Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study
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OBJECTIVES: To examine variations in the registration of extremely low birthweight and early gestation births and to assess their effect on perinatal and infant mortality rankings of industrialised countries. DESIGN: Retrospective population based study. SETTING: Australia, Canada, European countries, and the United States for 2004; Australia, Canada, and New Zealand for 2007. POPULATION: National data on live births and on fetal, neonatal, and infant deaths. MAIN OUTCOME MEASURES: Reported proportions of live births with birth weight/gestational age of less than 500 g, less than 1000 g, less than 24 weeks, and less than 28 weeks; crude rates of fetal, neonatal, and infant mortality; mortality rates calculated after exclusion of births under 500 g, under 1000 g, less than 24 weeks, and less than 28 weeks. RESULTS: The proportion of live births under 500 g varied widely from less than 1 per 10,000 live births in Belgium and Ireland to 10.8 per 10,000 live births in Canada and 16.9 in the United States. Neonatal deaths under 500 g, as a proportion of all neonatal deaths, also ranged from less than 1% in countries such as Luxembourg and Malta to 29.6% in Canada and 31.1% in the United States. Rankings of countries based on crude fetal, neonatal, and infant mortality rates differed substantially from rankings based on rates calculated after exclusion of births with a birth weight of less than 1000 g or a gestational age of less than 28 weeks. CONCLUSIONS: International differences in reported rates of extremely low birthweight and very early gestation births probably reflect variations in registration of births and compromise the validity of international rankings of perinatal and infant mortality.
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In most high‐income countries, the registration criterion for stillbirth is 22+0 weeks of gestation or even earlier.
“In most high‐income countries, the registration criterion for stillbirth is 22+0 weeks of gestation or even earlier.16”
From Parents’ experiences of care following the loss of a baby at the margins between miscarriage, stillbirth and neonatal death: a UK qualitative study (2020) · cites this paper as [16]
The Discussion section, “International differences in birth registration” (page unavailable), gives examples of stillbirth registration at 20 weeks in the United States and Canada. It also gives thresholds of 24 weeks for England and Wales and 28 weeks for Sweden, so it does not establish that most high-income countries use a threshold of 22 weeks or earlier. (LLM, conf=0.86)
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- Authors
- Joseph, K. S., Liu, S., Rouleau, J., Lisonkova, S., Hutcheon, J. A., Sauve, R., Allen, A. C., Kramer, M. S., & for the Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System
- Affiliations
- University of British Columbia (CA)
- Public Health Agency of Canada (CA)
- University of Calgary (CA)
- Dalhousie University (CA)
- McGill University (CA)
- Corresponding author
- Joseph, K. S.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2012-02-17
- Volume
- 344
- Issue
- feb17 1
- Pages
- e746-e746
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC3281499
- OpenAlex
- W2133565617
- Cited by
- 120
- References
- 18
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 3 · 2020: 6 · 2019: 10 · 2018: 15 · 2017: 13 · 2016: 8 · 2015: 15 · 2014: 12 · 2013: 19 · 2012: 4
- FWCI
- 28.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Child and Family Research Institute
- Michael Smith Health Research BC
- Canadian Institutes of Health Research (PLS56343)
- Topics
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- birth registration, extremely low birth weight, very preterm birth, perinatal mortality, infant mortality, neonatal mortality, fetal death, birth weight, gestational age
- MeSH terms
- Birth Certificates, Europe, Humans, Infant, Infant Mortality, Infant, Newborn, North America, Retrospective Studies, Developed Countries, Australasia, Fetal Mortality, Premature Birth, Live Birth, Infant, Extremely Low Birth Weight, Perinatal Mortality
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