Postponing or Preventing Death? Trends in Infant Survival-Reply

In Reply.—  Dujardin et al are correct in noting the limitations of vital records in studying underlying causes of death (determined in Georgia by nosologists, who review all diagnoses listed on death certificates), and their letter raises several issues regarding the question of postponement vs prevention of infant deaths. It is certainly plausible that some infants with chronic illness developing in the perinatal period may succumb late in infancy to infections, sudden infant death syndrome, or other diseases. We attempted to address this question in part by examining underlying causes of death in conjunction with other conditions listed on death certificates; however, multiple diagnoses were available on Georgia's computer records for only the most recent years of our study period. More importantly, we wish to emphasize that the rate of infant death for all causes combined declined for all birth-weight groups. Thus, misclassification of causes of death could not explain