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601 STATE REPORTING OF LIVE NEWBORNS WEIGHING LESS THAN 500 GRAMS AT BIRTH

In 1981 there was large variation in state reported incidence of live births of newborns weighing less than 500 grams at birth (.3 to 2.4 per 1,000 live births). The states with the lowest neonatal mortality rate (NMR) have the lowest incidence of birth weights less than 500 grams (rho=.70). Assuming that mortality for this weight category is 100%, there is marked variation (5 to 24%) in the contribution of this weight cohort to a state's total NMR. Major deficiencies in reporting may exist. For example, Alaska, Arizona and North Dakota report no Native American live births with weights less than 500 grams. Reporting may also depend on the definition of live birth. The American Academy of Pediatrics and American College of Obstetricians and Gynecologists Guidelines for Perinatal Care uses the World Health Organization (WHO) definition of live birth as a baby with signs of life “irrespective of duration of pregnancy”. Standard obstetric and pediatric textbooks offer guidance on this issue varying from adherence to the WHO definition to describing a live birth as greater than 500 grams. Thirty-six states officially use the WHO definition of live birth and nine states have definitions without gestational criteria. Four states have no definition of live birth including Vermont which has the nation's lowest NMR. There is evidence to suggest inconsistency in reporting the births of previable newborns which potentially affects national neonatal mortality statistics.