Maternal and Child Health Library

MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National Sudden and Unexpected Infant/Child and Pregnancy Loss Resource Center. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

November 26, 2008

1. AAP UPDATES TRAINING ON CREATING A SAFER SLEEP ENVIRONMENT TO PREVENT SUDDEN INFANT DEATH SYNDROME

Reducing the Risk of SIDS in Child Care Speaker's Kit is a tool designed for use by health and education professionals to educate communities about sudden infant death syndrome in child care. The updated kit, produced by the American Academy of Pediatrics' Healthy Child Care America Back to Sleep Campaign, is available in two formats: a PowerPoint version or a downloadable print version, including speaker's notes. Content is available in English and Spanish. Additional supplements available in English only include a sample policy and an alternative sleep position waiver from the North Carolina Healthy Start Foundation. The kit is available at http://www.healthychildcare.org/section_SIDS.cfm#train.

Readers: An article published in the October 2008 issue of Pediatrics describes a study to evaluate the use of the speaker's kit combined with a training and evaluation effort that incorporated direct observation of child care provider practices. The abstract is available at http://pediatrics.aappublications.org/cgi/content/abstract/122/4/788. 

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• CDC and the California Department of Health are conducting a study to examine the association among polymorphisms in inflammatory, endocrine, and vascular system genes; environmental factors; and spontaneous very preterm birth among mother-infant pairs. Analyzing mother-infant pairs will allow comparative assessment of the contribution of both maternal and fetal genotypes, of potential maternal and infant gene-gene interactions, and of potential maternal and infant gene-environment interactions that modify preterm birth risk.
• The Danish National Birth Cohort is a nested case-control study to examine associations among maternal stress, biomarkers, genetic polymorphisms, and preterm births. The study will assess early and midpregnancy maternal stress levels and the risk of preterm birth. It will provide the opportunity to observe and model complex interactions between self-reported stress and stress biomarkers.
• CDC is collaborating with Michigan State University to examine relationships between preterm birth and social and personal antecedents, biological factors, and placental histopathology. Analyses from this study may provide a better understanding of the underlying biological pathways to preterm birth and factors influencing these pathways.
• CDC is collaborating with investigators at the University of Kansas and the University of Tennessee, Memphis, to track the natural history of biomarkers through pregnancy and delivery in an observational cohort study of pregnant women, with a special enrollment emphasis on women with a previous spontaneous preterm birth. These analyses will be useful in identifying more accessible specimens for proteomic research and identification of inflammatory biomarkers that are predictive of preterm birth.
• With the University of Cincinnati, CDC is exploring the potential use of progesterone (17P) to prevent preterm birth. Although efficacy of 17P has been seen in the clinical setting, its effectiveness in a routine obstetrical setting is unknown. The study aims to understand potential barriers, such as sociocultural, racial, and ethnic differences.
• Since 1992, CDC has worked with the Healthy African American Families project in Los, Angeles, CA, to reduce the incidence of preterm birth by improving maternal health during pregnancy via diverse community partnerships. An integrated six-component, multilevel risk-communication strategy was developed. The project provides important information on engaging communities in self-defined prevention activities related to pregnancy and infant outcomes.

• Most of the nurses (eight) felt comfortable providing bereavement care. Among these, comfort was ascribed to past education for perinatal bereavement care, past experience providing that care, personal experience with perinatal and other losses, and maintenance of a focus on the nursing relationship with the family when providing this care.
• Some nurses (four) reported feeling uncomfortable with various aspects of bereavement care. Not knowing what to do contributed to the unease of two of these nurses.
• To cope with the challenges of providing bereavement care, nurses cited focusing on the care that the patient needs, finding support while providing care, and recovering after providing care.
• On influencing the context of providing care, most nurses (seven) indicated that volunteering was the best approach for determining who would care for bereaved families, and two nurses stated that taking turns was best.
• On how to avoid compromising bereavement care, several of the nurses commented on the difficulty of caring for a bereaved patient and a labor patient at the same time.
• On how to become comfortable and knowledgeable with bereavement care, most nurses (eight) expressed their belief that experience was necessary to become comfortable with perinatal loss. Many of the nurses found understanding the hospital routines and paperwork for perinatal loss stressful and overwhelming, and six nurses expressed the view that more education would be helpful.