Infant mortality statistics do not adequately reflect the impact of short gestation

The use of World Health Organization (WHO) rules to determine cause of death may underestimate the role that premature birth plays in infant mortality. The US National Center for Health Statistics uses the WHO rules to prepare death certificates. The rules rank medical conditions present prior to death and assign a single underlying cause of death. A total of 335 infant death certificates were reviewed by a neonatologist panel and the Florida State Office of Vital Statistics (OVS), which uses the WHO rules. The neonatologists and the OVS generally agreed on the cause of death among 146 infants with birth weights of 1,500 to 4,649 grams. However, they only agreed on 41% of the death certificates among 189 infants with birth weights from 0 to 1,499 grams. The WHO rules need to be modified so that premature birth can be listed as the underlying cause of death rather than other medical conditions.