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 - Who Makes Medical Decisions For Infants?

Prior to the 1980s in the United States, the courts were supportive of biologic parents making decisions regarding the medical care of their newborns. Parents often made these decisions in consultation with pediatricians. Medical advancements in the 1970s, however, allowed for the survival of infants who would have not had a chance for survival prior to that time. Parents' and physicians' decisions became more challenging and complex.

The history of federal and state laws pertaining to the medical care of infants began in 1982 with the "Baby Doe" regulations. These regulations created a standard of medical care for infants: the possibility of future handicaps in a child should play no role in his or her medical treatment decisions.

The "Baby Doe" Rules

In April 1982 an infant with Down syndrome was born at Bloomington Hospital in Indiana. The infant also had esophageal atresia, an obstruction in the esophagus that prevents the passage of food from the mouth to the stomach. Following their obstetrician's recommendation, the parents decided to forego surgery to repair the baby's esophagus. The baby would be kept pain-free with medication and allowed to die.

Disagreeing with the parents' decision, the hospital took them to the county court. The judge ruled that the parents had the legal right to their decision, which was based on a valid medical recommendation. The Indiana Supreme Court refused to hear the appeal. Before the county prosecutor could present the case to the U.S. Supreme Court, the six-day-old baby died.

TABLE 5.6 Percent of births with selected medical or health characteristics, by race, Hispanic origin, and birthplace of mother, 2003
TABLE 5.6
Percent of births with selected medical or health characteristics, by race, Hispanic origin, and birthplace of mother, 2003
Characteristic All originsa Origin of mother
Hispanic
Non-Hispanic
Total Mexican Puerto Rican Cuban Central and South American Other and unknown Hispanic
Totalb White Black
All births
Mother
    Prenatal care beginning in the first trimesterc 84.1 77.5 76.5 81.2 92.1 79.2 77.0 86.1 89.0 75.9
    Late or no prenatal carec 3.5 5.3 5.6 3.7 1.3 4.7 5.4 3.0 2.1 6.0
    Smokerc,d 10.7 2.7 2.0 7.9 2.4 1.1 6.6 12.6 14.3 8.3
    Drinkerc,e 0.7 0.4 0.4 0.6 0.3 0.3 0.9 0.8 0.9 0.8
    Weight gain of less than 16 lbsf 12.3 15.2 16.9 12.8 7.8 12.3 13.2 11.6 10.2 17.7
    Median weight gainf 30.5 28.7 27.3 30.7 31.9 30.1 30.3 30.7 31.0 29.8
    Cesarean delivery rate 27.5 26.5 25.8 27.6 39.8 28.4 25.9 27.8 27.6 29.2
Infant
    Preterm birthsg 12.3 11.9 11.7 13.8 11.8 11.4 12.6 12.5 11.3 17.8
    Birthweight
        Very low birthweighth 1.4 1.2 1.1 2.0 1.4 1.2 1.3 1.5 1.2 3.1
        Low birthweighti 7.9 6.7 6.3 10.0 7.0 6.7 8.0 8.3 7.0 13.6
        4,000 grams or morej 8.9 8.2 8.5 6.2 8.3 8.0 7.0 9.0 10.4 4.8
    5-minute Apgar score of less than 7k,i 1.4 1.1 1.1 1.5 0.8 0.9 1.2 1.5 1.3 2.3
Births to mothers born in the 50 states and District of Columbia
Mother
    Prenatal care beginning in the first trimesterc 85.7 80.8 80.6 80.7 91.5 84.2 77.8 86.3 89.1 75.9
    Late or no prenatal carec 3.0 4.1 4.1 3.9 1.4 3.1 5.2 2.9 2.1 5.8
    Smokerc,d 13.1 5.8 4.7 9.1 3.5 3.5 8.7 13.8 14.9 9.3
    Drinkerc,e 0.9 0.8 0.8 0.6 0.5 0.5 1.1 0.9 0.9 0.8
    Weight gain of less than 16 lbsf 11.9 13.6 14.7 12.2 7.9 9.0 13.1 11.7 10.2 18.0
    Median weight gainf 30.7 30.3 30.1 30.8 32.6 31.0 30.5 30.8 31.0 30.0
    Cesarean delivery rate 27.7 26.8 26.6 27.0 35.8 26.8 25.6 27.8 27.7 28.9
Infant
    Preterm birthsg 12.7 13.0 13.0 13.6 12.4 11.6 13.3 12.7 11.4 18.3
    Birthweight
        Very low birthweighth 1.5 1.4 1.3 2.0 1.7 1.6 1.3 1.5 1.2 3.2
        Low birthweighti 8.3 7.8 7.4 10.0 7.8 7.6 8.7 8.4 7.1 14.0
        4,000 grams or morej 9.1 7.3 7.6 6.3 7.3 7.4 6.8 9.3 10.4 4.4
    5-minute Apgar score of less than 7k,l 1.5 1.2 1.2 1.4 0.9 1.0 1.2 1.5 1.3 2.4
Births to mothers born outside the 50 states and District of Columbia
Mother
    Prenatal care beginning in the first trimesterc 79.1 75.6 74.1 82.3 92.6 78.5 75.2 84.5 86.9 76.5
    Late or no prenatal carec 5.1 5.9 6.5 3.4 1.1 4.9 5.8 3.8 3.1 6.9
    Smokerc,d 1.5 0.9 0.5 5.7 1.5 0.8 1.5 2.4 4.5 1.0
    Drinkerc,e 0.3 0.2 0.2 0.4 * 0.3 0.3 0.5 0.8 0.2
    Weight gain of less than 16 lbsf 13.8 16.2 18.2 13.9 7.7 12.7 13.3 10.7 9.0 15.9
    Median weight gainf 28.9 27.3 25.9 30.3 31.0 29.8 29.8 30.3 30.7 28.5
    Cesarean delivery rate 26.9 26.4 25.3 28.9 43.3 28.6 26.8 27.6 26.0 31.7

