Download PDF
Am J Perinatol 2019; 36(12): 1278-1287
DOI: 10.1055/s-0038-1676631
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Updating a Perinatal Risk Scoring System to Predict Infant Mortality

Amna Umer
1   Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
,
Christa Lilly
2   Department of Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
,
Candice Hamilton
1   Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
,
Lesley Cottrell
1   Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
,
Timothy Lefeber
1   Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
,
Thomas Hulsey
3   Department of Epidemiology, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
,
Collin John
1   Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
› Author Affiliations Funding The West Virginia WATCH/Birth Score Program is funded under an agreement with the West Virginia Department of Health and Human Resources, Bureau for Public Health, Office of Maternal, Child, and Family Health.
Further Information

Publication History

20 July 2018

07 November 2018

Publication Date:
28 December 2018 (online)

    Permissions and Reprints

Abstract

Objective The Birth Score Project (Project WATCH) began in the rural state of West Virginia (WV) in the United States in 1984. The project is intended to identify newborns with a greater risk of infant mortality. The primary objective of this study was to update the current Birth Score based on current literature and rigorous statistical methodology.

Study Design The study merged data from the Birth Score, Birth Certificate (birth years 2008–2013), and Infant Mortality Data (N = 121,640). The merged data were randomly divided into developmental (N = 85,148) and validation (N = 36,492) datasets. Risk scoring system was developed using the weighted multivariate risk score functions and consisted of infant and maternal factors.

Results The updated score ranged from 0 to 86. Infants with a score of ≥17 were categorized into the high score group (n = 15,387; 18.1%). The odds of infant mortality were 5.6 times higher (95% confidence interval: 4.4, 7.1) among those who had a high score versus low score.

Conclusion The updated score is a better predictor of infant mortality than the current Birth Score. This score has practical relevance for physicians in WV to identify newborns at the greatest risk of infant mortality and refer the infants to primary pediatric services and case management for close follow-up.

Keywords

infants - infant mortality - birth score - West Virginia

Authors' Contributions

A. U. conceptualized and designed the study, performed the initial analyses, and drafted the initial manuscript. C. L. conceptualized and designed the study, designed the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. C. H. conceptualized and designed the study, drafted the historical significance of manuscript, and critically reviewed the manuscript. L. C., T. L., and T. H. conceptualized and designed the study and contributed to critical revision of the manuscript for important intellectual content. C. J. conceptualized and designed the study and drafted the introduction and the discussion sections of the manuscript. All authors read and approved the final version of the manuscript.


Note

The data supporting the current findings are not publicly available.


Supplementary Material

 

