Library Index :: Death and Dying: End-of-Life Controversies :: Seriously Ill Children - Infant Mortality, Birth Defects, Low Birth Weight And Prematurity, Who Makes Medical Decisions For Infants?

Seriously Ill Children - Low Birth Weight And Prematurity

Low Birth Weight

Infants who weigh less than twenty-five hundred grams (or five pounds, eight ounces) at birth are

FIGURE 5.2 Spina bifida rates and number of live births with spina bifida, 1991–2003 Adapted from "Figure 1. Spina Bifida Rates, 1991–2002," and "Table 1. Number of Live Births and Spina Bifida Cases and Rates per 100,000 Live Births for the United States, 1991–2002," Trends in Spina Bifida and Anencephalus in the United States, 1991–2002, Centers for Disease Control and Prevention, National Center for Health Statistics, 2004, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/spine_anen.htm (accessed December 1, 2005). Data for 2003 are unpublished from the National Vital Statistics System, NCHS, CDC, December 1, 2005.

FIGURE 5.2 Spina bifida rates and number of live births with spina bifida, 1991–2003 Adapted from "Figure 1. Spina Bifida Rates, 1991–2002," and "Table 1. Number of Live Births and Spina Bifida Cases and Rates per 100,000 Live Births for the United States, 1991–2002," Trends in Spina Bifida and Anencephalus in the United States, 1991–2002, Centers for Disease Control and Prevention, National Center for Health Statistics, 2004, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/spine_anen.htm (accessed December 1, 2005). Data for 2003 are unpublished from the National Vital Statistics System, NCHS, CDC, December 1, 2005.

FIGURE 5.2
Spina bifida rates and number of live births with spina bifida, 1991–2003
Year Spina bifida cases Total live births Rate
Note: Excludes data for Maryland, New Mexico, and New York, which did not require reporting for spina bifida for some years.
SOURCE: Adapted from "Figure 1. Spina Bifida Rates, 1991–2002," and "Table 1. Number of Live Births and Spina Bifida Cases and Rates per 100,000 Live Births for the United States, 1991–2002," Trends in Spina Bifida and Anencephalus in the United States, 1991–2002, Centers for Disease Control and Prevention, National Center for Health Statistics, 2004, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/spine_anen.htm (accessed December 1, 2005). Data for 2003 are unpublished from the National Vital Statistics System, NCHS, CDC, December 1, 2005.
2003 702 3,715,577 18.89
2002 734 3,645,770 20.13
2001 730 3,640,555 20.05
2000 759 3,640,367 20.85
1999 732 3,533,565 20.72
1998 790 3,519,240 22.45
1997 857 3,469,667 24.70
1996 917 3,478,723 26.36
1995 975 3,484,539 27.98
1994 900 3,527,482 25.51
1993 896 3,562,723 25.15
1992 816 3,572,890 22.84
1991 887 3,564,453 24.88

considered to be of low birth weight. Those born weighing less than fifteen hundred grams (three pounds, four ounces) have very low birth weight. Low birth weight may result from various causes, including premature birth, poor maternal nutrition, teen pregnancy, drug and alcohol use, smoking, or sexually transmitted diseases.

In 2003, 7.9% of the more than four million live births that year were low-birth-weight infants, the highest level reported in more than two decades. About 1.4% were very-low-birth-weight infants. African-American mothers were about twice as likely as white and Hispanic mothers to have low-birth-weight babies (13.6% of children born to non-Hispanic African-American birth mothers had low birth weight compared with 7% and 6.7%, respectively, born to non-Hispanic white and Hispanic mothers). (See Table 5.6 and Table 5.7.) The highest percentages of low-birth weight babies

