Seriously Ill Children - Infant Mortality

Since 1960 the infant mortality rate in the United States has declined 74 percent—from 26 deaths per 1,000 live births in 1960 to 6.8 deaths per 1,000 live births in 2001. (Table 5.1 shows the decline from 1983 to 2001, while Table 5.2 shows figures for 2001 and preliminary figures for 2002.) Advances in neonatology (the medical subspecialty concerned with the care of newborns, especially those at risk), which date back to the 1960s, have contributed to the huge drop in infant death rates. Infants born prematurely or with low birthweights, who were once likely to die, now can survive life-threatening conditions because of the development of neonatal intensive care units (NICUs). However, the improvements are not consistent for newborns of all races. Black infants are more than twice as likely as white and Hispanic infants to die before their first birthday. In 2001 the national death rate for black infants was 13.3 percent, compared with 5.7 percent for white infants and 5.4 percent for Hispanic infants. (See Table 5.1.) In 2002 the national death rate for black infants was 14.3 percent, compared with 5.9 percent for non-Hispanic white infants and 5.6 percent for Hispanic infants. (See Table 5.2.) Additionally, the life expectancy at birth of black babies is less than that of white babies. Black babies born in 2002 had a life expectancy of 72.5 years, while white babies born that same year had a life expectancy of 77.8 years. (See Table 5.3.)

As neonatology has progressed, it has enabled physicians to aggressively treat more babies and those at greater risk. Margot C. J. Mabie, in Bioethics and the New Medical Technology (New York: Atheneum, 1993), points out that neonatologists have taken on infants with serious abnormalities that in the past would have caused the infant to die, as well as full-term normal babies who were injured in the birth process. Although many infants have been saved, some survive with constant pain. Others require continuous medical care, which can exact heavy emotional and financial tolls on the family.

Leading Causes of Infant Mortality

Birth defects are the leading cause of infant mortality in the United States. Some of the more serious birth defects are anencephaly (when most of the brain and spinal cord is missing), spina bifida (when the spinal column doesn't close completely, leaving portions of the spinal cord exposed), and Down's syndrome (when babies are born with an extra copy of chromosome 21 in their cells). Each year approximately 150,000 babies are born with birth defects in the United States. Many of those who survive will suffer from lifelong disabilities.

In 2002 birth defects identified as "congenital malformations, deformations and chromosomal abnormalities" by the Tenth Revision, International Classification of Diseases 1992, accounted for 20 percent of all infant deaths (5,655 out of 27,974 birth defects of all causes). (See Table 5.4.)

TABLE 5.1
Infant, neonatal, and postneonatal mortality rates, by race and Hispanic origin of mother, 1993–2001
[Data are based on linked birth and death certificates for infants]

Race and Hispanic origin of mother	19831	19851	19901	19952	19982	19992	20002	20012
	Infant3 deaths per 1,000 live births
All mothers	10.9	10.4	8.9	7.6	7.2	7.0	6.9	6.8
White	9.3	8.9	7.3	6.3	6.0	5.8	5.7	5.7
Black or African American	19.2	18.6	16.9	14.6	13.8	14.0	13.5	13.3
American Indian or Alaska Native	15.2	13.1	13.1	9.0	9.3	9.3	8.3	9.7
Asian or Pacific Islander	8.3	7.8	6.6	5.3	5.5	4.8	4.9	4.7
Chinese	9.5	5.8	4.3	3.8	4.0	2.9	3.5	3.2
Japanese	*5.6	*6.0	*5.5	*5.3	*3.4	*3.5	*4.5	*4.0
Filipino	8.4	7.7	6.0	5.6	6.2	5.8	5.7	5.5
Hawaiian	11.2	*9.9	*8.0	*6.5	9.9	*7.0	9.0	*7.3
Other Asian or Pacific Islander	8.1	8.5	7.4	5.5	5.7	5.1	4.8	4.8
Hispanic or Latino4, 5	9.5	8.8	7.5	6.3	5.8	5.7	5.6	5.4
Mexican	9.1	8.5	7.2	6.0	5.6	5.5	5.4	5.2
Puerto Rican	12.9	11.2	9.9	8.9	7.8	8.3	8.2	8.5
Cuban	7.5	8.5	7.2	5.3	*3.7	4.6	4.6	4.2
Central and South American	8.5	8.0	6.8	5.5	5.3	4.7	4.6	5.0
Other and unknown Hispanic or Latino	10.6	9.5	8.0	7.4	6.5	7.2	6.9	6.0
Not Hispanic or Latino:
White5	9.2	8.6	7.2	6.3	6.0	5.8	5.7	5.7
Black or African American5	19.1	18.3	16.9	14.7	13.9	14.1	13.6	13.5
	Neonatal3 deaths per 1,000 live births
All mothers	7.1	6.8	5.7	4.9	4.8	4.7	4.6	4.5
White	6.1	5.8	4.6	4.1	4.0	3.9	3.8	3.8
Black or African American	12.5	12.3	11.1	9.6	9.4	9.5	9.1	8.9
American Indian or Alaska Native	7.5	6.1	6.1	4.0	5.0	5.0	4.4	4.2
Asian or Pacific Islander	5.2	4.8	3.9	3.4	3.9	3.2	3.4	3.1
Chinese	5.5	3.3	2.3	2.3	2.7	1.8	2.5	1.9
Japanese	*3.7	*3.1	*3.5	*3.3	*2.5	*2.8	*2.6	*2.5
Filipino	5.6	5.1	3.5	3.4	4.6	3.9	4.1	4.0
Hawaiian	*7.0	*5.7	*4.3	*4.0	*7.2	*4.9	*6.2	*3.6
Other Asian or Pacific Islander	5.0	5.4	4.4	3.7	3.9	3.3	3.4	3.2
Hispanic or Latino4, 5	6.2	5.7	4.8	4.1	3.9	3.9	3.8	3.6
Mexican	5.9	5.4	4.5	3.9	3.7	3.7	3.6	3.5
Puerto Rican	8.7	7.6	6.9	6.1	5.2	5.9	5.8	6.0
Cuban	*5.0	6.2	5.3	*3.6	*2.7	*3.5	*3.2	*2.5
Central and South American	5.8	5.6	4.4	3.7	3.6	3.3	3.3	3.4
Other and unknown Hispanic or Latino	6.4	5.6	5.0	4.8	4.5	4.8	4.6	3.9
Not Hispanic or Latino:
White5	5.9	5.6	4.5	4.0	3.9	3.8	3.8	3.8
Black or African American5	12.0	11.9	11.0	9.6	9.4	9.6	9.2	9.0

Disorders related to short gestation (premature birth) and low birthweight accounted for the second leading cause of infant mortality (4,598 out of 27,974, or about 16 percent). Among black infants, such disorders were the leading cause of death (22 percent; 1,836 out of 8,380 birth defects of all causes). Other causes of infant deaths were Sudden Infant Death Syndrome (SIDS), maternal complications of pregnancy, and complications of the placenta, cord, and membranes. These five leading causes of infant mortality accounted for more than half (54 percent) of the total infant deaths in all races. (See Table 5.4.)