The public outcry following the death of "Baby Doe" (the infant's court-designated name) brought immediate reaction from President Ronald Reagan's administration. The Department of Health and Human Services (HHS) informed all hospitals receiving federal funding that discrimination against handicapped newborns would violate Section 504 of the Rehabilitation Act of 1973 (PL 93-112). This section (nondiscrimination under federal grants and programs) states:

No otherwise qualified individual with a disability in the United States … shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.

Furthermore, all hospital delivery rooms and nurseries were ordered to have posters warning that "DISCRIMINATORY FAILURE TO FEED AND CARE FOR HANDICAPPED INFANTS IN THIS FACILITY IS PROHIBITED BY FEDERAL LAW." The posters listed a toll-free hotline for anonymous reports of failure to comply.

Although government investigators (called "Baby Doe" squads) were summoned to many hospitals to verify claims of mistreatment (the hotline had five hundred calls in its first three weeks alone), no violation of the law could be found. On the contrary, the investigators found doctors resuscitating babies who were beyond treatment because they feared legal actions. Finally, a group led by the American Academy of Pediatrics filed

TABLE 5.6 Percent of births with selected medical or health characteristics, by race, Hispanic origin, and birthplace of mother, 2003 [CONTINUED] Joyce A. Martin, et al., "Table 25. Percentage of Births with Selected Medical or Health Characteristics, by Hispanic Origin of Mother and by Race for Mothers of Non-Hispanic Origin and by Place of Birth of Mother: United States, 2003," in "Births: Final Data for 2003," National Vital Statistics Reports, vol. 54, no. 2, September 8, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf (accessed November 2, 2005)

