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.
Dujardin B, Lagasse R, Vandenbussche P, Wollast E. Postponing or Preventing Death? Trends in Infant Survival. JAMA. 1986;256(9):1140. doi:10.1001/jama.1986.03380090068021