The application of a risk-approach model to reduce mortality in infancy

• Published in: The Journal of pediatrics 1998-05, Vol.132 (5), p.822-826
• Main Authors: Morgan, Lois A., Simons, C.J.R., Britton, Christine M., Johnson, Chet D.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Humans; Infant Mortality; Infant Welfare - classification; Infant, Newborn; Logistic Models; Medical sciences; Models, Statistical; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Specific populations (family, woman, child, elderly...)
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(98)70311-7

Objectives: To examine the utility of a risk-approach model in identifying infants at greater risk of postneonatal mortality (PNM) and to determine whether there is a relationship between PNM and linkage of at-risk infants to primary health care. Methods: The Sheffield Birth Score instrument was applied to 90,846 newborn infants to determine high-score (HS) and low-score (LS) infant risk groups. Health care visit data were collected on all HS infants who were referred for primary pediatric care. Mortality rates were calculated for both HS and LS infant groups and for HS infants who were linked and not linked to care. Results: The HS infant group was at significantly greater risk of PNM ( p < 0.0001). The linked group had a lower PNM rate ( p < 0.05), and linked/not-linked group differences were noted for 11 of 20 variables. When these 11 variables and the linked/not-linked variable were entered into a logistic regression analysis, linkage was the only significant variable ( p < 0.01) in predicting PNM. Conclusions: The Sheffield Birth Score differentiated at birth those infants who were at greater risk of PNM. The lower incidence of PNM among linked HS infants suggests a promising argument for early pediatric intervention. Further research to clarify specific factors that influence health care participation decisions is suggested. (J Pediatr 1998;132:822-6)