TABLE 5.6
Percent of births with selected medical or health characteristics, by race, Hispanic origin, and birthplace of mother, 2003 [CONTINUED]
Characteristic All originsa Origin of mother
Hispanic Non-Hispanic
Total Mexican Puerto Rican Cuban Central and South American Other and unknown Hispanic
Totalb White Black
*Figure does not meet standards of reliability or precision; based on fewer than 20 births in the numerator.
aIncludes origin not stated.
bIncludes races other thn white and black
cExcludes data for Pennsylvania and Washington, which implemented the 2003 Revision to the U.S. Standard Certificate of Liver Birth for data year 2003. This change has resulted in a lack of comparability between data based on the 2003 Revision and data based on the 1989 Revision to the U.S. Certificate. of Live Birth.
dExcludes data for California, which did not report tobacco use on the birth certificate.
eExcludes data for California, which did not report alcohol use on the birth certificate.
fExcludes data for California, which did not report weight gain on the birth certificate. Median weight gain shown in pounds.
gBorn prior to 37 completed weeks of gestation.
hBirthweight of less than 1,500 grams (3 lb 4 oz).
iBirthweight of less than 2,500 grams (5 lb 8 oz).
jEquivalent to 8 lb 14 oz.
kThe Apgar score is one measure of a newborn's health immediately after birth. The best possible score is 10.
lExcludes data for California and Texas, which did not report 5-minute Apgar score on the birth certificate.
Notes: Race and Hispanic origin are reported separately on birth certificates. Race categories are consistent with the 1977 Office of Management and Budget standards. Persons of Hispanic origin may be of any race. In this table Hispanic women are classified only by place of origin; non-Hispanic women are classified by race.
SOURCE: Joyce A. Martin, et al., "Table 25. Percentage of Births with Selected Medical or Health Characteristics, by Hispanic Origin of Mother and by Race for Mothers of Non-Hispanic Origin and by Place of Birth of Mother: United States, 2003," in "Births: Final Data for 2003," National Vital Statistics Reports, vol. 54, no. 2, September 8, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf (accessed November 2, 2005)
Infant
    Preterm birthsg 11.0 11.2 11.0 14.2 11.3 11.4 10.5 10.7 9.5 14.2
    Birthweight
        Very low birthweighth 1.1 1.0 0.9 2.0 1.1 1.1 0.9 1.3 1.0 2.6
        Low birthweighti 6.6 6.0 5.7 10.0 6.3 6.6 5.9 7.5 6.2 10.0
        4,000 grams or morej 8.2 8.7 9.0 6.1 9.2 8.1 7.4 7.4 10.4 7.7
    5-minute Apgar score of less than 7k,l 1.1 1.0 1.1 1.6 0.8 0.9 1.0 1.2 0.9 1.9

suit in March 1983 to have the Baby Doe rules overturned because they believed them to be harsh, unreasonably intrusive, and not necessarily in the best interests of the child. After various legal battles, in 1986 the U.S. Supreme Court ruled that the HHS did not have the authority to require such regulations and invalidated them.

Child Abuse Amendments of 1984 and Their Legacy

As the Baby Doe regulations were being fought in the courts, Congress enacted and President Reagan signed the Child Abuse Amendments of 1984 (PL 98-457; CAA). The CAA extended and improved the provissions of the Child Abuse Prevention and Treatment Act and the Child Abuse Prevention and Treatment and Adoption Reform Act of 1978. The CAA established that states' child protection services systems would respond to complaints of medical neglect of children, including instances of withholding medically indicated treatment from disabled infants with life-threatening conditions. It noted that parents were the ones to make medical decisions for their disabled infants based on the advice of their physicians. These laws have been amended many times over the years, most recently by the Keeping Children and Families Safe Act of 2003 (PL 108-36), without voiding the states' and parents' responsibilities to disabled infants.

Born-Alive Infants Protection Act of 2001

The Born-Alive Infants Protection Act of 2001 (PL 107-207) was signed by President George W. Bush on August 5, 2002. The purpose of the law is to ensure that all infants born alive, whether developmentally able to survive long-term, are given legal protection as persons under federal law. The law neither prohibits nor requires medical care for newly born infants who are below a certain weight or developmental age.

The American Academy of Pediatrics Neonatal Resuscitation Program (NRP) Steering Committee has responded that the law "should not in any way affect the approach that physicians currently follow with respect to the extremely premature infant…. At the time of delivery, and regardless of the circumstances of the delivery, the medical condition and prognosis of the newly born infant should be assessed. At that point decisions about withholding or discontinuing medical treatment that is considered futile may be considered by the medical care providers in conjunction with the parents acting in the best interest of their child. Those newly born infants who are deemed appropriate to not resuscitate or to have medical support withdrawn should be treated with dignity and respect, and provided with 'comfort care' measures" (David Boyle et al, "Born-Alive Infants Protection Act of 2001, Public Law No. 107-207," Pediatrics, vol. 111, 2003, http://pediatrics.aappublications.org/cgi/reprint/111/3/680-a).