TABLE 5.5 Estimated prevalence and lifetime economic costs for certain developmental disabilities, by cost category, 2003 A. Honeycutt, et al., "Table. Estimated Prevalence and Lifetime Economic Costs for Mental Retardation, Cerebral Palsy, Hearing Loss, and Vision Impairment, by Cost Category—United States, 2003," in "Economic Costs Associated with Mental Retardation, Cerebral Palsy, Hearing Loss, and Vision Impairment—United States, 2003," Morbidity & Mortality Weekly Report, vol. 53, no. 3, January 30, 2004, http://www.cdc.gov/mmwr/PDF/wk/mm5303.pdf (accessed December 5, 2005)

TABLE 5.5
Estimated prevalence and lifetime economic costs for certain developmental disabilities, by cost category, 2003
Developmenta disability Ratea Direct medical costsb (millions) Direct nonmedical costsc (millions) Indirect costsd (millions) Total costs (millions) Average costs per person
Note: Lifutime economic costs are present value estimates, in 2003 dollars, of lifetime costs for persons born in 2000, based on a 3% discount rate
aPer 1,000 children aged 5-10 years, on the basis of Metropolitan Atlanta Developmental Disabilities Surveillance Program data for 1991–1994.
bIncludes physician visits, prescription medications, hospital inpatient stays, assistive devices, therapy and rehabilitation (for persons aged <18 years), and long-term care (for persons aged 18-76 years), adjusted for age-specific survival.
cIncludes costs of home and vehicle modifications for persons aged < 76 years and costs of special education for persons aged 3-17 years.
dIncludes productivity losses from increased morbidity (i.e., inability to work or limitation in the amount or type of work performed) and premature mortality for persons aged ≤ 35 years with mental retardation, aged ≤ 25 years with cerebral palsy, and aged ≤ 17 years with hearing loss and vision impairment.
SOURCE: A. Honeycutt, et al., "Table. Estimated Prevalence and Lifetime Economic Costs for Mental Retardation, Cerebral Palsy, Hearing Loss, and Vision Impairment, by Cost Category—United States, 2003," in "Economic Costs Associated with Mental Retardation, Cerebral Palsy, Hearing Loss, and Vision Impairment—United States, 2003," Morbidity & Mortality Weekly Report, vol. 53, no. 3, January 30, 2004, http://www.cdc.gov/mmwr/PDF/wk/mm5303.pdf (accessed December 5, 2005)
Mental retardation 12.0 $7,061 $5,249 $38,927 $51,237 $1,014,000
Cerebral palsy 3.0 1,175 1,054 9,241 11,470 921,000
Hearing loss 1.2 132 640 1,330 2,102 417,000
Vision impairment 1.1 159 409 1,915 2,484 566,000

are born to teenage mothers and to women over forty years of age. (See Table 5.7.)

Like the proportion of low-birth-weight babies, the proportion of very-low-birth-weight babies has also been increasing since the 1980s, although rates stabilized from the late 1990s through 2003. (See Table 5.8.) The increase in low- and very-low-birth-weight babies during the 1990s is attributed to the increase in the multiple birth rate. Babies born as part of a multiple birth are at much greater risk of low birth weight than babies born as a single birth.

Prematurity

The usual length of human pregnancy is forty weeks. Infants born before thirty-seven weeks of pregnancy are considered premature. A premature infant does not have fully formed organ systems. If the premature infant is born with a birth weight comparable to a full-term baby and has organ systems only slightly undeveloped, the chances of survival are great. Premature infants of very low birth weight are susceptible to numerous risks and are less likely to survive than full-term infants. If they survive, they may suffer from mental retardation and other abnormalities of the nervous system.

A severe medical condition called hyaline membrane disease, or respiratory distress syndrome (RDS), commonly affects premature infants. It is caused by the inability of the immature lungs to function properly. Occurring right after birth, it may cause infant death within hours. Intensive care includes the use of a mechanical ventilator to facilitate breathing. Also, premature infants' immature gastrointestinal systems preclude them from taking in nourishment properly. Unable to suck and swallow, they must be fed through a stomach tube.

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