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.
June 26, 2009
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1. MCH Library Releases New Edition of Knowledge Path
About Infant Mortality and Pregnancy Loss
2. IOM Committee Updates Pregnancy Weight Gain Guidelines
3. Authors Review Fetal Testing to Help Pediatricians
More Effectively Communicate with the Obstetric Team
4. Authors Report Apparent Disappearance of Black-White
Infant Mortality Gap in Dane County, Wisconsin
5. Article Examines Bed-Sharing Practices and Associated
Risk Factors Among Births and Infant Deaths in Alaska
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1. MCH LIBRARY RELEASES NEW EDITION OF KNOWLEDGE PATH ABOUT INFANT
MORTALITY AND PREGNANCY LOSS
Infant Mortality and Pregnancy Loss: Knowledge Path is an electronic
guide to resources that analyze data, report on research aimed at
identifying causes and promising intervention strategies, and describe
risk-reduction efforts as well as bereavement-support programs. The new
edition of the knowledge path, produced by the Maternal and Child
Health (MCH) Library at Georgetown University, contains information on
Web sites, publications, databases, electronic newsletters, and online
discussion forums. Separate sections present resources about factors
that contribute to infant mortality and pregnancy loss: birth defects,
injuries, low birthweight and prematurity, and safe sleep environment.
The knowledge path for health professionals, policymakers, researchers,
and families will be updated periodically. The knowledge path is
available at http://www.mchlibrary.info/KnowledgePaths/kp_infmort.html.
MCH Library knowledge paths on other topics are available at http://www.mchlibrary.info/KnowledgePaths/index.html.
The MCH Library welcomes feedback on the usefulness and value of these
knowledge paths. A feedback form is available at http://www.mchlibrary.info/feedback/index.html.
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2. IOM COMMITTEE UPDATES PREGNANCY WEIGHT GAIN GUIDELINES
Weight Gain During Pregnancy: Reexamining the Guidelines presents new
recommendations for total and rate of weight gain during pregnancy. The
brief, published by the National Academies Press, summarizes
recommendations issued by the Committee to Reexamine IOM Pregnancy
Weight Guidelines. The recommendations are based on the perspective
that factors that affect pregnancy begin before conception and continue
through the first year after delivery. The brief outlines ways in which
the new guidelines differ from those issued in 1990 and discusses the
committee's recommendations for action, including specific areas on
which the National Institutes and other relevant agencies should focus
to fill major gaps in research. The brief is available at
http://www.iom.edu/Object.File/Master/68/230/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf.
A resource sheet containing tables and figures designed to assist
health professionals in discussing the new guidelines with pregnant
women is available at http://www.iom.edu/File.aspx?ID=68228.
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3. AUTHORS REVIEW FETAL TESTING TO HELP PEDIATRICIANS MORE EFFECTIVELY
COMMUNICATE WITH THE OBSTETRIC TEAM
"In many instances the results of fetal testing can be ambiguous,"
state the authors of an article published in the June 2009 issue of
Pediatric Clinics of North America. According to the American College
of Obstetricians and Gynecologists (ACOG), the primary goal of
antepartum fetal surveillance is the prevention of fetal death. The
various forms of fetal surveillance carry a wide range of positive
predictive values, making interpretation somewhat difficult and often
requiring further testing. The article addresses the goals of fetal
monitoring during pregnancy.
Following a brief review of pertinent fetal physiology, the authors
discuss techniques and definitions, methods of surveillance and their
clinical implications, new guidelines for the interpretation of fetal
heart rate monitoring from the National Institute for Child Health and
Human Development, and clinical algorithms (a step-by-step method of
solving a problem or making a decision, as in making a diagnosis). A
summary is also included.
The authors conclude that "clear communication between the obstetric
care team and the receiving pediatrician is imperative to ensure
optimal obstetric and pediatric outcomes."