TABLE 5.7 Number and percent of low birthweight and number of live births by selected characteristics, 2003

TABLE 5.7
Number and percent of low birthweight and number of live births by selected characteristics, 2003
Birthweightb
Age and race and Hispanic origin of mother Low birthweighta Total Less than 500 grams 500-999 grams 1,000-1,499 grams 1,500-1,999 grams 2,000-2,499 grams 2,500-2,999 grams 3,000-3,499 grams 3,500-3,999 grams 4,000-4,499 grams 4,500-4,999 grams 5,000 grams or more Not stated
Number Percent
All racesc
All ages 324,064 7.9 4,089,950 6,307 22,980 29,930 63,791 201,056 711,003 1,557,864 1,131,577 309,721 46,690 5,431 3,600
Under 15 years 848 12.7 6,661 32 85 87 149 495 1,698 2,694 1,220 179 14 1 7
   15-19 years 40,211 9.7 414,580 804 3,152 3,637 7,462 25,156 92,531 169,390 91,699 18,154 2,014 178 403
   15 years 2,103 11.5 18,238 50 191 210 412 1,240 4,423 7,548 3,524 553 59 2 26
   16 years 4,402 10.7 41,344 77 381 414 825 2,705 9,843 16,996 8,390 1,502 146 19 46
   17 years 7,549 10.1 74,802 161 622 670 1,383 4,713 16,990 30,720 16,087 3,053 295 32 76
   18 years 11,268 9.6 117,750 234 858 981 2,066 7,129 26,522 48,060 26,044 5,127 574 43 112
   19 years 14,889 9.2 162,446 282 1,100 1,362 2,776 9,369 34,753 66,066 37,654 7,919 940 82 143
20-24 years 82,494 8.0 1,032,305 1,604 5,732 7,084 15,167 52,907 199,835 412,228 264,313 63,142 8,526 878 889
25-29 years 76,631 7.1 1,086,366 1,522 5,399 6,943 14,862 47,905 178,150 415,463 314,316 86,511 12,886 1,477 932
30-34 years 71,477 7.3 975,546 1,454 4,944 6,822 14,636 43,621 148,022 357,144 293,569 88,696 14,155 1,701 782
35-39 years 40,550 8.7 467 642 685 2,863 4,059 8,797 24,146 72,708 164,600 137,185 43,764 7,397 991 447
40-44 years 10,655 10.6 101,005 194 730 1,151 2,403 6,177 16,858 34,639 27,995 8,908 1,626 198 126
45-54 years 1,198 20.5 5,845 12 75 147 315 649 1,201 1,706 1,280 367 72 7 14
White totald
All ages 223,612 6.9 3,225,848 3,593 14,096 20,173 44,419 141,331 511,317 1,220,632 951,782 270,180 41,156 4,664 2,505
Under 15 years 378 10.3 3,677 8 41 42 68 219 838 1,573 752 124 10 1 1
15-19 years 24,774 8.3 298,347 409 1,771 2,193 4,604 15,797 61,144 123,409 72,095 14,884 1,666 138 237
   15 years 1,107 9.6 11,484 26 93 107 221 660 2,503 4,899 2,522 396 45 2 10
   16 years 2,536 9.0 28,151 30 199 247 482 1,578 6,120 11,844 6,301 1,197 119 12 22
   17 years 4,669 8.8 52,941 78 357 418 849 2,967 11,026 21,981 12,452 2,487 249 27 50
   18 years 7,054 8.2 85,734 127 496 596 1,281 4,554 17,756 35,474 20,627 4,246 467 33 77
   19 years 9,408 7.8 120,037 148 626 825 1,771 6,038 23,739 49,211 30,193 6,558 786 64 78
20-24 years 53,600 6.8 790,910 824 3,323 4,447 9,751 35,255 140,299 316,971 217,687 53,701 7,340 717 595
25-29 years 54,143 6.2 871,496 901 3,401 4,750 10,617 34,474 130,541 330,559 267,011 75,912 11,397 1,267 666
30-34 years 52,407 6.6 795,902 882 3,209 4,927 10,888 32,501 110,515 287,041 252,401 78,817 12,650 1,503 568
35-39 years 29,593 7.8 379,773 435 1,791 2,878 6,520 17,969 54,448 132,207 117,123 38,636 6,593 854 319
40-44 years 7,751 9.6 81,031 125 500 824 1,718 4,584 12,592 27,513 23,658 7,799 1,436 177 105
45-54 years 966 20.6 4,712 9 60 112 253 532 940 1,359 1,055 307 64 7 14
Non-Hispanic white
All-ages 163,331 7.0 2,321,904 2,529 9,998 14,882 32,915 103,007 356,232 858,305 700,819 206,407 31,570 3,415 1,825
Under-15 years 144 10.3 1,399 3 19 18 30 74 309 551 323 67 5 0 0
15-19 years 14,904 8.6 172,620 258 1,122 1,369 2,811 9,344 33,960 69,160 43,514 9,726 1,120 75 161
   15 years 525 10.8 4,878 10 46 53 113 303 994 1,973 1,152 208 21 0 5
   16 years 1,266 9.5 13,375 16 111 119 232 788 2,703 5,432 3,208 684 68 4 10
   17 years 2,666 9.3 28,550 49 218 253 509 1,637 5,654 11,474 6,991 1,556 159 16 34
   18 years 4,316 8.6 50,484 88 321 380 789 2,738 10,061 20,199 12,708 2,795 323 21 61
   19 years 6,131 8.1 75,333 95 426 564 1,168 3,878 14,548 30,082 19,455 4,483 549 34 51
20-24 years 36,764 7.0 522,275 571 2,273 3,141 6,777 24,002 91,307 204,117 146,151 37,745 5,273 497 421
25-29 years 39,730 6.3 627,437 615 2,438 3,503 7,900 25,274 92,116 233,898 194,930 56,873 8,508 904 478
30-34 years 41,263 6.6 626,315 661 2,383 3,849 8,613 25,757 85,088 223,247 201,188 63,791 10,175 1,132 431
35-39 years 23,634 7.8 303,354 319 1,334 2,282 5,231 14,468 42,777 104,440 94,704 31,608 5,284 665 242
40-44 years 6,083 9.4 64,600 95 380 628 1,340 3,640 9,895 21,760 19,149 6,344 1,152 137 80
45-54 years 809 20.8 3,904 7 49 92 213 448 780 1,132 860 253 53 5 12

