BL Fisher Note:

Somebody better check out whether the now-routine practice of injecting all American newborns, including premature and health compromised newborns, with hepatitis B vaccine at 12 hours of age is contributing to the increase in infant deaths in the first week of life in the U.S. .

WebSource: http://www.washingtonpost.com/wp-dyn/articles/A34507-2004Feb11.html

The Washington Post

U.S. Infant Mortality Rate Rises 3%
First Increase Since '58 Surprises Officials as Other Health Indicators Keep Improving

By Rob Stein
Washington Post Staff Writer
Thursday, February 12, 2004; Page A11


The number of U.S. babies dying shortly after birth has crept up for the first time in more than four decades, federal health officials reported yesterday.

The cause of the small but disturbing rise remains unclear, but it may be a combination of the surge in older women having babies, the popularity of fertility treatments, and, paradoxically, advancements in identifying and saving fetuses in distress, experts said.

Regardless of the cause, the surprising increase has raised alarm because the infant mortality rate is considered a fundamental measure of a society's well-being.

"It's always a matter of concern when an important measure of public health such as infant mortality increases," said Joyce A. Martin of the federal Centers for Disease Control and Prevention, which released the new numbers. "It's so basic. The saving of young lives is important to everyone."

The increase was particularly unexpected because it comes as a number of other important measures of the nation's health continued long-term positive trends. The overall death rate in the United States has been dropping, as have the rates from the leading causes of mortality -- heart disease, stroke, accidents and cancer. And U.S. life expectancy has reached a new high -- 77.4 years

The United States has long had one of the highest infant mortality rates among developed countries, but the rate had either declined or remained steady every year since 1958. So government scientists were caught off guard when a preliminary analysis of the most recent data showed that the infant mortality rate had inched up -- climbing from 6.8 deaths per 1,000 live births in 2001 to 7.0 deaths in 2002 -- a 3 percent increase.

"I have to say, it was a surprise," said Martin, lead statistician for the National Center for Health Statistics, part of the CDC. "We weren't expecting it."

A follow-up analysis confirmed that the increase would hold true in the final numbers. When researchers parsed the data, they found the increase was caused by a jump in deaths in the first week of life among babies who were either born with birth defects, who were unusually small or whose mothers had complications during their pregnancies, such as high blood pressure or diabetes, Martin said.

Because of the number of babies who are being born early has been increasing in recent years, the findings suggest that trend could be driving the uptick in infant mortality, Martin said.

"All of the improvement in infant mortality in recent years has come as a result of our doing better at saving the high-risk infants that are born, not in preventing high-risk pregnancies in the first place. The data suggest the possibility that these high-risk events are starting to influence the overall infant mortality rate," she said. "It may be that they've increased to the point where they are starting to push up the infant mortality rate."

At least part of the increase in the preterm and high-risk pregnancies may be due to the increase in the number of women who are delaying having babies, Martin said. Older mothers are at increased risk for developing complications during pregnancy and for having babies with birth defects or low birth weight. But because the number of babies born to older women is still relatively small, that could not fully explain the increase, she said.

Another contributing factor may be the rise in the use of in vitro fertilization techniques and fertility drugs, which has increased the number of twins, triplets and quintuplets, she said. Those babies tend to be born earlier, smaller and to mothers who have had complications of pregnancy.

"Assisted reproductive technologies appear to result in smaller and earlier deliveries for all births, not just multiple births. That could be having an impact," she said.

Fertility experts, however, questioned the suggestion that in vitro fertilization and other assisted-reproduction treatments may be playing a role in the increase in infant mortality.

"That strikes me as a bit of a leap," said Robert W. Rebar, executive director of American Society for Reproductive Medicine, adding that there were many other possible explanations for the data.

Jun Zhang of the National Institute of Child Health and Human Development agreed that fertility treatments and older mothers could be a factor. But Zhang said a more important influence was probably improvements in doctors' ability to identify fetuses having problems in the womb, deliver them early and then keep them alive when they are born preterm.

"Because of these improvements, obstetricians have had more freedom to deliver a baby that may be in jeopardy," Zhang said.

That has prompted an increase in doctors inducing delivery early or delivering babies preterm through Caesarean sections.

While overall the number of fetuses that survive through birth and beyond would increase as a result of such aggressive interventions, the number that die shortly after delivery might rise. "So it's a shift from fetal death to early neonatal death," Zhang said.

In fact, when researchers examined the overall death rate for fetuses both in late pregnancy and after birth, they found no increase.

Martin agreed and added that some of the alarm has been offset by a very preliminary analysis of the 2003 data, which look like they may show a resumption of the overall decline in infant mortality.

"We're hopeful that except for this one year the rate will continue on its downward trend, but it's too early to know for sure," Martin said.

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