Comment on Ohio infant death rate




I read with great interest the article by Donovan et al about infant death rate in Ohio in the July issue. I believe that there are some errors in the table. Unadjusted infant mortality rate (deaths/births × 1000) is 3.106 at 38 weeks, 2.317 at 39 weeks, 2.121 at 40 weeks, and 2.997 at 41 weeks. The reference adjusted rate [(269 + 185)/(116,102 + 87,214)] should be 2.233. I don’t have the math skills to be able to calculate their last column of logistic regression.


I would like to see the data manipulated differently. What happens to outcomes when the “plan” is to deliver at a specific gestational age? How do we decide what’s too early and too late for an “elective” delivery at a specific gestational age? A planned delivery at 39, 40, or 41 weeks would have the added mortality of the child who died in the 38th week while awaiting our intervention. There are a number of studies suggesting increasing stillbirth rates weekly at term. What would the data look like if the intent was to deliver infants between 32-41 weeks?


An example by extremes would be if 10% of infants die at 38 weeks but none at 39 weeks. The 39-week data may show the lowest weekly mortality rate, but the right intervention would be delivery at 37 weeks, not 39. The data presented are interesting but not presented in a format that allows decisions to be made to guide management.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

May 31, 2017 | Posted by in GYNECOLOGY | Comments Off on Comment on Ohio infant death rate

Full access? Get Clinical Tree

Get Clinical Tree app for offline access