TABLE 5.7 Number and percent of low birthweight and number of live births by selected characteristics, 2003 [CONTINUED]

TABLE 5.7
Number and percent of low birthweight and number of live births by selected characteristics, 2003 [CONTINUED]
Birthweightb
Age and race and Hispanic origin of mother Low birthweighta Total Less than 500 grams 500-999 grams 1,000-1,499 grams 1,500-1,999 grams 2,000-2,499 grams 2,500-2,999 grams 3,000-3,499 grams 3,500-3,999 grams 4,000-4,499 grams 4,500-4,999 grams 5,000 grams or more Not stated
Number Percent
Black totald
All ages 80,088 13.4 599,847 2,427 7,765 8,204 15,654 46,038 143,176 228,356 117,889 25,428 3,546 504 860
Under 15 years 437 16.1 2,726 20 42 41 76 258 807 1,016 416 41 3 0 6
15-19 years 14,092 14.0 100,951 359 1,281 1,328 2,620 8,504 27,963 39,811 16,167 2,493 246 33 146
   15 years 913 15.1 6,056 21 92 93 178 529 1,777 2,361 852 125 13 0 15
   16 years 1,686 14.5 11,654 41 172 154 312 1,007 3,374 4,565 1,739 243 20 6 21
   17 years 2,648 13.8 19,145 74 249 238 483 1,604 5,349 7,643 3,020 436 22 4 23
   18 years 3,861 13.9 27,817 100 329 348 729 2,355 7,808 10,877 4,474 678 81 8 30
   19 years 4,984 13.8 36,279 123 439 495 918 3,009 9,655 14,365 6,082 1,011 110 15 57
20-24 years 25,500 13.0 196,268 730 2,228 2,386 4,856 15,300 49,599 76,813 36,184 6,970 838 114 250
25-29 years 17,182 12.3 139,947 557 1,733 1,816 3,341 9,735 31,287 53,465 29,962 6,744 958 146 203
30-34 years 13,021 13.4 97,529 495 1,431 1,471 2,601 7,023 20,197 35,739 21,850 5,546 907 120 149
35-39 years 7,712 15.5 49,889 200 865 904 1,652 4,091 10,553 17,226 10,784 2,965 476 76 97
40-44 years 2,007 16.9 11,895 64 171 237 470 1,065 2,632 4,086 2,400 632 114 15 9
45-54 years 137 21.3 642 2 14 21 38 62 138 200 126 37 4 0 0
Non-Hispanic black
All ages 77,947 13.6 576,033 2,350 7,575 7,998 15,211 44,813 138,440 218,901 112,139 23,992 3,340 484 790
Under 15 years 423 16.0 2,642 20 40 40 75 248 784 986 402 38 3 0 6
15-19 years 13,738 14.1 97,509 342 1,250 1,296 2,562 8,288 27,154 38,392 15,462 2,364 229 32 138
   15 years 884 15.1 5,852 21 90 88 175 510 1,726 2,279 818 120 13 0 12
   16 years 1,637 14.6 11,247 37 165 151 307 977 3,277 4,396 1,660 234 17 6 20
   17 years 2,575 14.0 18,431 70 238 230 472 1,565 5,169 7,352 2,884 406 20 3 22
   18 years 3,779 14.1 26,915 98 323 343 710 2,305 7,601 10,502 4,282 639 76 8 28
   19 years 4,863 13.9 35,064 116 434 484 898 2,931 9,381 13,863 5,818 965 103 15 56
20-24 years 24,899 13.2 189,020 707 2,179 2,333 4,735 14,945 48,011 73,795 34,567 6,620 786 109 233
25-29 years 16,668 12.5 133,821 544 1,694 1,772 3,228 9,430 30,194 51,072 28,330 6,332 895 142 188
30-34 years 12,667 13.6 93,346 480 1,396 1,432 2,523 6,836 19,462 34,164 20,738 5,202 865 112 136
35-39 years 7,484 15.7 47,661 195 837 872 1,606 3,974 10,166 16,383 10,230 2,798 446 74 80
40-44 years 1,933 16.9 11,419 60 165 232 445 1,031 2,532 3,923 2,290 605 112 15 9
45-54 years 135 22.0 615 2 14 21 37 61 137 186 120 33 4 0 0

