U.S. babies not healthier, comparative study shows

Improved access to preconception, prenatal, and perinatal care appears to do more to improve health outcomes for babies than the availability of high-technology neonatal intensive care, according to a study published in June in Pediatrics, the journal of the American Academy of Pediatrics.1

Researchers in the Department of Pediatrics at the Center for the Evaluative Clinical Sciences and Department of Community and Family Medicine at Dartmouth Medical School in Hanover, NH, compared different indicators of reproductive health care and infant survival rates among four industrialized nations: the United States, Canada, Australia, and the United Kingdom.

They conclude that the United States has significantly greater neonatal intensive care resources per capita, compared with the other three countries, but does not have consistently better birth weight-specific mortality. The United States has low birth-weight rates that exceed other countries, and has proportionately more providers per low birth-weight infants, but offers less extensive preconception and prenatal services.

Unlike the other countries, the United States does not provide free family planning services or prenatal and perinatal physician care. And the United Kingdom and Australia also pay for all contraception.

The United States has high neonatal intensive care capacity, with an average 6.1 neonatalogists per 10,000 live births — Australia has 3.7; Canada 3.3; and the United Kingdom, 2.7. For intensive care beds, the United States has 3.3 beds per 10,000 live births; Australia and Canada, 2.6; and United Kingdom, 0.67.

But greater neonatal intensive care resources were not consistently associated with lower mortality.

"What the study demonstrates is that, even in areas with far fewer neonatalogists and neonatal intensive care units, the difference in mortality was not that significant — you can’t demonstrate that the different levels of resources made a difference," says David C. Goodman, MD, a co-author of the study and assistant professor of pediatrics at Dartmouth. "Of course, their low birth-weight rates are much lower, and therefore their overall birth cohort does better."

There has been a longstanding assertion that, even though the overall infant mortality rates in those countries are lower, babies born prematurely would do better in this country because we have more intensive care resources, he says. "But that was never looked at in any systematic way. Now, we see that just having more of us doesn’t lead to better outcomes."

Reference

1. Thompson LA, Goodman DC, Little GA. Is more neonatal intensive care always better? Insights from a cross-national comparison of reproductive care. Pediatrics 2002; 109:1,036-1,043.