alveolar-arterial oxygen difference (A-aDO2), was more closely associated with death than any of four "traditional" risk factors: low birth weight, short gestation, the diagnosis of respiratory distress syndrome, and male sex. Mean pH in the first 12 hours was as strongly associated with death as birth weight. Multiple logistic regression models were derived in infants from hospital A using the four traditional risk factors with measures of oxygenation and pH. The validity of each model was then tested in infants from hospital B. The model based on the four traditional risk factors alone predicted death in hospital B with only 31% sensitivity. Adding mean a/AO2 ratio and mean pH increased its sensitivity to 75%, and when mean a/AO2 ratio was replaced by mean FIO2 its sensitivity increased further to 81%. Based on crude mortality rates alone, the odds of death in hospital A versus hospital B were 0.67 (95% confidence interval 0.37 to 1.23). After correcting for traditional risk factors and mean FIO2 and mean pH, however, the odds of death in hospital A increased to 3.27 (1.35 to 7.92; p less than 0.01). This increased risk persisted after adjusting for the time difference between each cohort. CONCLUSIONS--Crude comparisons of hospital mortality can be highly misleading. Reliable assessment of neonatal outcome is impossible without correcting for major risk factors, particularly initial disease severity. International agreement on a minimum core dataset of clinical and physiological information could improve neonatal audit and help to identify effective treatments and policies.     

Adaptive norm and stabilizing selection for anthropometric characters at birth]

Analysis carried out on medical documentation containing data on several thousand healthy and affected babies has revealed patterns of differential mortality and differential morbidity for newborns and infants which allow to estimate relative risk as a function of birth weight and body length. Adaptive norm for anthropometric traits at birth was defined as the weight or length interval in which mortality/morbidity rates were lower than the overall population level. The intensity of stabilizing selection associated with birth weight calculated from these data is several times higher in the neonatal period than for the age interval 1-12 months. Neonatal mortality in more than 50% cases can be attributed to the effects of stabilizing selection associated with birth weight.     

Birthweight, maternal weight trajectories and global DNA methylation of LINE-1 repetitive elements

Low birthweight, premature birth, intrauterine growth retardation, and maternal malnutrition have been related to an increased risk of cardiovascular disease, type 2 diabetes mellitus, obesity, and neuropsychiatric disorders later in life. Conversely, high birthweight has been linked to future risk of cancer. Global DNA methylation estimated by the methylation of repetitive sequences in the genome is an indicator of susceptibility to chronic diseases. We used data and biospecimens from an epigenetic birth cohort to explore the association between trajectories of fetal and maternal weight and LINE-1 methylation in 319 mother-child dyads. Newborns with low or high birthweight had significantly lower LINE-1 methylation levels in their cord blood compared to normal weight infants after adjusting for gestational age, sex of the child, maternal age at delivery, and maternal smoking during pregnancy (p = 0.007 and p = 0.036, respectively), but the magnitude of the difference was small. Infants born prematurely also had lower LINE-1 methylation levels in cord blood compared to term infants, and this difference, though small, was statistically significant (p = 0.004). We did not find important associations between maternal prepregnancy BMI or gestational weight gain and global methylation of the cord blood or fetal placental tissue. In conclusion, we found significant differences in cord blood LINE-1 methylation among newborns with low and high birthweight as well as among prematurely born infants. Future studies may elucidate whether chromosomal instabilities or other functional consequences of these changes contribute to the increased risk of chronic diseases among individuals with these characteristics.     

Race of parents and infant birthweight in the United States.

Detailed 1977 national natality data are used to investigate social, demographic, and genetic effects on birthweight differentials. Analysis of birthweight differences among infants with white, black, and mixed black-white parents indicates that a portion of the observed weight differentials appear to be due to biologic factors. Infants with a black mother and father have the lowest mean birthweights, while infants with two white parents have the highest weights. Newborns with mixed-race parents have intermediate birthweight distributions. Multivariate analysis suggests that the effects of parental race on birthweight are not the result of maternal/obstetric differences among parents of the same or mixed race.     

Effectiveness of neonatal transport.

The condition of 259 infants transferred to the neonatal intensive care unit (NICU) of the Montreal Children''s Hospital from Oct. 1, 1974 to Mar. 31, 1975 was evaluated. Their transport was provided by personnel and equipment from the Montreal Children''s Hospital. When the transport team arrived at the referring hospital hypothermia (temperature of less than 36 degrees C) was present in 25.2% of the 163 infants for whom complete temperature measurements were available. Most (77.3%) of the infants were warmed during transport and only 3.1% arrived at the NICU with a temperature of less than 35 degrees C. The mortality was significantly higher in babies of all birth weight groups whose core temperature had been below the optimal temperature for survival (36 to 37 degrees C). It appears that the use of appropriate equipment and trained personnel can reduce the incidence of hypothermia and therefore the mortality in infants requiring transfer.     

Sister chromatid exchange in newborns

Summary Siter chromatid exchanges (SCE) were analyzed in the cord and postnatal blood of controlled groups of low and high birth weight infants to detect possible associations between abnormal birth weight and SCE frequency. Structural chromosome aberration rates had previously been evaluated for all infants, and possible correlations between aberration and SCE rates were sought.No correlation was found between neonatal or postnatal SCE frequency and birthweight, nor was there evidence of association of chromosome aberration rates with SCE frequency. In all groups of infants, however, mean postnatal SCE frequencies were significantly lower than mean neonatal SCE frequencies.     

