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Improving Health in the Community: A Role for Performance Monitoring
these diseases before and during pregnancy can reduce their negative effects. The adverse effect of some maternal infections (e.g., HIV, hepatitis B, group B streptococcus) occurs with their transmission to infants before or during birth. In some cases, treatment of the mother or early treatment of the infant can reduce these adverse effects.
When preterm delivery cannot be prevented, infants are at increased risk for a variety of conditions including respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. Improved treatment has increased survival, but treatment itself carries risks for conditions such as bronchopulmonary dysplasia and retinopathy of prematurity (Horbar and Lucey, 1995). Although proper management of these conditions in the appropriate intensive care nursery setting can improve outcomes, these infants are at greater risk than full-term, normal weight infants for neurologic and other impairments at later ages.
The most significant diseases after the first month of life are infections of various sorts. Appropriate immunization provides protection against conditions such as diphtheria, tetanus, pertussis, polio, hepatitis B, and Haemophilus influenzae type b disease. Effective therapies are available to treat many other infections such as otitis media, pneumonia, and gastroenteritis. Infants in group day care have a higher incidence of common respiratory and gastrointestinal infections compared with babies not in day care settings. The causes of SIDS are not fully understood, but evidence suggests that placing infants on their back or side to sleep, not on their stomach, may reduce its incidence (Willinger, 1995).
Indicators that might be considered include the following:
Number (or rate) of neonatal infant deaths.
Number (or rate) of postneonatal deaths.
Infant deaths are widely used as an indicator of infant health. Although some deaths are due to injuries rather than disease and to factors for which preventive interventions are not presently available (e.g., congenital anomalies), changes in the number of deaths relative to the number of births may help a community determine whether conditions affecting infant health are improving or worsening. The overall infant mortality rate is included in the community health profile indicators proposed by the committee (see Chapter 5). Examining early and later infant deaths separately makes it easier to assess the differing factors that operate in these periods. In many communities, the number of deaths