Farley D, Dudley DJ. 2009. Fetal assessment during pregnancy. Pediatric
Clinics of North America 56(3):489-504. Abstract available at http://www.mdconsult.com/das/citation/body/143889840-3/jorg=journal&source=MI&sp=22219303&sid=853365939/N/22219303/1.html?issn=0031-3955.
Readers: ACOG has developed a pamphlet to explain fetal testing to
patients. The pamphlet is available in a printer-friendly, electronic
format at http://www.acog.org/publications/patient_education/bp098.cfm?printerFriendly=yes.
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4. AUTHORS REPORT APPARENT DISAPPEARANCE OF BLACK-WHITE INFANT
MORTALITY GAP IN DANE COUNTY, WISCONSIN
"The black IMR (infant mortality rate) in Dane County, Wisconsin, has
declined substantially, achieving parity with whites and meeting
Healthy People 2010 objective 16-1 for reducing fetal and infant
deaths," state the authors of a report published in the May 29, 2009,
issue of Morbidity and Mortality Weekly Report. Among states with
sufficient numbers of black infant deaths to generate reliable rates
for the years 2002-2004, Wisconsin had the highest black IMR,
approximately three times the state rate for whites. However, in
contrast to trends in Wisconsin and the other states, the black IMR in
Dane County, Wisconsin, declined 67 percent from the period 1990-2001
to the period 2002-2007. To understand this development, Public Health
Madison Dane County (PHMDC) analyzed approximately 100,000 birth and
death records from 1990 through 2007 for infant mortality risk factors.
The report presents findings from the PHMDC analysis.
Mean non-Hispanic black and non-Hispanic white IMRs were calculated for
1990-2001 and 2002-2007. For each period, percentages and mortality
rates were calculated, by race, for prematurity (defined as less than
37 weeks' gestation), extreme prematurity (defined as 28 weeks' or less
gestation), low birthweight (defined as less than 2,500 g), very low
birthweight (defined as less than 1,500 g), and other risk factors.
Fetal death was defined as any delivery of 20 weeks' or more gestation
or if a fetus weighs 350 g or more when death is indicated by the fact
that the fetus shows no evidence of life.
The authors found that
- The change in infant mortality risk factors for blacks that most
affected the IMR over time was a decline in the percentage of extremely
premature births, from 2.8 percent to 1.1 percent.
- The mean IMR of 391 per 1,000 black infants weighing less than
1,500 g for 1990-2001 dropped to 154 per 1,000 for 2002-2007, a decline
in birthweight-specific mortality of 61 percent.
- For all races, during the 18 years studied, 70 percent of infant
deaths occurred during the neonatal period (ages 28 days or less).
"Because the observed trend in black infant mortality is based on small
reductions in the absolute number of deaths (approximately three
infants per year), conclusions based on these results should be
considered preliminary, and additional studies are needed to confirm
the reduction in rates over time," conclude the authors.
Schlenker T, Ndiaye M. 2009. Apparent disappearance of the black-white
infant mortality gap -- Dane County, Wisconsin, 1990-2007. Morbidity
and Mortality Weekly Report 58(20):561-565. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5820a2.htm.
Readers: More information is available from the following MCH Library
resources:
- Infant Mortality: Bibliography at
http://www.mchlibrary.info/databases/bibliography.php?target=auto_search_infmortality
- Infant Mortality Prevention: Organizations Resource List at
http://www.mchlibrary.info/databases/organizations.php?target=auto_search_infmort
- Racial and Ethnic Disparities in Health: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_race.html
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5. ARTICLE EXAMINES BED-SHARING PRACTICES AND ASSOCIATED RISK FACTORS
AMONG BIRTHS AND INFANT DEATHS IN ALASKA
"Despite this high bed-sharing prevalence among infant deaths, our
investigation found that bed sharing likely was not an independent risk
factor for death," state the authors of an article published in the
July-August 2009 issue of Public Health Reports. Since completing a
comprehensive review in 2000 of Alaskan infant deaths, the Alaska
Division of Public Health (ADPH) has recommended that infants sleep in
the supine position and either in an infant crib or with a nonsmoking,
unimpaired caregiver on an adult, non-water mattress. Data from the
Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) indicate
that the prevalence of infants who always or almost always share a bed
increased from 33 percent of births in 1996 to 43 percent in 2005. The
frequent occurrence of bed sharing in Alaska, in combination with the
American Academy of Pediatrics' 2005 policy statement recommending no
bed sharing, led to the current evaluation to determine whether
Alaska's policy needed modification. The article examines the frequency
of Alaskan infant deaths occurring while bed sharing and the presence
of known risk factors associated with these deaths to determine whether
bed sharing was contributing independently to infant mortality in
Alaska.
