1. Section Editor(s): Brandon, Debra PhD, RN, CCNS, FAAN
  2. McGrath, Jacqueline M. PhD, RN, FNAP, FAAN

Article Content

Infant mortality rates are typically described as the number of deaths under 1 year of age per 1000 live births in a particular geographical area. Worldwide, infant mortality is reported by country or state and generally reflects the overall health of the population in the geographical area represented. Mortality and morbidity rates across countries and states have traditionally compared "developed" versus "developing countries." Developed countries are typically industrialized nations with per capita incomes above $12,000, with an average per capita income of $38,000, while developing countries will have many citizens with per capita incomes $12,000 or less.


As a nation, the United States takes pride in having the best healthcare in the world, yet our rate of 6.1 infant deaths per 1000 live births continues to lag behind the rest of the developed world. Countries such as the Czech Republic, Poland, and Hungry each have lower infant mortality rates (2.7, 5.0, and 5.3 per 1000 live births, respectively).1 Worldwide, over 1 million infants die from prematurity and the complications of preterm birth annually,2 and while the rate of US preterm births (<37 weeks) has decreased in recent years to 9.57% in 2014, preliminary data on 2015 preterm rates have inched up to 9.62%.3You might be asking, so why are all these global statistics important to me?


In collaboration with the March of Dimes and other groups, the World Health Organization (WHO) published "Born Too Soon. The global Action Report On Preterm Birth" to increase policy efforts globally to reduce preterm births.2 Specifically, the March of Dimes seeks to bring the US prematurity rate in line with the other very high human development index countries.4 The human development index (HDI) was established by the United Nations to further describe countries beyond economic growth. The HDI is a summary index of a country's human capacity on 3 dimensions: (1) a long and healthy life, (2) being knowledgeable, and (3) having a decent standard of living. Using these dimensions, countries are ranked from "very high" to "low" levels of human development. The United States ranks 8th of 49 countries with a very high human development index, yet our infant mortality rate is much higher than many countries that are ranked 9th through 49th. The aforementioned data highlight the unbalanced nature of how the healthcare dollars in the United States are distributed.


Deaths of infants in the acute care setting are not unfamiliar to most neonatal providers, but given the US infant mortality comes in large part from preterm births,1 how we can impact infant mortality rates? The WHO posits that deaths from preterm birth should be addressed by reducing preterm births and providing appropriate feasible healthcare to all preterm infants at birth, with appropriate management of labor and delivery centered between these 2 major areas. The March of Dimes has set a goal to reduce the US premature birth rate to 5.5% by 2030, with a goal of bringing the United States in line with other very high human development index countries. As neonatal healthcare providers, we should be asking ourselves why does the United States continue to lag behind developed countries that spend less on healthcare and with far less health human capacity and how can we help the March of Dimes achieve this admiral goal?


While some of the difference in our rates may be explained by our counting of 23 and 24-week births as live births and other countries may consider these infants to be a product of miscarriage,4 it does not explain all the differences. Based on 2005 data, a preterm infant born at less than 28 weeks' gestation had annual healthcare costs that exceeded $200,000 each year through the first 7 years of life,5 but the resources to support infant healthcare continue to be threatened by how we as a country spend our healthcare dollars. While we will never eliminate all preterm births, if we are to achieve the targeted March of Dimes goal of 5.5% by 2030, we all must engage in policy and advocacy work. Our infants cannot advocate for themselves. Join the NANN advocacy committee or other advocacy groups that support infant health. In addition, reflect on how you can advocate specifically for:


* Increasing resources for preterm infant interventions in proportion to the burden of healthcare expenditures, especially in the first year of life when deaths from the complications of preterm birth are highest.


* Similarly, increasing resources for research around preterm infant care needs to receive proportional attention to advance neonatal science.


* Ensuring evidence-based interventions for preterm infants are accessible to all. These interventions should include affordable access for all preterm infants to early neonatal tertiary care, postdischarge primary and specialty care, and early intervention services.


* The families caring for these infants. The burden of caring for a preterm infant goes beyond the economic impact and must also include providing resources to support the family in managing the psychological effects of having a preterm infant who may have lifelong special needs.


Given our chosen profession and passions, we are stewards for at-risk and preterm infants and as such this stewardship must go beyond care at the bedside. We owe this to the infants and family in our care.


Please consider our plea to action.


Debra Brandon, PhD, RN, CCNS, FAAN


Coeditor; Advances in Neonatal Care


Jacqueline M. McGrath, PhD, RN, FNAP, FAAN


Coeditor; Advances in Neonatal Care




1. MacDorman MF, Mathews TJ, Mohango AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe. Natl Vital Stat Rep. 2014;63(5):1-6. [Context Link]


2. World Health Organization. Born Too Soon. The global Action Report on Preterm Birth. Geneva, Switzerland: World Health Organization; 2012. [Context Link]


3. Hamilton BE, Martin JA, Osterman MJ. Births: preliminary data for 2015. Natl Vital Stat Rep. 2016;65(3):1-7. [Context Link]


4. McCabe E, Carrino GE, Russell RB, Howse JL. Fighting for the next generation: US prematurity in 2030. Pediatrics. 2014;134:1193-1199. [Context Link]


5. Behrman RE, Butler AS, eds. Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: National Academies Press; 2007. [Context Link]