MCH Alert: Focus on Infant Mortality


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.


May 29, 2009

1. Podcast Series on Women's Health and Research Focuses on Preterm Birth
2. Brief Explores the Impact of Fetal Mortality on U.S. Families
3. Report Guides Pediatricians on Safe Transportation of Preterm and Low-Birthweight Infants
4. Article Assesses the Timing of Attaining Physiologic Milestones for Preterm Infants
5. Study Shows That Prepregnancy Depressive Mood Is a Risk Factor for Preterm Birth

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1. PODCAST SERIES ON WOMEN'S HEALTH AND RESEARCH FOCUSES ON PRETERM BIRTH

In Pinn Point on Women's Health: Preterm Birth, Vivian W. Pinn, M.D., Director of the Office of Research on Women's Health at the National Institutes of Health (NIH) and Catherine Spong, M.D., Chief of the Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development at NIH, discuss what women can do to maximize their chances for a healthy pregnancy and reduce the risk of giving birth prematurely. The podcast is one in a series of monthly broadcasts hosted by Dr. Pinn that looks at developments in women's health and research. The series is a production of the NIH Radio News Service. Podcast topics include what preterm birth is, why it is important, and risk factors for preterm birth. The podcast is available at http://orwh.od.nih.gov/podcast/pinncast2009-04e.mp3. The transcript is available at http://orwh.od.nih.gov/podcast/Transcript%20-%20Preterm%20Birth.pdf.

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2. BRIEF EXPLORES THE IMPACT OF FETAL MORTALITY ON U.S. FAMILIES

The Challenge of Fetal Mortality examines data from the National Vital Statistics System on fetal death (defined as spontaneous intrauterine death at any time during pregnancy). The brief, published by the National Center for Health Statistics, discusses the recent trend in fetal mortality and a growing awareness of the effect of fetal mortality on U.S. families. The brief presents key findings on differences in fetal mortality rates by maternal race and ethnicity, single compared with multiple pregnancies, maternal age, and number of pregnancies; definitions; data sources and methods; and references. The brief also summarizes federal initiatives to improve the quality of cause-of-fetal-death data from vital statistics, to study the causes and prevention of fetal death, and to conduct active surveillance of fetal deaths. The brief is available at http://www.cdc.gov/nchs/data/databriefs/db16.pdf.

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3. REPORT GUIDES PEDIATRICIANS ON SAFE TRANSPORTATION OF PRETERM AND LOW-BIRTHWEIGHT INFANTS

"Proper selection and use of car safety seats or car beds are important for ensuring that preterm and low birth weight infants are transported as safely as possible," state the authors of a clinical report published in the May 2009 issue of Pediatrics. Improved survival rates and earlier discharge of preterm (less than 37 weeks' gestation at birth) and low-birthweight (less than 2,500 g at birth) infants have increased the number of small infants who are being transported in private vehicles. The Federal Motor Vehicle Safety Standard (FMVSS) 213 establishes design and dynamic performance requirements for child-restraint systems. However, the standard has no minimum weight limit and does not address the relative risk of respiratory compromise in preterm or low-birthweight infants. This clinical report provides guidelines for pediatricians and other caregivers who counsel parents of preterm and low-birthweight infants about car safety seats.

The authors present several considerations for transportation of preterm and low-birthweight infants at risk for recurrent oxygen desaturation, apnea, or bradycardia. Specific national guidance on selecting car safety seats and positioning preterm and low-birthweight infants is also presented. The report concludes with a discussion of research implications and a summary, as follows:
Bull MJ, Engle WA, the Committee on Injury, Violence, and Poison Prevention, and the Committee on Fetus and Newborn. 2009. Safe transportation of preterm and low birth weight infants at hospital discharge. Pediatrics 123(5):1424-1429. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/123/5/1424?rss=1.

Readers: More information is available from the following MCH Library resource:

- Child Safety and Injury Prevention: Resource Brief at
http://mchlibrary.info/guides/childsafety.html

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4. ARTICLE ASSESSES THE TIMING OF ATTAINING PHYSIOLOGIC MILESTONES FOR PRETERM INFANTS

"Our study of 865 infants born at a gestational age of less than or equal to 32 weeks provides reference data on the normative process of attaining physiologic milestones before discharge," write the authors of an article published in the May 2009 issue of Pediatrics. Preterm births account for 12.5 percent of all live births in the United States, representing an 18 percent increase from 1990 through 2004. Compared with the mid-1980s, advances in perinatal and neonatal care have contributed to increased survival rates, even for the smallest infants. This increased survival has necessitated a closer examination of the factors that result in the successful discharge of a premature infant. The goal of the study described in this article was to define the postmenstrual age (PMA) when prematurely born infants achieve specific physiologic milestones in four broad categories that are needed for successful discharge from the hospital: adequate control of breathing, successful breathing without the need for supplemental oxygen, adequate oral feeding, and maintenance of body temperature without the provision of supplemental heat. The study also determined how various factors, such as younger gestational age, gender, and the diagnosis of bronchopulmonary dysplasia (BPD), influenced the speed of the maturation process.

