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