Data for the study were drawn from ongoing surveillance programs of the
ADPH. The initial evaluation included two categories of deaths: (1)
Maternal-Infant Mortality Review (MIMR) committee or death certificate
report of sudden infant death syndrome (SIDS) or asphyxia as the cause
of death and (2) any case with a report that death occurred during
sleep, regardless of assigned cause. For deaths that occurred in
association with bed sharing, the analysis ascertained the presence of
five risk factors: sleep position, bed sharing with a non-caregiver,
maternal tobacco use, impairment of bed-sharing partner, and sleep
surface.
At the time of the current study, the MIMR committee had reviewed 891
infant deaths. Of 891 infant deaths that occurred during 1992-2004 and
were available for analysis, the study identified 291 (33 percent) that
resulted from SIDS or asphyxia or that occurred during sleep. Of these,
246 (84 percent) had bed-sharing information available, of which 126
(51 percent) occurred while bed sharing. The 126 (14 percent of the 891
deaths reviewed) formed the study group for further analysis. The
authors found that
- Among the 126 infants who died while bed sharing, the study
identified 39 (31 percent) with a single risk factor, 44 (35 percent)
with two risk factors, and 36 (29 percent) with more than two risk
factors.
- The most prevalent risk factor, present in 75 percent of
bed-sharing deaths, was evidence of either prenatal or postnatal
maternal tobacco use. The second most common, present in 43 percent,
was sharing a bed with a person who had documented use of alcohol or
other impairment-causing drug on the night of death.
The analysis also used PRAMS data to examine background population
prevalences of certain risk factors of interest among all births and
among women whose infants frequently bed share. PRAMS data indicated
that
- Among infants born in Alaska in 1996-2003, 37.9 percent always or
almost always shared a bed with their mother or with someone else.
- Among women whose infants frequently shared a bed and for whom
all relevant data were known, 40.2 percent reported at least one of the
following risk factors: prenatal or current cigarette smoking, prenatal
chew use, prenatal marijuana use, current daily drinking, or placing
their infant to sleep in the prone position most often.
"Thus," the authors state, "the ADPH reaffirms that (1) parents always
put their infants to sleep on their back unless told otherwise by a
medical provider, (2) infants never sleep on a water bed or couch, and
(3) infants sleep in an infant crib or with a nonsmoking, unimpaired
caregiver on a standard, adult, non-water mattress."
Blabey MH, Gessner BD. 2009. Infant bed-sharing practices and
associated risk factors among births and infant deaths in Alaska.
Public Health Reports 124(4):527-534. Available at http://www.publichealthreports.org/userfiles/124_4/527-534.pdf.
Readers: The American Academy of Pediatrics' 2005 policy statement,
referenced above, is available at
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;116/5/1245.pdf.
More information is available from the National Sudden and Unexpected
Infant-Child Death and Pregnancy Loss Resource Center and partners as
follows:
- Bed-Sharing, Co-sleeping and Sudden Infant Death Syndrome (SIDS): A
Selected Annotated Bibliography at
http://www.sidscenter.org/TopicalBib/BedSharing.html
- Safe Sleep Environment at
http://www.sidscenter.org/SafeSleep/index.html
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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
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MCH Alert
Maternal and Child Health Library
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