  • References

  • 1 Kochanek KD, Murphy SL, Xu J, Tejada-Vera B. Deaths: final data for 2014. Natl Vital Stat Rep 2016; 65 (04) 1-122
    Google Scholar
  • 2 MacDorman MF, Matthews TJ, Mohangoo AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe, 2010. Natl Vital Stat Rep 2014; 63 (05) 1-6
    PubMedGoogle Scholar
  • 3 Chen A, Oster E, Williams H. Why is infant mortality higher in the United States than in Europe?. Am Econ J Econ Policy 2016; 8 (02) 89-124
    CrossrefPubMedGoogle Scholar
  • 4 Matthews TJ, MacDorman MF, Thoma ME. Infant mortality statistics from the 2013 period linked birth/infant death data set. Natl Vital Stat Syst 2015; 64 (09) 1-30
    PubMedGoogle Scholar
  • 5 Myerberg DZ, Carpenter RG, Myerberg CF, Britton CM, Bailey CW, Fink BE. Reducing postneonatal mortality in West Virginia: a statewide intervention program targeting risk identified at and after birth. Am J Public Health 1995; 85 (05) 631-637
    CrossrefPubMedGoogle Scholar
  • 6 Carpenter RG, Gardner A, Jepson M. , et al. Prevention of unexpected infant death. Evaluation of the first seven years of the Sheffield Intervention Programme. Lancet 1983; 1 (8327): 723-727
    PubMedGoogle Scholar
  • 7 Positioning and SIDS. American Academy of Pediatrics AAP Task Force on infant positioning and SIDS: positioning and SIDS. Pediatrics 1992; 89 (6 Pt 1): 1120-1126
    PubMedGoogle Scholar
  • 8 Moon RY. ; Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 128 (05) e1341-e1367
    CrossrefPubMedGoogle Scholar
  • 9 Article 22B. Birth Score Program. Available at: https://www.wvdhhr.org/birthscore/ . Accessed December 12, 2018
    PubMedGoogle Scholar
  • 10 Mullett MD, Britton CM, John C, Hamilton CW. WV Birth Score: maternal smoking and drugs of abuse. W V Med J 2010; 106 (4 Spec No): 16-18
    PubMedGoogle Scholar
  • 11 National Center for Health Statistics. Infant Mortality Rates by State, 2014. Available at: https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm . Accessed December 12, 2018
    PubMedGoogle Scholar
  • 12 Baker M, Shanholtzer BA. West Virginia Bureau for Public Health News: infant mortality in West Virginia. W V Med J 2013; 109 (01) 39
    PubMedGoogle Scholar
  • 13 Thiese MS, Ronna B, Ott U. P value interpretations and considerations. J Thorac Dis 2016; 8 (09) E928-E931
    CrossrefPubMedGoogle Scholar
  • 14 Sullivan LM, Massaro JM, D'Agostino Sr RB. Presentation of multivariate data for clinical use: The Framingham Study risk score functions. Stat Med 2004; 23 (10) 1631-1660
    CrossrefPubMedGoogle Scholar
  • 15 Lane RH, Joss-Moore L, Bierer R, Moyer-Mileur LJ. Intrauterine nutrition and children's health. In: Landrigan PJ, Etzel RA. , eds. Textbook of Children's Environmental Health. New York, NY: Oxford University Press; 2013
    Google Scholar
  • 16 WHO. Preterm birth. Fact sheet. Available at: http://www.who.int/mediacentre/factsheets/fs363/en/ . Accessed December 19, 2016
    PubMedGoogle Scholar
  • 17 Breborowicz GH. Limits of fetal viability and its enhancement. Early Pregnancy 2001; 5 (01) 49-50
    PubMedGoogle Scholar
  • 18 Iliodromiti S, Mackay DF, Smith GC, Pell JP, Nelson SM. Apgar score and the risk of cause-specific infant mortality: a population-based cohort study. Lancet 2014; 384 (9956): 1749-1755
    CrossrefPubMedGoogle Scholar
  • 19 Li F, Wu T, Lei X, Zhang H, Mao M, Zhang J. The Apgar score and infant mortality. PLoS One 2013; 8 (07) e69072
    CrossrefPubMedGoogle Scholar
  • 20 Powers DA. Black-white differences in maternal age, maternal birth cohort, and period effects on infant mortality in the US (1983-2002). Soc Sci Res 2013; 42 (04) 1033-1045
    CrossrefPubMedGoogle Scholar
  • 21 Mathews TJ, MacDorman MF. Infant mortality statistics from the 2009 period linked birth/infant death data set. Natl Vital Stat Rep 2013; 61 (08) 1-27
    PubMedGoogle Scholar
  • 22 Kenny LC, Lavender T, McNamee R, O'Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS One 2013; 8 (02) e56583
    CrossrefPubMedGoogle Scholar
  • 23 Buekens P, Kotelchuck M, Blondel B, Kristensen FB, Chen JH, Masuy-Stroobant G. A comparison of prenatal care use in the United States and Europe. Am J Public Health 1993; 83 (01) 31-36
    CrossrefPubMedGoogle Scholar
  • 24 Carter EB, Tuuli MG, Caughey AB, Odibo AO, Macones GA, Cahill AG. Number of prenatal visits and pregnancy outcomes in low-risk women. J Perinatol 2016; 36 (03) 178-181
    CrossrefPubMedGoogle Scholar
  • 25 Santos HG, Andrade SM, Silva AM, Carvalho WO, Mesas AE. Risk factors for infant mortality in a municipality in southern Brazil: a comparison of two cohorts using hierarchical analysis. Cad Saude Publica 2012; 28 (10) 1915-1926
    CrossrefPubMedGoogle Scholar
  • 26 Chong DS, Yip PS, Karlberg J. Maternal smoking: an increasing unique risk factor for sudden infant death syndrome in Sweden. Acta Paediatr 2004; 93 (04) 471-478
    CrossrefPubMedGoogle Scholar
  • 27 Lloyd-Jones DM. Cardiovascular risk prediction: basic concepts, current status, and future directions. Circulation 2010; 121 (15) 1768-1777
    CrossrefPubMedGoogle Scholar
  • 28 McGorrian C, Yusuf S, Islam S. , et al; INTERHEART Investigators. Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score. Eur Heart J 2011; 32 (05) 581-589
    CrossrefPubMedGoogle Scholar