TABLE 5.7 Number and percent of low birthweight and number of live births by selected characteristics, 2003 [CONTINUED] Joyce A. Martin, et al., "Table 45. Number and Percentage Low Birthweight and Number of Live Births by Birthweight, by Age and Race and Hispanic Origin of Mother: United States, 2003," in "Births: Final Data for 2003," National Vital Statistics Reports, vol. 54, no. 2, September 8, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf (accessed November 2, 2005)

TABLE 5.7
Number and percent of low birthweight and number of live births by selected characteristics, 2003 [CONTINUED]
Age and race and Hispanic origin of mother Low birthweighta Birthweightb
Total Less than 500 grams 500-999 grams 1,000-1,499 grams 1,500-1,999 grams 2,000-2,499 grams 2,500-2,999 grams 3,000-3,499 grams 3,500-3,999 grams 4,000-4,499 grams 4,500-4,999 grams 5,000grams or more Not stated
Number Percent
aLess than 2,500 grams (5 lb 8 oz).
bLess than 500 grams=1 lb 1 oz or less 3,000-3,499 grams=6 lb 10 oz-7 lb 11 oz
500-999 grams=1 lb 2 oz-2 lb 3 oz 3,500-3,999 grams=7 lb 12 oz-8 lb 13 oz
1,000-1,499 grams=2 lb 4 oz-3 lb 4 oz 4,000-4,499 grams=8 lb 14 oz-9 lb 14 oz
1,500-1,999 grams=3 lb 5 oz-4 lb 6 oz 4,500-4,999 grams=9 lb 15 oz-11 lb 0 oz
2,000-2,499 grams=4 lb 7 oz-5 lb 8 oz 5,000 grams or more=11 lb 1 oz or more
2,500-2,999 grams=5 lb 9 oz-6 lb 9 oz.
cIncludes races other than white and black and origin not stated.
dRace and Hispanic origin are reported separately on the birth certificate. Race categories are consistent with the 1977 Office of Management and Budget standards. Data for persons of Hispanic origin are included in the date for each group according to the mother's reported race.
eIncludes all persons of Hispanic origin of any race
SOURCE: Joyce A. Martin, et al., "Table 45. Number and Percentage Low Birthweight and Number of Live Births by Birthweight, by Age and Race and Hispanic Origin of Mother: United States, 2003," in "Births: Final Data for 2003," National Vital Statistics Reports, vol. 54, no. 2, September 8, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf (accessed November 2, 2005)
Hispanice
All ages 60,973 6.7 912,329 1,037 4,140 5,366 11,655 38,775 157,583 366,508 252,230 63,688 9,619 1,246 482
Under 15 years 244 10.4 2,356 5 24 24 36 155 556 1,045 444 61 5 0 1
15-19 years 10,120 7.9 128,524 160 669 853 1,834 6,604 27,891 55,455 29,109 5,255 565 60 69
   15 years 610 9.0 6,818 16 50 60 110 374 1,552 3,021 1,409 194 25 2 5
   16 years 1,303 8.6 15,151 15 91 129 256 812 3,520 6,566 3,163 524 57 8 10
   17 years 2,054 8.2 24,986 28 147 171 348 1,360 5,533 10,756 5,573 952 93 11 14
   18 years 2,791 7.8 35,927 40 174 226 503 1,848 7,866 15,574 8,050 1,472 146 12 16
   19 years 3,362 7.4 45,642 61 207 267 617 2,210 9,420 19,538 10,914 2,113 244 27 24
20-24 years 17,173 6.3 273,311 254 1,075 1,339 3,052 11,453 50,176 114,882 72,521 16,079 2,105 225 150
25-29 years 14,624 5.9 246,361 274 975 1,266 2,780 9,329 38,964 97,748 72,557 19,065 2,921 364 118
30-34 years 11,122 6.6 169,054 209 813 1,075 2,277 6,748 25,497 63,815 50,866 14,839 2,460 370 85
35-39 years 5,914 7.8 75,801 104 455 601 1,272 3,482 11,665 27,649 22,118 6,939 1,281 190 45
40-44 years 1,641 10.2 16,172 29 119 190 374 929 2,692 5,689 4,432 1,399 272 35 12
45-54 years 135 18.0 750 2 10 18 30 75 142 225 183 51 10 2 2

