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Towards reducing variations in infant mortality and morbidity : a population-based approach
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Field, David, Boyle, Elaine, Draper, Elizabeth S., Evans, Alun, Johnson, Samantha, Khan, Kamran, Manktelow, Bradley, Marlow, Neil, Petrou, Stavros, Pritchard, Catherine, Seaton, Sarah and Smith, Lucy (2016) Towards reducing variations in infant mortality and morbidity : a population-based approach. Programme Grants for Applied Research, 4 (1). pp. 1-218. doi:10.3310/pgfar04010 ISSN 2050-4322.
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Official URL: http://dx.doi.org/10.3310/pgfar04010
Abstract
Background:
Our aims were (1) to improve understanding of regional variation in early-life mortality rates and the UK’s poor performance in international comparisons; and (2) to identify the extent to which late and moderately preterm (LMPT) birth contributes to early childhood mortality and morbidity.
Objective:
To undertake a programme of linked population-based research studies to work towards reducing variations in infant mortality and morbidity rates.
Design:
Two interlinked streams: (1) a detailed analysis of national and regional data sets and (2) establishment of cohorts of LMPT babies and term-born control babies.
Setting:
Cohorts were drawn from the geographically defined areas of Leicestershire and Nottinghamshire, and analyses were carried out at the University of Leicester.
Data sources:
For stream 1, national data were obtained from four sources: the Office for National Statistics, NHS Numbers for Babies, Centre for Maternal and Child Enquiries and East Midlands and South Yorkshire Congenital Anomalies Register. For stream 2, prospective data were collected for 1130 LMPT babies and 1255 term-born control babies.
Main outcome measures:
Detailed analysis of stillbirth and early childhood mortality rates with a particular focus on factors leading to biased or unfair comparison; review of clinical, health economic and developmental outcomes over the first 2 years of life for LMPT and term-born babies.
Results:
The deprivation gap in neonatal mortality has widened over time, despite government efforts to reduce it. Stillbirth rates are twice as high in the most deprived as in the least deprived decile. Approximately 70% of all infant deaths are the result of either preterm birth or a major congenital abnormality, and these are heavily influenced by mothers’ exposure to deprivation. Births at < 24 weeks’ gestation constitute only 1% of all births, but account for 20% of infant mortality. Classification of birth status for these babies varies widely across England. Risk of LMPT birth is greatest in the most deprived groups within society. Compared with term-born peers, LMPT babies are at an increased risk of neonatal morbidity, neonatal unit admission and poorer long-term health and developmental outcomes. Cognitive and socioemotional development problems confer the greatest long-term burden, with the risk being amplified by socioeconomic factors. During the first 24 months of life each child born LMPT generates approximately £3500 of additional health and societal costs.
Conclusions:
Health professionals should be cautious in reviewing unadjusted early-life mortality rates, particularly when these relate to individual trusts. When more sophisticated analysis is not possible, babies of < 24 weeks’ gestation should be excluded. Neonatal services should review the care they offer to babies born LMPT to ensure that it is appropriate to their needs. The risk of adverse outcome is low in LMPT children. However, the risk appears higher for some types of antenatal problems and when the mother is from a deprived background.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RG Gynecology and obstetrics R Medicine > RJ Pediatrics |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Poor women -- Premature infants -- Great Britain , Poor women -- Stillbirth -- Great Britain , Newborn infants -- Mortality -- Statistics, Newborn infants -- Morbidity -- Statistics | ||||||||
| Journal or Publication Title: | Programme Grants for Applied Research | ||||||||
| Publisher: | National Institute for Health Research | ||||||||
| ISSN: | 2050-4322 | ||||||||
| Official Date: | March 2016 | ||||||||
| Dates: |
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| Volume: | 4 | ||||||||
| Number: | 1 | ||||||||
| Page Range: | pp. 1-218 | ||||||||
| DOI: | 10.3310/pgfar04010 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||||
| Date of first compliant deposit: | 10 June 2016 | ||||||||
| Date of first compliant Open Access: | 10 June 2016 | ||||||||
| Funder: | National Institute for Health Research (Great Britain) (NIHR) |
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