To answer these questions, the authors present data from a large cohort of infants born between 24 and 32 weeks' gestation at five Northern California Kaiser Permanente hospitals from 1998 through 2001. The original data source was the Kaiser Permanente Neonatal Minimum Data Set, which tracks all neonatal intensive care unit (NICU) admissions in the Kaiser Permanente Medical Care Center. These data were supplemented with detailed information on ventilator and incubator settings, body temperature, apnea and bradycardia spells, use of methylxanthines, feeding method, and requirements for intraveneous fluids. Abstraction began at 31 weeks of age, or later if born after 31 weeks' gestational age.

The authors found that
The authors conclude that "complications of prematurity had the largest effect [on the maturation process of prematurely born infants], resulting in longer hospitalizations and higher medical costs."

Bakewell-Sachs S, Medoff-Cooper B, Escobar GJ, e al. 2009. Infant functional status: The timing of physiologic maturation of premature infants. Pediatrics 123(5):3878-E886. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/123/5/e878.

Readers: More information is available from the following MCH Library resource:

- Prematurity: Bibliography at
http://mchlibrary.info/databases/bibliography.php?target=auto_search_premature

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5. TUDY SHOWS THAT PREPREGNANCY DEPRESSIVE MOOD IS A RISK FACTOR FOR PRETERM BIRTH

"Our study highlights the importance of examining prepregnancy depression status with respect to the risk of delivering preterm infants," state the authors of an article published in the Journal of Women's Health (online ahead of print) in May 2009. Although the overall infant mortality rate has been declining, black women are significantly more likely than white women to deliver preterm infants. Possible explanations for black-white differences in preterm birth include racial differences in socioeconomic position, health behaviors, and medical risk factors; however, none of these explanations completely explains the racial difference in preterm birth. Although findings from a handful of research studies suggest that depressive mood during the prenatal period may be associated with preterm birth, a growing number of studies found no association between antenatal depressive mood and preterm birth. To date, there are no empirical studies that examine the consequences of depressive mood during the prepregnancy period and the subsequent effect of depressive mood on preterm birth. The article presents findings from a study to examine the association between prepregnancy depressive mood and preterm birth in a cohort of black and white women. First, the study evaluated whether prepregnancy depressive mood has an independent effect on preterm birth among women in the sample. Second, the research examined whether prepregnancy depressive mood mediates the association between race and preterm birth.

Data for the study were drawn from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a prospective cohort study designed to examine the factors associated with the development of coronary artery disease risk factors among young adults. Analyses were limited to women who participated in year 0 (1985-1986), year 5 (1990-1991), year 7 (1992-1993), and year 10 (1995-1996) and who reported one or more singleton births delivered between the year 5 and year 10 examinations. A total of 555 women had at least one eligible birth. Preterm delivery was defined as less than 37 completed weeks of gestation. A modified version of the Center for Epidemiologic Studies Depression Scale, administered during the year 5 examination, was used to assess depressive mood. Maternal anthropometric characteristics and sociodemographic factors were also assessed. The analyses examined whether racial differences in preterm birth could be accounted for by prepregnancy depressive mood.

The authors found that
"These findings suggest a modest and significant association between prepregnancy depressive mood and preterm birth; however, there is little evidence to suggest that black-white differences in prepregnancy mood may directly contribute to explanations of black-white differences in preterm birth," conclude the authors.

Gavin AR, Chae DH, Mustillo S, et al. 2009. Prepregnancy depressive mood and preterm birth in black and white women: Findings from the CARDIA study. Journal of Women's Health [published online ahead of print in May 2009]. Abstract available at http://www.liebertonline.com/doi/abs/10.1089/jwh.2008.0984.

Readers: More information is available from the following MCH Library resources:

- Preconception and Pregnancy: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_pregnancy.html

- Racial and Ethnic Disparities in Health at
http://mchlibrary.info/KnowledgePaths/kp_race.html

- Mental Health in Primary Care at
http://mchlibrary.info/databases/bibliography.php?target=auto_search_mental

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MCH Alert © 1998-2009 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert: Focus on Infant Mortality is produced by Maternal and Child Health Library at the National Center for Education in Maternal and Child Health at Georgetown University under its cooperative agreements (U02MC00001 and U48MC08717) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
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