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Postponing or Preventing Death? Trends in Infant Survival

Bruno Dujardin, MD, MPH; Raphael Lagasse, MD, PhD; Paul Vandenbussche, BS, MPH; Elisabeth Wollast, BS, DrPH
JAMA. 1986;256(9):1140. doi:10.1001/jama.1986.03380090068021.
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To the Editor.—  In a recent article, "Postponing or Preventing Death," Buehler et al1 examined trends in infant survival by birth-weight groups and studied the perinatal-related postneonatal deaths. They concluded that "advances in perinatal care have led to postponement rather than prevention of a few infant deaths, although overall many more deaths were prevented."In a correspondence about this article, Sepkowitz2 discusses the idea that recent declines in neonatal mortality in the United States could be largely attributed to a greater utilization of neonatal intensive care units among low-birth-weight infants.To explain his statement, Sepkowitz invokes different biases such as selection biases as possible factors leading to a distortion of neonatal mortality rates reported from neonatal intensive care units.However, we think that other biases could also explain an underestimation of the number of perinatal-related postneonatal deaths in Buehler's study. The problem concerns the cause of death ascertainment.


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