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A medical student from the United States is discussing infant mortality with a medical student from another country. Which of the following is the most important factor to consider when comparing infant mortality between the 2 countries?

A. The method by which gestational age is estimated in each country

B. The prevalence of multiple gestations in each country

C. The precise formula each country uses to describe infant mortality

D. The etiologies of infant death in each country

E. The differences in population size

Answer: C

Comparison of infant mortality between entities (countries, regions) requires use of a common definition. The infant mortality ratio, the ratio of infant deaths to live births each year, is one way to standardize the reporting of infant mortality. This ratio relies on consistency in reporting of infant deaths and live births, which are very specifically defined. Although gestational age, causes of death, and multiple gestations impact the risk of infant mortality, they are not included in calculations for infant mortality. Differences in population size should not impact comparisons in infant mortality if infant mortality is being described by the infant mortality ratio.

A pregnant woman experiencing preterm labor at 23 weeks' gestation arrives at a small community hospital with special care neonatal services but no subspecialty care services. What is the most compelling rationale for transferring this woman to a regional subspecialty center prior to delivery?

A. Regional subspecialty centers have more support for establishing successful breastfeeding.

B. Regional subspecialty centers have more social work support for mothers of preterm babies.

C. Delivering the baby at a special care center would be more costly.

D. Delivering the baby at a regional subspecialty center reduces the risk of neonatal mortality.

E. Regional subspecialty centers provide parents support groups for preterm infants.

Answer: D

Neonatal outcomes for very-low-birth-weight infants (including a reduction in neonatal mortality) are improved when delivery occurs at a regionalized, large subspecialty center. Notable differences in subspecialty centers, as compared to basic centers or special care centers, include 24-hour neonatologist coverage, availability of advanced respiratory support, availability of all medical and surgical specialists, and high-risk follow-up. Despite these additional services, delivery at a subspecialty center is not more costly when compared to delivery at a special care center. ...

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