Jun 3, 2002 3 min read

CHICAGO (AP) – Contrary to medical thinking, low-birthweight newborns in the United States die at rates similar to those in other developed countries with far fewer resources for at-risk infants, a study found. The researchers compared newborn death rates by weight with those in Canada, Australia and the United Kingdom, which all devote comparatively more medical resources to prenatal care than to intensive newborn care.

The results suggest that U.S. medical resources could be more evenly distributed with potentially better outcomes, the researchers said. “The U.S. spends far more on sick babies and less on preventing sick babies and still isn’t improving survival compared to these other countries we looked at,” said lead researcher Dr. Lindsay Thompson of Dartmouth Medical School. “It was disappointing.”

The study in June’s Pediatrics follows research by another Dartmouth team published last month suggesting that medical advances have contributed to a U.S. glut of neonatologists – specialists in intensive care of at-risk newborns, including premature and low-birthweight babies. That study found similar newborn death rates across the United States, even in areas with comparatively few neonatologists.

Thompson’s study is based on a review of data from 1993 to 2000, including newborn death rates in 1997. The overall U.S. newborn mortality rate that year was 4.7 per 1,000 births, compared with 3.8 per 1,000 in England and Wales, 3.7 per 1,000 in Canada and three per 1,000 in Australia.

Previous studies also have found higher overall U.S. infant mortality rates than in other developed countries.

What was surprising, Thompson said, was the similarity in death rates for the smallest, sickest babies, born weighing less than 2 pounds. Doctors had thought such babies did better in the United States given the country’s neonatal resources, she said. But in all countries studied, there were more than 300 deaths per 1,000 births in 1997, and differences among them were not significant, she said.

The United States has 6.1 neonatologists per 10,000 births, compared with 3.7 in Australia, 3.3 in Canada and 2.7 in the United Kingdom. The U.S. figure remains significantly higher even considering that more low-birthweight babies are born here, Thompson said.

More than 300,000 U.S. newborns, or about 7.8 percent annually, have low birthweights, less than 5 pounds, 8 ounces. The rate was 7.2 percent in the United Kingdom, 6.1 percent in Australia and 5.7 percent in Canada during the study period.

The number of neonatal intensive-care beds is also proportionately higher in the United States, the study found.

The United States is the only country studied without national insurance and the only one where the government does not provide free family planning services and free prenatal care, Thompson said.

Focusing more on such services could help improve newborn mortality rates, she said.

Dr. James Collins, a neonatologist at Chicago’s Children’s Memorial Hospital, said he agreed that “prevention is better than a cure.”

But Collins said the study is flawed because it compared only broad categories of birthweights and didn’t adequately account for the higher U.S. rate of low-birthweight babies.

Also, Collins said, focusing only on death rates doesn’t tell the whole story. He said premature U.S. babies who survive likely fare better later in childhood than those in other countries, in part because of the intensive care they get as newborns.

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On the Net:

Pediatrics: http://www.pediatrics.org