50 Years Ago in The Journal of Pediatrics:

Article Outline

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Baumgartner L, Jacobziner H, Pakter J. J Pediatr 1958;54:725-40

In 1938, a special program for the care of prematurely born infants was begun by the Department of Health in New York City. By 1958, there were 11 centers in operation with 263 beds to accommodate the 9% of infants born prematurely (14% to 15% in the non-white population). The cost to care for a premature infant (estimated at $26.00/day) was believed to “pose a financial strain on the hospital and family.” At the time, 42% of mothers received late or no prenatal care. Most premature infants (defined as weighing less than 2500 grams) weighed between 2001 and 2500 grams (67.7%), and only 14.9% weighed 1500 grams or less. The mortality rate for infants born in Premature Infant Centers was 92.4% for infants weighing less than 1000 grams and 44.7% for infants 1001 to 1500 grams. Survival rates for infants weighing 1001 grams and over were believed to be the best in the nation. The optimal opportunity for enhancing survival was thought to be for infants in the 1501 to 2500 gram weight group, where the most significant progress had been made. Follow-up of these infants after discharge from the hospital was provided by social service caseworkers and public health nurses.

In 2006, there were 2056 infants born in the five boroughs of New York weighing less than 1500 grams. These infants were cared for in 37 NICUs (with 700 beds) staffed by 150 neonatologists. New York State has regionalized neonatal intensive care services and most infants weighing less than 1500 grams are cared for by neonatologists who work in Level 3 or regional perinatal centers. In 2008, the mortality rates for all birth weight categories are much better than they were 50 years ago, but the news is not all positive. By 2004, the rate of prematurity had increased to 12.4% and was 17.8% in non-Hispanic African American mothers. The etiology of prematurity is only partially understood, and few interventions to prevent a premature birth are effective. Further expansion or better regionalization of neonatal intensive care facilities is unlikely to have a major impact on mortality, although prevention of premature birth offers the greatest opportunity to lower mortality rates and improve outcomes.