FETUS and INFANT

There has been a growing realization by international agencies and policy makers in developing countries that the neonatal period warrants special focus. First, perinatal and neonatal mortality represent a sizable problem. More than 9 million deaths occur before or just after birth each year, 98% of them in developing countries (1). About 56 of every 1000 infants die in the perinatal period (from 22 wk gestation to age 7 d) and about 34 of every 1000 liveborn babies suffer neonatal death (from birth to age 1 mo). Neonatal deaths account for two-thirds of deaths in infancy and 40% of deaths before age 5 y. The World Bank estimates that perinatal deaths account for 7.3% of the global burden of disease (1), a figure that exceeds the combined global burden of disease due to malaria and all vaccine-preventable infections.

 Second, infants with neonatal problems or malnutrition are less likely to attain their full potential. Low-birth-weight (LBW)4 infants (,2500 g) seem to perform less well on later educational and intelligence tests than do infants of normal birth weight (2), and there is growing evidence for and interest in the importance of intrauterine health for future cognitive

development.

Other benefits too are linked to improved newborn care. When neonatal mortality rates fall, women tend to space their pregnancies, thus contributing to the demographic transition from high to low mortality and fertility. Because postneonatal causes of infant mortality (from 1 mo to 1 y) have been reduced, neonatal—and especially early neonatal—deaths now represent a much larger proportion of the overall infant mortality rate. Further reductions in infant mortality will depend on improving care for newborn infants.

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