Herman A. Hein

The changing pattern of neonatal mortality in a regionalized system of perinatal care: A current update.

Objective. Our earlier studies about the changing pattern of neonatal mortality were based on data from 1978–1979 and 1982–1983. In this report, we provide a modern update of the causes of neonatal deaths to help focus prevention measures. Study Design. We reviewed neonatal deaths for the years 1995 and 1996 and assigned a clinical cause of death. Deaths were reviewed and analyzed by place of birth and death, according to level of care. We provided an estimate of the change in causes of death between 1982–1983 and 1995–1996 and calculated an idealized neonatal mortality rate for each level of care and for the entire state. Results. The major changes in causes of death occurred in the respiratory distress syndrome (RDS) and extremely low birth weight (ELBW) categories. RDS showed a substantial decline, but ELBW deaths increased by nearly the same amount that RDS declined. The idealized neonatal mortality rate calculations suggest that fewer potentially medically preventable deaths occur now than in 1982–1983. Currently, more neonatal deaths of level I births occur in level III facilities than in 1982–1983. However, at that time, Iowa had only one tertiary facility, and the level II regional hospitals were the site of more deaths. Conclusion. We believe that assigning deaths to a clinical category rather than to a catastrophic final event helps focus on sources of preventable death in the medical care system. To reduce neonatal mortality, the incidence of lethal congenital malformations and ELBW infants must be impacted.

An analysis of reasons for institutionalizing children with mongolism

A sample of 77 institutionalized children with mongolism and their families was studied to ascertain what factors were involved in the decision to place the child in an institution supposedly for medical care or educational training. Two children had medical reasons for hospitalization; 12 children were from communities where facilities for educational training were inadequate to meet their needs; the remaining 63 had been placed for various social reasons. In analyzing these social reasons, it became clear that the majority of parents acted because they were told, usually by a physician, that it would be undesirable to keep the child at home for reasons whose validity we doubt. Frequently the parents did not understand the problem of the childs capabilities, disorder, or the natural history of mongolism. We doubt that the majority of these children would need to have been institutionalized had more adequate counseling services been available to them when the problem first arose and during the critical early years when parents need it most.

Teenage Pregnancy and Educational Opportunity-Reply

In Reply. —I have read Dr Devitts letter and find little to refute. I disagree only on his assertion that I assumed all unplanned pregnancies were undesired. I stand unreproved about my remarks in the Commentary. I join with Devitt in urging the best possible general education for all young Americans.