The influence of birth timing upon infant growth and survival in Captive Rhesus Macaques (Macaca mulatto)

Weights, growth rates, and mortality data of 815 captive-born Macaca mulattainfants were studied to determine if date of birth influences infant growth and survival. The six groups studied displayed a unimodal spring-summer birth season that has become systematically more restricted since 1977. Males exhibited higher rates of stillbirth and neonatal death and were more frequently born outside the normal birth season, when infant mortality was more common. Within the normal birth season, infant weight increased linearly with birth date, and infant growth rate declined linearly with birth date. Female infants with weights and growth rates near the developmental norm, especially those born in the middle of the birth season, have the greatest probability of survival. Males are more likely to survive if their weights and growth rates exceed the developmental norm, and thus male infants might be initially more costly to produce than female infants. These results are inconsistent with the hypothesis that offspring of high-ranking males, which conceived predominantly in the first third of the breeding season, enjoy a selective advantage.     

High-altitude chronic hypoxia during gestation and after birth modifies cardiovascular responses in newborn sheep

Perinatal exposure to chronic hypoxia induces sustained pulmonary hypertension and structural and functional changes in both pulmonary and systemic vascular beds. The aim of this study was to analyze consequences of high-altitude chronic hypoxia during gestation and early after birth in pulmonary and femoral vascular responses in newborn sheep. Lowland (LLNB; 580 m) and highland (HLNB; 3,600 m) newborn lambs were cathetherized under general anesthesia and submitted to acute sustained or stepwise hypoxic episodes. Contractile and dilator responses of isolated pulmonary and femoral small arteries were analyzed in a wire myograph. Under basal conditions, HLNB had a higher pulmonary arterial pressure (PAP; 20.2 +/- 2.4 vs. 13.6 +/- 0.5 mmHg, P < 0.05) and cardiac output (342 +/- 23 vs. 279 +/- 13 ml x min(-1) x kg(-1), P < 0.05) compared with LLNB. In small pulmonary arteries, HLNB showed greater contractile capacity and higher sensitivity to nitric oxide. In small femoral arteries, HLNB had lower maximal contraction than LLNB with higher maximal response and sensitivity to noradrenaline and phenylephrine. In acute superimposed hypoxia, HLNB reached higher PAP and femoral vascular resistance than LLNB. Graded hypoxia showed that average PAP was always higher in HLNB compared with LLNB at any Po2. Newborn lambs from pregnancies at high altitude have stronger pulmonary vascular responses to acute hypoxia associated with higher arterial contractile status. In addition, systemic vascular response to acute hypoxia is increased in high-altitude newborns, associated with higher arterial adrenergic responses. These responses determined in intrauterine life and early after birth could be adaptive to chronic hypoxia in the Andean altiplano.     

Secular trend in neonatal mortality in the moutain states

Reviewing trends in neonatal mortality from 1957 to 1967, it is clear that neonatal and infant mortality has declined faster in the mountain states than in the low altitude states. Accordingly, the increased neonatal and infant mortality at high altitudes or in the mountain states cannot be attributed to high altitude hypoxia alone. Furthermore, the decline in neonatal mortality in the mountain states has not been accompanied by a decrease in the frequency of low birth weight (below 2500 gm) and is therefore not a product of increasing body size in the neonate.     

Factors associated with neonatal lamb mortality

Three factors were associated with lamb neonatal mortality: birthweight (P<0.003), number of lambs born per ewe (P<0.001) and lamb sex (P<0.32). Lamb birthweight had the greatest predictive power for survival during the neonatal period. The neonatal mortality rate was 14.3%. The age specific mortality for lambs one day old was 7.9% (P<0.05). Seventy-nine percent of the lambs that died, did so by the end of the fourth post-natal day. Starvation was associated with 58.3% (P < 0.05) of the lamb deaths.     

Relationships between pregnancy spacing,sex of infants,maternal age,and birth order,and neonatal and post‐neonatal mortality in Bangladesh

Abstract

The relationships between length of the interpregnancy interval, outcome of the pregnancy preceding the interval, sex of the infants, pregnancy order, maternal age, and maternal history of previous child deaths and neonatal and postneonatal mortality were explored in a rural Bangladeshi population using a multiple regression analysis. Specific interactions between the interpregnancy interval, outcome of the pregnancy preceding the interval, sex of the infants, and history of previous child deaths were examined. An inverse relationship was observed between postneonatal mortality and the length of the interpregnancy interval when the pregnancy preceding the interval was a surviving infant. No such trend was observed for neonatal mortality. Post‐neonatal mortality rates among children whose mothers had experienced two or more previous child deaths were essentially the same as that for infants whose mothers had experienced 0–1 child deaths when the interpregnancy intervals were more than 24 months. Although female infants have a lower neonatal mortality than male infants, the neonatal mortality rate for female infants conceived less than twelve months following a male infant birth was higher than for a male infant conceived less than twelve months following another male infant birth. Post‐neonatal mortality is consistently higher for female compared to male infants in all interval categories.     

Neonatal intensive care and cost effectiveness.

During the past decade the rate of death among newborns weighing less than 1500 g at birth has decreased by approximately half. This dramatic reduction has resulted from the application of research findings and technologic advances, but it has proved expensive. Perhaps as a consequence of articles demonstrating the costs as well as the recognition that the overall prevalence of disabilities in infants is relatively unchanged, neonatal intensive care has recently been viewed as a possible area for cost containment. We reviewed the literature on the cost of neonatal intensive care and the limited information on other expensive medical programs and found that the cost of neonatal intensive care compared favourably, especially for infants whose birth weight was 1000 to 1500 g. Better information on the outcome of infants of very low birth weight and comparable rigorous studies of the cost effectiveness of other expensive medical programs are required, and other less easily quantified factors must be considered before decisions are made to limit neonatal intensive care on the basis of gestational age or birth weight.