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Bruno Dujardin, MD, MPH; Raphael Lagasse, MD, PhD; Paul Vandenbussche, BS, MPH; Elisabeth Wollast, BS, DrPH
School of Public Health Free University of Brussels

JAMA. 1986;256(9):1140.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

In a recent article, "Postponing or Preventing Death," Buehler et al¹ examined trends in infant survival by birth-weight groups and studied the perinatal-related postneonatal deaths. They concluded that "advances in perinatal care have led to postponement rather than prevention of a few infant deaths, although overall many more deaths were prevented."

In a correspondence about this article, Sepkowitz² discusses the idea that recent declines in neonatal mortality in the United States could be largely attributed to a greater utilization of neonatal intensive care units among low-birth-weight infants.

To explain his statement, Sepkowitz invokes different biases such as selection biases as possible factors leading to a distortion of neonatal mortality rates reported from neonatal intensive care units.

However, we think that other biases could also explain an underestimation of the number of perinatal-related postneonatal deaths in Buehler's study. The problem concerns the cause of death ascertainment. . . . [Full Text PDF of this Article]

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