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November 15, 1985

Postponing or Preventing Deaths? Trends in Infant Survival

Author Affiliations

Oklahoma City

JAMA. 1985;254(19):2736-2737. doi:10.1001/jama.1985.03360190042009

To the Editor.—  Buehler et al1 in their article on infant survival in Georgia state that "recent declines in neonatal mortality in the United States have been largely attributed to lower mortality among low-birth-weight infants." Such is not the case in Georgia, based on the information supplied by the authors.Although neonatal mortality declined from 12 per 1,000 live births in 1974-1975 to 8.1 per 1,000 live births in 1980-1981, the percentage of low-birth-weight deaths remained the same (77.3% vs 77.5%). These similar proportions suggest diverse sources of causation for the decline or a generalized one operating in both weight groups; it argues against the greater utilization of neonatal intensive care units (NICUs) as a single cause of the decline in neonatal mortality.The interpretation of weight-specific neonatal mortality declines is a specious one. Demonstrating an increased utilization of NICU care over time hardly justifies the statement that improved