TABLE 5.8 Low-birth-weight live births, by mother's race, Hispanic origin, and smoking status, selected years 1970–2003 "Table 13. Low-Birthweight Live Births, according to Mother's Detailed Race, Hispanic Origin, and Smoking Status: United States, Selected Years 1970–2003," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed February 27, 2006)

TABLE 5.8
Low-birth-weight live births, by mother's race, Hispanic origin, and smoking status, selected years 1970–2003
[Data are based on birth certificates]
Birth-weight, race, Hispanic origin of mother, and smoking status of mother 1970 1975 1980 1985 1990 1995 1998 1999 2000 2001 2002 2003
aExcludes live births with unknown birthweight. Percent based on live births with known birthweight.
bFor 2003, data are not shown for Asian or Pacific Islander subgroups during the transition from single race to multiple race reporting.
cPrior to 1993, data from states lacking an Hispanic-origin item on the birth certificate were excluded. Data for non-Hispanic white and non-Hispanic black women for years prior to 1989 are not nationally representative and are provided for comparison with Hispanic data.
dPercent based on live births with known smoking status of mother and known birthweight. Data from states that did not require the reporting of mother's tobacco use during pregnancy on the birth certificate are not included. Reporting area for tobacco use increased from 43 states and the District of Columbia (DC) in 1989 to 49 states and DC in 2000–02. In 2003 California did not require reporting of tobacco use during pregnancy. Data for 2003 also exclude Pennsylvania and Washington that implemented the 2003 revision to the U.S. Standard Certificate of Live Birth. Tobacco use data based on the 2003 revision are not comparable with data based on the 1989 revision to the U.S. Standard Certificate of Live Birth.
Notes: "—"= Data not available. The race groups, white, black, American Indian or Alaska Native, and Asian or Pacific Islander, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Interpretation of trend data should take into consideration expansion of reporting areas and immigration.
SOURCE: "Table 13. Low-Birthweight Live Births, according to Mother's Detailed Race, Hispanic Origin, and Smoking Status: United States, Selected Years 1970–2003," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed February 27, 2006)
Low birth-weight (less than 2,500 grams) Percent of live birthsa
All races 7.93 7.38 6.84 6.75 6.97 7.32 7.57 7.62 7.57 7.68 7.82 7.93
White 6.85 6.27 5.72 5.65 5.70 6.22 6.52 6.57 6.55 6.68 6.80 6.94
Black or African American 13.90 13.19 12.69 12.65 13.25 13.13 13.05 13.11 12.99 12.95 13.29 13.37
American Indian or Alaska Native 7.97 6.41 6.44 5.86 6.11 6.61 6.81 7.15 6.76 7.33 7.23 7.37
