Analysis of causes of neonatal death in the United States with specific emphasis on fatal hyaline membrane disease.

National mortality statistics for hyaline membrane disease (HMD) and the respiratory distress syndrome (RDS) and other major causalities were examined in this study for the years 1968 to 1978. A progressive reduction in total neonatal deaths began in 1971 such that only 56% as many newborn deaths occurred in 1978 as in 1968 (31,618 vs 66,456). In each of the 11 years surveyed, the majority of deaths occurred during the first four days of life, with more than half of the infants dying before 48 hours of age. HMD/RDS was the leading cause of death during nine of the 11 years analyzed, accounting for an average 19.5% of neonatal fatalities. Deaths associated with HMD/RDS increased for 1968 to 1971 plateaved and progressively decreased in the ensuing years between 1974 and 1978. Thus, the percent of all neonatal deaths attributable to HMD/RDS increased from 14.7% in 1968 to a maximum of 21.3% in 1974, before declining to 17.5% in 1978. The average contribution of other major causes of death to overall neonatal mortality were: perinatal asphyxia, 13.4%; immaturity, 13.4%; and complications of pregnancy, 11.1%. These data indicate that: (1) despite the declining incidence of fatal HMD/RDS the disorder accounted for an increasing percent of total deaths through the later part of the 11-year period; (2) prevention and/or improved management of asphyxia made the most significant (29%) contribution to reduced neonatal mortality; (3) less change occurred in fatal complications of pregnancy, implying a continuing need for improved maternal/fetal care. Comparing national mortality statistics with those of Wisconsin suggests that further reduction in HMD/RDS death rates should be possible and could have a marked influence on national neonatal mortality statistics.