Premature birth and the changing composition of newborn infectious disease mortality: reconsidering "exogenous" mortality.

Linked death and birth records from San Antonio, Texas revealed that infectious infant mortality is increasingly a function of premature birth and low birth weight. Between 1935 and 1944, 4% of infectious infant deaths had associated causes involving prematurity and related conditions; by 1980, 25% of infectious infant deaths involved prematurity and more than 40% of those infants weighed less than 2,500 grams. The shift in birth-weight composition results almost entirely from an increase in very low-weight births. Under conditions of advanced perinatal technology, infectious infant mortality should no longer be viewed as wholly exogenous. These findings further undermine the contemporary relevance of the exogenous-endogenous distinction.