Article thumbnail

Inclusion of non-viable neonates in the birth record and its impact on infant mortality rates in Shelby County, Tennessee, USA

By Bryan L. Williams and Melina S. Magsumbol


Rates of infant death are one of the most common indicators of a population's overall health status. Infant mortality rates (IMRs) are used to make broad inferences about the quality of health care, effects of health policies and even environmental quality. The purpose of our study was threefold: i) to examine the characteristics of births in the area in relation to gestational age and birthweight; ii) to estimate infant mortality using variable gestational age and/or birthweight criteria for live birth, and iii) to calculate proportional mortality ratios for each cause of death using variable gestational age and/or birthweight criteria for live birth. We conducted a retrospective analysis of all Shelby County resident-linked birth and infant death certificates during the years 1999 to 2004. Descriptive test statistics were used to examine infant mortality rates in relation to specific maternal and infant risk factors. Through careful examination of 1999–2004 resident-linked birth and infant death data sets, we observed a disproportionate number of non-viable live births (≤20 weeks gestation or ≤350 grams) in Shelby County. Issuance of birth certificates to these non-viable neonates is a factor that contributes to an inflated IMR. Our study demonstrates the complexity and the appropriateness of comparing infant mortality rates in smaller geographic units, given the unique characteristics of live births in Shelby County. The disproportionate number of pre-viable infants born in Shelby County greatly obfuscates neonatal mortality and de-emphasizes the importance of post-neonatal mortality

Topics: Article
Publisher: PAGEPress Publications
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. (2007). A comparison of LMP-based and ultrasound-based estimates of gestational age using linked California livebirth and prenatal screening records. Paediatr Perinat Epidemiol
  2. (1984). Actual infant mortality compared with legal infant mortality. Bol Asoc Demogr Hist
  3. (1990). An assessment of error in parental occupation from the birth certificate.
  4. Are reported preterm birth rates reliable? An analysis of interhospital differences in the calculation of the weeks of gestation at delivery and preterm birth rate.
  5. (2007). Assessing the quality of last menstrual period date on California birth records. Paediatr Perinat Epidemiol
  6. (1991). Bias in congenital malformations information from the birth certificate.
  7. Birth certificate methods in five hospitals.
  8. Birth certificates are an inappropriate source for identifying cases of birth defects in epidemiologic studies.
  9. (1999). Birth defects surveillance: assessing the "gold standard".
  10. (2005). Born to Die - 38108 The infant death capital.
  11. (1999). CfDCa. Compressed Mortality File
  12. Comparative accuracy of clinical estimate versus menstrual gestational age in computerized birth certificates. Public Health Reports 2001;116: 15-
  13. Comparison of gestational age classifications: date of last menstrual period vs. clinical estimate.
  14. Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination.
  15. (1998). Completeness of ascertainment of prenatal smoking using birth certificates and confidential questionnaires: variations by maternal attributes and infant birth weight. PRAMS Working Group. Pregnancy Risk Assessment Monitoring System. Am J Epidemiol
  16. Correlation between self-reported gestational age and ultrasound measurements.
  17. (2007). Cost of Hospitalization for preterm and low birth weight infants in the United States. Pediatrics
  18. (2007). Decision-making in the delivery room: A survey of neonatologists.
  19. (1995). Effects of reporting methods on infant mortality rate estimates for racial and ethnic subgroups.
  20. (1997). Evaluation of prenatal care information on birth certificates. Paediatr Perinat Epidemiol
  21. Explaining the 2001-02 infant mortality increase: data from the linked birth/infant death data set.
  22. First trimester embryonic/fetal heart rate in normal pregnant women.
  23. How to decide with precision, justice, and equity? Reflections on decision-making in the context of extreme prematurity. Part two: moving toward making the best possible decision: defining conditions for putting decisions into practice.
  24. Implausible birth weight for gestational age.
  25. (1936). Infant Mortality in Memphis: Children's
  26. (2010). Infant mortality is not an adequate summary measure of population health. J Epidemiol Community Health 2003;57:319. [page 8] [Pediatric Reports
  27. (2007). Infant mortality statistics from the 2004 period linked birth/infant death data set. Natl Vital Stat Rep
  28. Invited commentary: using vital statistics databases for perinatal epidemiology: does the quality go in before the name goes on?
  29. Measuring the accuracy and completeness of linking certificates for deliveries to the same woman. Paediatr Perinat Epidemiol
  30. (2003). Methodological difficulties in the comparison of indicators of perinatal health across Europe. Eur J Obstet Gynecol Reprod Biol
  31. (2007). NCHS Data Definitions. Volume
  32. Perinatal intervention and neonatal outcomes near the limit of viability.
  33. (2006). Problems in using birth certificate files in the capture-recapture model to estimate the completeness of case ascertainment in a population-based birth defects registry in New York State. Birth Defects Res A Clin Mol Teratol
  34. (1998). Quality of data acceptable for perinatal epidemiology surveillance: assessment of the health certificate at birth and the national obstetrics medical file. Study in three Seine-Maritime maternal wards.
  35. (1995). Racial and ethnic disparities in infant mortality rates--60 largest U.S. cities,
  36. (2003). Random error and undercounting in birth defects surveillance data: implications for inference. Birth Defects Res A Clin Mol Teratol
  37. (1984). Record linkage in the study of infant mortality: some aspects concerning data quality.
  38. (2007). Regional Core Health Data Initiative.
  39. (2002). Registration artifacts in international comparisons of infant mortality. Paediatr Perinat Epidemiol
  40. Registration Completeness and International Comparisons of Infant Mortality.
  41. (1992). Reliability of birth certificate reporting of congenital anomalies.
  42. Resuscitation in the "gray zone" of viability: determining physician preferences and predicting infant outcomes.
  43. The contribution of birth defects to preterm birth and low birth weight.
  44. The impact of deviations from the definition of live births on the rate of infant mortality.
  45. The marginally viable newborn: legal challenges, conceptual inadequacies, and reasonableness.
  46. (1997). The quality of vital perinatal statistics data, with special reference to prenatal care. Paediatr Perinat Epidemiol
  47. The reliability and validity of birth certificates.
  48. Trends in neonatal morbidity and mortality ArticleArticle for very low birthweight infants.
  49. (1980). Validity of birth certificate data for the outcome of the previous pregnancy,
  50. Workup of stillbirth: a review of the evidence.