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 at Georgetown University. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

April 24, 2009

Special Notice: Improving Infant Death Investigation through Doll Re-Enactment (a Maternal and Child Health Bureau-sponsored Webcast) will be held on Tuesday, April 28, 2009, from 3:00 p.m. to 4:30 p.m., ET. The Webcast will discuss the importance of conducting doll re-enactments to help investigators and families better understand the causes of infant deaths in sleeping environments and will also demonstrate techniques for conducting such re-enactments. Registration is open to the maternal and child health community. More information is available at http://www.mchcom.com/liveWebcastDetail.asp?leid=395. Video and audio archives will be available shortly after the event at http://webcast.hrsa.gov/Postevents/recentEvents.asp.

1. RESOURCE CENTER LAUNCHES PODCAST SERIES

Wisdom from the Field is a new podcast series featuring personal stories from people in the sudden and unexpected infant and child death and pregnancy loss field, including parents, doctors and nurse practitioners, researchers, members of the faith-based community, bereavement counselors, and others. The series was launched by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University as part of Multimedia Resources Online, a Web page containing selected audio, video, PowerPoint presentations, and archived Webcasts on SIDS, safe sleep, and related topics. The series content includes Home Visiting and Grief Counseling, a podcast featuring nurses speaking about bereavement support and grief counseling. Also included are the following podcast proceedings from First Candle's 2009 Research and Advocacy Symposium:

• In Family Perspectives on Stillbirth and Sudden Unexpected Infant Death, three parents discuss their experiences of loss and the support they received from the medical and faith communities. They offer advice to those who have also lost a child and the families and professionals who support them.
• In Perinatal Grief Support for Families: The Role of Clergy, Congregation, and Community, a grief counselor who is also a chaplain converses with two families who have experienced perinatal loss. Topics include the benefits and limitations of support from clergy and the church community.
• In Peer-Support Programs, a bereaved parent who is an international speaker and an author talks about the importance of peer-support programs.
• In Risk Reduction: Kick Counting and Individualizing Risk, an obstetrician-gynecologist speaks about researchers and parents who have joined together to address stillbirth.
  

The series is available at http://www.sidscenter.org/multimedia.html.

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• BV infection, especially when found early in pregnancy, is associated with late miscarriage, preterm premature rupture of membranes, preterm labor, preterm birth, chorioamnionitis, and postpartum endometritis.
• Screening for BV in the first trimester may assist in the identification of women at risk for late miscarriage and preterm delivery.
• Administering antibiotics to women with asymptomatic BV does not improve obstetrical outcome but may reduce incidence of late miscarriage.
• The mainstay of treatment for symptomatic BV is metronidazole and clindamycin.
• Women with symptomatic BV should be considered at increased risk for adverse obstetrical outcome.
• Treatment of symptomatic BV may result in reducing a pregnant woman’s risk for adverse outcomes such as chorioamnionitis, postpartum endomyometritis, late miscarriage, and preterm birth and its associated adverse neonatal outcomes.
• Condom use may be protective, whereas use of petroleum-based lubricants or saliva for lubrication increases risk for BV.
• Vaginal hygiene may be maintained with a washcloth. Other methods such as douching or digital cleansing increase risk for BV.
• Having multiple or new sexual partners increases risk for BV, as does sharing of sex toys.
• Individuals with BV should be counseled on the increased risk for contracting sexually transmitted infections such as HIV, HSV type 2, trichomoniasis, gonorrhea, chlamydia, and pelvic inflammatory disease.

• Over the study period, prenatal care use increased substantially for both AIANs and whites. Inadequate prenatal care in the first trimester narrowed between AIANs and whites. However, compared with whites, AIANs' adjusted risk for inadequate prenatal care increased over the study period.
• The adjusted odds of having a low-birthweight infant were lower for AIANs than for whites throughout the study period.
• Neonatal, postneonatal, and overall infant death rates decreased for both AIANs and whites over the study period. The unadjusted neonatal death rates of AIANs were higher than those of whites in 1985-1987 and 1989-1991, but not in 1995-1997.
• The postneonatal death rates of AIANs were significantly higher than those of whites in each of the three time periods. The adjusted odds of postneonatal death among AIANs compared with whites diminished slightly (but not statistically significantly), from 1.55 in 1985-1987 to 1.46 in 1995-1997.

• The mean number of practitioners' utterances per meeting was 239, amounting to 70 percent of the total. The mean number of actor-family members' utterances was 101, amounting to 30 percent of the total.
• Among practitioners', physicians spoke the most (56 percent of utterances), followed by nurses (33 percent), and social workers and chaplains (11 percent).
• Practitioners, especially physicians, devoted most (38%) of their statements to providing biomedical information.
• Actor-family members used statements to ensure that they correctly understood the information provided, such as recapping what the practitioners had said and paraphrasing, more frequently than practitioners (12 percent vs. 3 percent).
• No differences were found across disciplines in offering emotional support.
• Nurses' communicative contributions differed neither from those of physicians in providing biomedical information nor from those of social workers and chaplains in providing psychosocial information and engaging families in social talk.
• Compared to other practitioners, social workers and chaplains asked more psychosocial questions, sought more family opinion and understanding, and more frequently expressed agreement and approval.