Deaths of newborn are divided in two categories: fetal deaths (stillbirths, fetuses weighing more than fourteen ounces and born dead), and neonatal deaths (infants born alive weighing more than fourteen ounces but dying within the first four weeks of life). The summation of the two is termed the perinatal death rate. This rate is expressed differently from the maternal death rate, which is per 10,000 live births; the perinatal rate is per 1000 live births.
The Decline in the Perinatal Rate
The perinatal death rate in the United States in 1935 was 68.2; in 1940, 51.4; and in 1959, 35.2. In other words, the rate has virtually been cut in half in twenty-five years. In 1959 there were 68,613 fetal deaths, and 80,778 live-born children died between birth and the end of the first month. More than half of these deaths occurred during the first twenty-four hours of life.
The Causes of Fetal Deaths
Until ten years ago syphilis was one of the primary causes: now it has almost been eliminated. The prominent causes still remaining are antepartum hemorrhage of the mother late in pregnancy; accidents to the navel cord such as prolapse, cord about the neck, and knots; maternal conditions such as toxemia and diabetes; and fetal conditions such as congenital malformations, birth injuries, and erythroblastosis.
The Causes of Neonatal Deaths
The chief cause of death within the first week of life is prematurity. Only an occasional baby survives who weighs less than 2 pounds, 3 ounces, at birth, and but 55 per cent of those between 2 pounds, 3 ounces, and 3 pounds, 4 ounces. Prematurity either causes or is an associated cause in 60 per cent of neonatal deaths. Other causes for neonatal death are imperfect expansion of the lungs, which interferes with breathing, and infections resulting in fatal pneumonia, sepsis, or diarrhea. Causes of fetal death may also be causes of neonatal death; the main ones are birth injuries, congenital malformations, erythroblastosis, maternal diabetes, and hemorrhage complications of the mother before delivery.
The 149,000 babies who died perinatally in 1959 would have populated a city, or, with the addition of unrecorded abortions, a metropolis. Totaling the perinatal death rate of 35 and the involuntary abortion rate of approximately 100, one derives a combined fetal wastage rate of 135 per 1000 live births. In other words, the average woman when she becomes pregnant has an 86-per-cent chance of bringing a baby home from the hospital, a 10- to-11-per-cent possibility of aborting, a 1- to-2-per-cent chance of having her baby born dead, and a 1- to-2-per-cent likelihood of its being born alive but not surviving the first month.