Evaluation of the Nottingham birth scoring system.

A case-control study of postneonatal deaths occurring in 1974-1976 in the City of Nottingham, England, revealed that most were attributable to respiratory infections and SIDS, and primarily occurred in wintertime, at home, in the less well-off parts of Nottingham. By means of a step-wise discriminant analysis, 9% of the infant population was identified as a high-risk group in whom 53% of postneonatal deaths could be expected to occur. From January 1, 1978, this group of infants was followed up more intensively by health visitors and general practitioners, who gave advice on the early recognition of respiratory symptoms. Although the postneonatal mortality rate fell from 6.5 per 1,000 live births in 1977 to 5.2 per 1,000 in 1983, it is not possible to show that the rate of improvement was any faster after the introduction of the system. The system was discontinued on March 31, 1985. Birth scoring systems are not recommended; instead, resources should be concentrated on general improvements in services and symptom recognition, and basic research into the causes of SIDS.