The Silent EpidemicUniting to Reduce Infant Mortality

Infant Mortality in Virginia

Significance of Infant MortalityWorld View

Infant Mortality: The ProblemWorld Rank

Infant Mortality: The Problem World Rank

29th

23th

12th1960

1990

2004

• Only ranks within the top 30 states for protecting the lives of infants

• Infant mortality rate ranked 18th highest in the nation by the CDC in 2006

• Infant mortality rate twice as high for African-Americans

Infant Mortality: The Problem – Virginia

Infant Mortality: Comparative Deaths

Just the Beginning of the Uphill Climb

123 more babies lived in 2008

Healthy People 2010: 4.5

Total Infant Mortality Rates Per 1,000 Births in Virginia

Infant Mortality: 5 Year Death Rates by Race/Ethnicity

Infant Mortality Rates Per 1,000 BirthsBy Race/Ethnicity 1998-2008

5.4

14.5

12.912.4

13.8

15.5

12.2

3.9

6.1

14.413.9

14.4

15.5

14.5

0

2

4

6

8

10

12

14

16

18

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

White

Black

Asian

Hispanic

Cause of Death 2007 2008

Disorders Related to Short Gestation and Low Birth Weight

194 163

Congenital Malformations, Deformations, and Chromosomal Abnormalities

135 130

SIDS 81 60

Maternal Complications of Pregnancy 63 48

Other Conditions in the Perinatal Period 42 24

Abnormal Clinical Findings 29 36

Complications of Placenta, Cord, and Membranes 26 24

Unintentional Injury (Accidents) 25 25

Top Causes of Death

Infant Mortality by Age at Death

Infant Mortality: Maternal Age 2008

Infant Mortality by Education and Race/Ethnicity

Less than 12 Years 12 Years > 12 Years

Resident Infant Death Rates by Method of Payment and Race/Ethnicity

Medicaid Private Insurance Self Pay

Infant Mortality: By GeographyInfant Deaths 2008 VA residents by number of live births

Prematurity: The Rising Trend

0

2

4

6

8

10

12

1990 1995 2005 2006 2007 2008

Virginia Resident and Cesarean Births

35%

22%1996

2008

Prematurity and Late Preterm Births

35 Weeks 39 Weeks

• A premature infant less than 37 weeks sleeping prone is 85 times more likely to die of SIDS

• A premature infant lying on its side is 40 times more likely to die of SIDS

Prematurity and SIDS

Prematurity: SIDS Rate and Sleep Position

Rates of SIDS Deaths

Babies Sleeping on their Backs

Engage• Healthcare

Providers• Pregnant women

and their families• Community

Groups• Health Insurers

Changing Attitudes

• Accessible prenatal care

• Promote breastfeeding

• Education about preterm labor signs and symptoms

• Decrease smoking and exposure to second-hand smoke

Interventions that May Reduce Prematurity/Infant Deaths

• Assess for substance use and intervene

• Assess for domestic violence and intervene

• Reduce major stress levels

• Refer to community services

Interventions That May Reduce Prematurity/Infant Deaths

Breastfeeding: The Benefits

• Lower rates of SIDS

• Fewer ear infections

• Fewer asthma/allergy cases

• Less obesity

• Less diabetes

• Fewer childhood leukemia cases

• Fewer infections in premature babies

• Educate mothers before birth

• Provide support from family, friends, healthcare workers, employers, society

• Provide safe places to nurse and pump

Promote Breastfeeding

Prematurity and Smoking

Exposure to smoking is associated with

• 20% of all low birth weight babies

• 8% of preterm births

• SIDS

Prematurity: Smoking and Pregnancy

Successful treatment of tobacco dependence

• 20% reduction in low-birth-weight babies

• 17% decrease in preterm births

• Prematurity

• Birth Defects

• SIDS

Infant Mortality: Causes

• Good prenatal nutrition

• Maternal health behaviors/effects

• Planned pregnancy with early, quality prenatal care

• Prevention of preterm & low birth weight babies

Infant Mortality: Solutions

• Infant sleep position and environment

• Family/caretaker violence prevention & safe home

• Home visiting nurses

Infant Mortality: Solutions

“Saving Babies” Initiative•Save babies from dying in their first year of life

•Focus on results

•Targeting 10 localities with the highest number of infant deaths

•Collaborating with other stakeholders

“Saving Babies” Outcomes•Determining women at high risk

•Increasing awareness of signs/symptoms of premature labor

•Promoting safe sleep education

“Saving Babies” Outcomes•Improving coordination/ efforts of private and public providers

•Enhancing outcomes through folic acid promotion, insurance coverage and transportation to prenatal care

•Communicate the facts

•Provide intervention tips

•Support the Commissioner’s Infant Mortality Workgroup

Infant Mortality Reduction: Raise Awareness

Infant Mortality Reduction: Spread the Word• Control Weight

• Don’t Smoke

• Don’t Drink

• Take Vitamins with Folic Acid

• Visit Your Dentist

• Breastfeed

Infant Mortality Reduction: Practice Safe Sleep Habits

Baby should…

• Sleep alone

• Sleep on his/her back

• Sleep in a crib without soft toys, bumper pads or quilts

The Silent EpidemicUniting to Reduce Infant Mortality

Optional Slides Follow

Healthy 2010 Goal: 4.5

Infant Mortality – Recent History

14.1

5.7

3.4

5.6

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1998-2002 1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 2004-2008

White

Black

Asian

Hispanic

Prematurity*- the problem

*Less than 37 weeks

Healthy 2010 Goal: 7.6

Top 4 Causes of Infant Death, Virginia 1998-2008

0

50

100

150

200

250

1998 2000 2002 2004 2006 2008

Disorders Related to Short Gestation and Low Birth Weight P07

Congenital Malformations, Deformations, and Chromosomal Abnormalities Q00-Q99

Sudden Infant Death Syndrome R95

Newborn Affected By Maternal Complications of Pregnancy P01