According to a new study on infant mortality worldwide, the US ranked 41 out of 45 industrialized nations.

In a 20 year analysis of newborn death rates around the world, the study published in PLoS Medicine revealed the number of infants who die before they are 4 weeks old account for 41% of child deaths worldwide. Newborn deaths in the United States ranked 41 out of 45 among industrialized countries, on par with Qatar and Croatia.

America's low ranking among modern nations may come as surprise to many who regard the U.S. health care system as the best in the world. Researchers say preterm delivery (delivering before 37 weeks) plays a role in the United State's lower ranking.

"Prenatal care is not all created equal. There are areas of the United States where access to prenatal and preventive care is a real problem. It puts the mother at a disadvantage and contributes to premature births and death rate," says the study's author Dr. Joy Lawn of the non-government organization Save the Children.

The study says the leading causes of newborn death worldwide are preterm delivery, asphyxia and severe infections. More than a half million babies in the United States-1 in every 8-are born premature each year.

This is a misleading statistic as Dr. Linda Halderman explains:

Low birth weight infants are not counted against the "live birth" statistics for many countries reporting low infant mortality rates.

According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.

But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies - considered "unsalvageable" outside of the U.S. and therefore never alive - is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.

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Some of the countries reporting infant mortality rates lower than the U.S. classify babies as "stillborn" if they survive less than 24 hours whether or not such babies breathe, move, or have a beating heart at birth.

Forty percent of all infant deaths occur in the first 24 hours of life.

In the United States, all infants who show signs of life at birth (take a breath, move voluntarily, have a heartbeat) are considered alive.

If a child in Hong Kong or Japan is born alive but dies within the first 24 hours of birth, he or she is reported as a "miscarriage" and does not affect the country's reported infant mortality rates.

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Too short to count?

In Switzerland and other parts of Europe, a baby born who is less than 30 centimeters long is not counted as a live birth. Therefore, unlike in the U.S., such high-risk infants cannot affect Swiss infant mortality rates.

Efforts to salvage these tiny babies reflect this classification. Since 2000, 42 of the world's 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States.

Because we don't have socialized medicine - yet - heroic efforts to save newborns are common in America while these same infants are considered "unsalvageable" in other countries and not counted against their mortality statistics.

Even if the counting methods were uniform, we'd still be lower than many countries. This is preventable through education of young mothers who invariably fail to get available pre-natal care. That, and making an attempt to address the epidemic of babies having babies would go a long way to lowering the infant mortality rate.