Asian or Pacific Islanderb — — 6.68 6.16 6.45 6.90 7.42 7.45 7.31 7.51 7.78 7.78
    Chinese 6.67 5.29 5.21 4.98 4.69 5.29 5.34 5.19 5.10 5.33 5.52 —
    Japanese 9.03 7.47 6.60 6.21 6.16 7.26 7.50 7.95 7.14 7.28 7.57 —
    Filipino 10.02 8.08 7.40 6.95 7.30 7.83 8.23 8.30 8.46 8.66 8.61 —
    Hawaiian — — 7.23 6.49 7.24 6.84 7.15 7.69 6.76 7.91 8.14 —
    Other Asian or Pacific Islander — — 6.83 6.19 6.65 7.05 7.76 7.76 7.67 7.76 8.16 ?a
Hispanic or Latinoc — — 6.12 6.16 6.06 6.29 6.44 6.38 6.41 6.47 6.55 6.69
    Mexican — — 5.62 5.77 5.55 5.81 5.97 5.94 6.01 6.08 6.16 6.28
    Puerto Rican — — 8.95 8.69 8.99 9.41 9.68 9.30 9.30 9.34 9.68 10.01
    Cuban — — 5.62 6.02 5.67 6.50 6.50 6.80 6.49 6.49 6.50 7.04
    Central and South American — — 5.76 5.68 5.84 6.20 6.47 6.38 6.34 6.49 6.53 6.70
    Other and unknown Hispanic or Latino — — 6.96 6.83 6.87 7.55 7.59 7.63 7.84 7.96 7.87 8.01
Not Hispanic or Latino:c
    White — — 5.69 5.61 5.61 6.20 6.55 6.64 6.60 6.76 6.91 7.04
    Black or African American — — 12.71 12.62 13.32 13.21 13.17 13.23 13.13 13.07 13.39 13.55
Cigarette smokerd — — — — 11.25 12.18 12.01 12.06 11.88 11.90 12.15 12.40
Nonsmokerd — — — — 6.14 6.79 7.18 7.21 7.19 7.32 7.48 7.66
Very low birth-weight(less than 1,500 grams)
All races 1.17 1.16 1.15 1.21 1.27 1.35 1.45 1.45 1.43 1.44 1.46 1.45
White 0.95 0.92 0.90 0.94 0.95 1.06 1.15 1.15 1.14 1.16 1.17 1.17
Black or African American 2.40 2.40 2.48 2.71 2.92 2.97 3.08 3.14 3.07 3.04 3.13 3.07
American Indian or Alaska Native 0.98 0.95 0.92 1.01 1.01 1.10 1.24 1.26 1.16 1.26 1.28 1.30
Asian or Pacific Islanderb — — 0.92 0.85 0.87 0.91 1.10 1.08 1.05 1.03 1.12 1.09
    Chinese 0.80 0.52 0.66 0.57 0.51 0.67 0.75 0.68 0.77 0.69 0.74 —
    Japanese 1.48 0.89 0.94 0.84 0.73 0.87 0.84 0.86 0.75 0.71 0.97 —
    Filipino 1.08 0.93 0.99 0.86 1.05 1.13 1.35 1.41 1.38 1.23 1.31 —
    Hawaiian — — 1.05 1.03 0.97 0.94 1.53 1.41 1.39 1.50 1.55 —
    Other Asian or Pacific Islander — — 0.96 0.91 0.92 0.91 1.12 1.09 1.04 1.06 1.17 —
Hispanic or Latinoc — — 0.98 1.01 1.03 1.11 1.15 1.14 1.14 1.14 1.17 1.16
    Mexican — — 0.92 0.97 0.92 1.01 1.02 1.04 1.03 1.05 1.06 1.06
    Puerto Rican — — 1.29 1.30 1.62 1.79 1.86 1.86 1.93 1.85 1.96 2.01
    Cuban — — 1.02 1.18 1.20 1.19 1.33 1.49 1.21 1.27 1.15 1.37
    Central and South American — — 0.99 1.01 1.05 1.13 1.23 1.15 1.20 1.19 1.20 1.17
    Other and unknown Hispanic or Latino — — 1.01 0.96 1.09 1.28 1.38 1.32 1.42 1.27 1.44 1.28
Not Hispanic or Latino:c
    White — — 0.87 0.91 0.93 1.04 1.15 1.15 1.14 1.17 1.17 1.18
    Black or African American — — 2.47 2.67 2.93 2.98 3.11 3.18 3.10 3.08 3.15 3.12
Cigarette smokerd — — — — 1.73 1.85 1.87 1.91 1.91 1.88 1.88 1.92
Nonsmokerd — — — — 1.18 1.31 1.44 1.43 1.40 1.42 1.45 1.44

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