BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

'42 Patterns of Mortality inChildhood
girl result in a woman at maturity who has
a significantly elevated level of reproductive
risk. Her pregnancy is more frequently
disturbed and her child more often of low
birth weight. Such a child is at increased
risk of neurointegrative abnormality and
of deficient IQ and school achievement."
The data on birth weight collected in this
Investigation deserve careful study and
point to the need for additional research to
clarify the role of nutritional status of
mothers (and possibly other factors such as
ethnic group, altitude, and maternal infection)
on the weight of products of pregnancy.
The evaluation of nutritional status
of infants and children must begin with
their status at birth, and the most satisfactory
and essential measurement is birth
weight.
BACKGROUND
The Sixth Revision of the International
Classificationof Diseasesof WHO (1948-a),
in Section XV on Certain Diseases of Early
Infancy, gave the following definition: "For
the purpose of this Classification an iminature
infant is a livehorn infant with a birth
weight of 5/ pounds (2,500 grams) or less,
or specified as immature." In July 1948
the first World Health Assembly adopted
Regulations (WHO, 1948-1)) governing application
of the InternationialClassification
by WHO Member Countries. Thus a definition
of immaturity in terms of birth weight
was established which should automatically
be applied in countries using the Classification.
In this Investigation efforts were made
to obtain data on length of gestation for
each birth, but the data were not as complete
and reliable as those on birth weight
and thus the definition utilizing weight only
has been maintained, although the limitations
of defining immaturity on the basis of
birth weight alone are recognized.
In the United States, when the standard
birth certificate was revised in 1949, new
certificates that included an item for birth
weight were placed in use in many states.
One of the authors (Puffer) assisted in introducing
the- new certificate in tile btate
of Tennessee, and she placed emphasis on
the completion of the birth-weight item. It
was necessary not only to obtain the cooperation
of hospital staffs but also to furnish
scales to midwives for weighing the newborn.
In 1949 birth weights of 2,500 grams
or less were recorded for 7.6 per cent of
live births in Tennessee and for 62 per cent
of neonatal deaths. Neonatal death rates
were calculated according to birth-weight
group. In a paper on uses of statistics on
prematurity in Tennessee (Hutcheson and
Puffer, 1951), the statement was made:
"In the field of prematurity rapid strides
are being made in the development of coinparable
and useful data." Material that
served to show the nature and size of the
prematurity problem on the basis of birth
weight was used at a series of workshops
attended by health personnel in that state.
Data for the United States for three
months in 1950 were analyzed in depth by
Shapiro and Unger (1965) and Loeb (1965).
The National Center for Health Statistics
in its annual reports on natality gives the
distributions of births by birth weight.
Also, reports and analyses are available for