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Medical technologies may hinder rather than help newborn survival

whose gestational age has been overestimated by inaccurate ultrasound.

Dr Barros comments: "The existence of three successive cohorts has enabled us to understand the relatively small change in neonatal mortality since 1990 was due to a combination of increased rates of low birthweight and preterm deliveries with improved care of neonates. This information presents new challenges for the local and national policymakers, because in order to reach the Millennium Development Goal for child survival, strategies will have to be implemented to improve birthweight and reduce preterm deliveries."

In an accompanying commentary Anthony Costello (Institute of Child Health, UK) and colleagues conclude: "In middle income countries with high institutional usage, a focus on quality of perinatal care is a priority, and health outcomes must be monitored rigorously. Doing the simple things better is probably the most cost-effective policy: increasing coverage of syphilis screening, making sure that unimmunised women receive tetanus toxoid, and careful monitoring in labour. As Barros and colleagues show, the risks of medicalisation should not be ignored because they might offset the gains resulting from improved maternal health and survival of newborns."


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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
3-Mar-2005


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