The Definition of Life: The Impact of Physicians’ Reporting Practices on Neonatal Mortality Rate in New York City

Abstract

A factor often ignored in analyses of neonatal mortality rate is the reporting practices of hospitals. This study examined hospital reporting practices by comparing hospitals where the reporting requirement of New York City Department of Health was followed and all births were reported regardless of gestational age and hospitals where gestational age was taken into account in the reporting.In 2008, a survey was conducted among neonatologists in charge of neonatal intensive care units and obstetricians in charge of departments of obstetrics in New York City maternity hospitals. The survey collected information on hospitals' definitions of live birth and fetal death, their resuscitation practices for extremely premature infants, and their reporting practices for live births and infant deaths.Data from the 2008 survey and New York City's linked live birth/neonatal death data sets for 2007-2009 were used to examine the impact of hospitals' reporting practices on neonatal mortality rate. The neonatal mortality rate for hospitals where gestational age was taken into account was significantly lower than the hospitals where all live births were reported regardless of gestational age (2.68 versus 3.54, p=0.0033). Removal of infants born at less than 23 weeks gestation resulted in almost equal neonatal morality rates (2.53 versus 2.77, p=0.41).When the data was separated by race and insurance coverage, the difference in reporting practices resulted in significantly lower neonatal morality for births to white mothers (p=0.0032) and women covered by Medicaid (p=0.0005).