ABSTRACT
The Born-Alive Infant Protection Act (BAIPA) of 2002 defined a live birth in the United
States without regard to gestation. The objective of this analysis was to determine
if a significant decline in the fetal death rate or an increase in the live born death
rate at previable gestational ages of 17 to 22 weeks has occurred. U.S. public use
fetal death files and linked birth and infant death files were obtained for the years
2000 to 2005 for gestations of 17 to 22 weeks. The fetal death rate declined from
53.8% in the 2000 to 2002 period to 52.6% for the period 2003 to 2005 and the live
birth mortality rate increased from 46.2 to 47.4% (p < 0.02). The average annual live birth death rate increased significantly only at
17 weeks gestation (p < 0.02). Although there was a small but statistically significant change in the fetal
and live birth death rates for infants considered to be previable for the period following
the passage of the BAIPA, the change appears to be isolated to only the most immature
at 17 weeks gestation.
KEYWORDS
Fetal mortality - infant mortality - previable infants - The Born-Alive Infant Protection
Act
REFERENCES
- 1
Department of Health and Human Services .
Discrimination against the handicapped by withholding treatment or nourishment, notice
to health care providers.
Fed Regist.
1982;
47
26027
and Fed Regist. 1983;48:9630
- 2
Department of Health and Human Services .
Child abuse and neglect prevention and treatment program—HHS. Final rule.
Fed Regist.
1985;
50
14878-14892
- 3
Stevenson D K, Ariagno R L, Kutner J S, Raffin T A, Young E WD.
The “Baby Doe” rule.
JAMA.
1986;
255
1909-1912
- 4
Annas G J.
Asking the courts to set the standard of emergency care—the case of Baby K.
N Engl J Med.
1994;
330
1542-1545
- 5
Fost N.
Decisions regarding treatment of seriously ill newborns.
JAMA.
1999;
281
2041-2043
- 6
Sayeed S A.
Baby Doe redux? The Department of Health and Human Services and the Born-Alive Infants
Protection Act of 2002: a cautionary note on normative neonatal practice.
Pediatrics.
2005;
116
e576-e585
- 7
Emergency Medical Treatment and Active Labor Act, P.L. 99272, 42 U.S.C. sec. 1395dd
(1985).
- 8
Pub L No. 107–207, 116 Stat 926 (2002).
- 9
Partridge J C, Sendowski M D, Drey E A, Martinez A M.
Resuscitation of likely nonviable newborns: would neonatology practices in California
change if the Born-Alive Infants Protection Act were enforced?.
Pediatrics.
2009;
123
1088-1094
- 10
Boyle D, Carlo W A, Goldsmith J American Academy of Pediatrics Neonatal Resuscitation
Program Steering Committee et al.
Born-Alive Infants Protection Act of 2001, Public Law No. 107-207.
Pediatrics.
2003;
111
680-681
- 11 National Center for Health Statistics .United States Fetal Death Files and United
States Linked Birth/Infant Death Period Public Use Files. Years 2000, 2001, 2002,
2003,2004, and 2005. Hyattsville, MD: U.S. Public Health Service, issued annually. Available
online at: http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm Accessed July 9, 2010
- 12 National Center for Health Statistics .Vital Statistics of the United States, 2003:
Technical Appendix, Natality. Hyattsville, MD: National Center for Health Statistics;
2005: 26-27
- 13 National Center for Health Statistics .Instruction Manual Part 12: Computer Edits
for Natality Data, Effective 1993: Vital Statistics, Data Preparation. Hyattsville,
MD: National Center for Health Statistics; 1995: 33-35
- 14 Kattwinkel J. Textbook of Neonatal Resuscitation. 4th ed. Elk grove Village, IL:
American Academy of Pediatrics/American Heart Association; 2000
- 15
MacDonald H. American Academy of Pediatrics. Committee on Fetus and Newborn .
Perinatal care at the threshold of viability.
Pediatrics.
2002;
110
1024-1027
- 16
Peerzada J M, Richardson D K, Burns J P.
Delivery room decision-making at the threshold of viability.
J Pediatr.
2004;
145
492-498
- 17
Batton D G. Committee on Fetus and Newborn .
Clinical report—antenatal counseling regarding resuscitation at an extremely low gestational
age.
Pediatrics.
2009;
124
422-427
- 18
Lucey J F, Rowan C A, Shiono P et al..
Fetal infants: the fate of 4172 infants with birth weights of 401 to 500 grams—the
Vermont Oxford Network experience (1996–2000).
Pediatrics.
2004;
113
1559-1566
- 19
Itabashi K, Horiuchi T, Kusuda S et al..
Mortality rates for extremely low birth weight infants born in Japan in 2005.
Pediatrics.
2009;
123
445-450
- 20
Parikh N A, Arnold C, Langer J, Tyson J E.
Evidence-based treatment decisions for extremely preterm newborns.
Pediatrics.
2010;
125
813-816
- 21
McCullough L B.
Neonatal ethics at the limits of viability.
Pediatrics.
2005;
116
1019-1021
- 22
MacDorman M F, Kirmeyer S.
Fetal and perinatal mortality, United States, 2005.
Natl Vital Stat Rep.
2009;
57
1-19
- 23
Martin J A, Hoyert D L.
The national fetal death file.
Semin Perinatol.
2002;
26
3-11
- 24 Model State Vital Statistics Act and Regulations, 1992 Revision, DHHS Publication
No (PHS) 94–115, 1995.
- 25
Malloy M H.
Impact of cesarean section on neonatal mortality rates among very preterm infants
in the United States, 2000-2003.
Pediatrics.
2008;
122
285-292
- 26
Alexander G R, Himes J H, Kaufman R B, Mor J, Kogan M.
A United States national reference for fetal growth.
Obstet Gynecol.
1996;
87
163-168
Michael H MalloyM.D. M.S.
Professor, Department of Pediatrics, The University of Texas Medical Branch
301 University Blvd., Galveston, TX 77555-0354
Email: mmalloy@utmb.edu