Maternal and Child Health Journal

, Volume 15, Issue 4, pp 446–452

The Definition of Life: A Survey of Obstetricians and Neonatologists in New York City Hospitals Regarding Extremely Premature Births



Among obstetricians and neonatologists in administrative roles in New York City hospitals, a survey was initiated to compare the physicians’ definitions of live birth and fetal death, the gestational age at which they consider infants viable, and the resuscitation practices of the neonatologists. The target survey population was 34 neonatologists, and 39 obstetricians representing 41 of the City’s 43 maternity hospitals. A telephone survey was used to gather qualitative data from the physicians regarding their definitions of live birth, fetal death, and viability, and their practices regarding extremely premature births. Surveys were completed for 58 physicians, a response rate of 79% (94% for neonatologists and 67% for obstetricians). Physicians’ definitions of live birth and fetal death varied, with almost a third (29%) of physicians including gestational age as part of their live birth criteria. Most of the physicians (90%) consider infants born at ≥23 weeks gestation viable. Most neonatologists (97%) said they always resuscitate infants born at ≥23 weeks gestation, and most (94%) said they would never resuscitate infants born at <20 weeks gestation. For infants born at 20–22 weeks gestation, there were differences in resuscitation practices. There is a gap between clinical practices and reporting requirements for live birth and fetal death. Whereas reporting requirements are based on definitions of live birth and fetal death, physicians make resuscitation and other clinical decisions regarding extremely premature infants based on definitions of viability.


Fetal death Infant mortality rate Premature birth Pediatric resuscitation Viable gestational age 


  1. 1.
    MacDonald, H., & The Committee on Fetus, Newborn. (2002). Perinatal care at the threshold of viability. Pediatrics, 110(5), 1024–1027.PubMedCrossRefGoogle Scholar
  2. 2.
    Hoyert, D. L., Barfield, W., & Martin, J. A. (2004). Recent trends in fetal mortality, United States. WHO Family of International Classification Network Meeting, Reykjavik, Iceland, October 24–30, 2004.Google Scholar
  3. 3.
    Behrman, R. E., & Stith, B. A. (Eds.). (2008). Preterm birth: Causes, consequences, and prevention. National Academy of Sciences 2008. Downloaded July 14, 2008, from
  4. 4.
    Prematurity Research Expansion and Education for Mothers who deliver Infants Early Act, S.707, 109th Congress of the Unites States of America, Second Session, January 3, 2006.Google Scholar
  5. 5.
    Nuffield Council on Bioethics. (2006). Critical care decisions in fetal and neonatal medicine: Ethical issues. London, England: Nuffield Council on Bioethics.Google Scholar
  6. 6.
    Biarent, D., Bingham, R., Richmond, S., et al. (2005). European resuscitation council guidelines for resuscitation 2005, section 6, paediatric life support. Resuscitation, 67S1, S97–S133.CrossRefGoogle Scholar
  7. 7.
    American Academy of Pediatrics. (2000). Special considerations. In D. Braner, J. Kattwinkel, S. Denson, & J. Zaichkin (Eds.), Textbook of neonatal resuscitation (4th ed., pp. 7–19). IL: Elk Grove Village.Google Scholar
  8. 8.
    US Agency for International Development. (2009). With USAID support Kazakhstan adopts live birth definition. USAID Europe and Eurasia. Downloaded April 22, 2009, from
  9. 9.
    Lockwood, C. J., & Lemons, J. A. (Eds.). (2007). Guidelines for perinatal care (6th ed.). Elk Grove Village, IL: American Academy of Pediatrics and American College of Obstetricians and Gynecologists.Google Scholar
  10. 10.
    Mathews, T. J., & MacDorman, M. F. (2007). Infant mortality statistics from the 2004 period linked birth/infant death data set. National Vital Statistics Report, 55(14), 1–32.Google Scholar
  11. 11.
    Summary of Vital Statistics. (2007). The City of New York. Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, December 2008.Google Scholar
  12. 12.
    Summary of Vital Statistics. (1997). The City of New York. Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, December 1998.Google Scholar
  13. 13.
    Centers for Disease Control and Prevention; Health Resources Services Administration (lead agencies). Healthy People 2010, 16: Maternal, Infant, and Child Health. Downloaded on April 22 from HU
  14. 14.
    Heron, M. P., Hoyert, D. L., Murphy, S. L., Xu, J. Q., Kochanek, K. D., & Tejada-Vera, B. (2009). Deaths: Final data for 2006. National vital statistics reports, Vol. 57, No. 14. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  15. 15.
    Yankauer, A. (1994). A classic study of infant mortality—1911–1915. Pediatrics, 94, 874–877.PubMedGoogle Scholar
  16. 16.
    MacDorman, M. F., Callaghan, W. M., Mathews, T. J., Hoyert, D. L., & Kochanek, K. D. (2007). Trends in preterm-related infant mortality by race and ethnicity: United States, 1999–2004. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics.Google Scholar
  17. 17.
    US Census Bureau. (2009). Percent of the total population who are Black or African American. 20052007 American community survey 3-year estimates. Downloaded May 16, 2009, from
  18. 18.
    Gamble, S. B., Strauss, L. T., Parker, W. Y., Cook, D. A., Zane, S. B., & Hamdan, S. (2008). Abortion surveillance—United States, 2005. Surveillance Summaries, 57(SS13), 1–32. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, November 28, 2008.Google Scholar
  19. 19.
    Cnattingius, S., Bergstrom, R., Lipworth, L., & Kramer, M. S. (1998). Prepregnancy weight and the risk of adverse pregnancy outcomes. The New England Journal of Medicine, 338(3), 147–152.PubMedCrossRefGoogle Scholar
  20. 20.
    Stephansson, O., Dickman, P. W., Johansson, A., & Cnattingius, S. (2001). Maternal weight, pregnancy weight gain, and the risk of antepartum stillbirth. American Journal of Obstetrics and Gynecology, 184(3), 463–469.PubMedCrossRefGoogle Scholar
  21. 21.
    Nohr, E. A., Bech, B. H., Davies, M. J., Frydenberg, M., Henriksen, T. B., & Olsen, J. (2005). Prepregnancy obesity and fetal death: A study within the danish national birth cohort. Obstetrics and Gynecology, 106(2), 250–259.PubMedCrossRefGoogle Scholar
  22. 22.
    Chen, A., Feresu, S. A., Fernandez, C., & Rogan, W. J. (2009). Maternal obesity and the risk of infant death in the United States. Epidemiology, 20(1), 74–81.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Mailman School of Public HealthColumbia UniversityOxfordUSA
  2. 2.Department of Environmental Health Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUSA

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