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.


October 30, 2009

1. National Center Compiles Resources on Child Care and SIDS
2. Guide Provides Tips on Infant Safety for Parents and Other Caregivers
3. Study Identifies Promising Data Elements for Environmental Public Health Tracking of Reproductive Outcomes
4. Authors Examine Opportunities and Limitations in Using Death Certificates to Characterize SIDS
5. Article Evaluates the Relationships Between Infant Mortality and Place, Poverty, and Race in the Lower Mississippi Delta

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1. NATIONAL CENTER COMPILES RESOURCES ON CHILD CARE AND SIDS

Child Care and SIDS contains a selection of resources for families and professionals on child care and sudden infant death syndrome (SIDS). The resource, produced by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University, lists brochures, fact sheets, model policies, training courses, campaigns, self-learning modules, curricula, licensing regulations, legislation, and standards available from national organizations and state programs. Several of the listed resources are available in Spanish. Topics include infant sleep position, tummy time, foster care, emergency procedures, and bereavement support. The resource is available at http://sidscenter.org/childcare.html.

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2. GUIDE PROVIDES TIPS ON INFANT SAFETY FOR PARENTS AND OTHER CAREGIVERS

Baby Safety Basics: A Guide to Keeping Your Baby Safe During the First Year of Life provides information on infant safety for new and expecting parents and other caregivers. The guide, published by Safe Kids USA and Cribs for Kids, addresses infant safety during sleep; while feeding, bathing, or playing; and when riding in the car. Content includes tips on buying a crib, do's and don'ts of safe sleep, recommended toys and toys to avoid, preventing poisonings and falls, and installing a car seat. Additional information on infant product safety and ways to make the home safer is presented. The guide is available at http://sk.convio.net/site/DocServer/Baby_Safety_Guide.pdf?docID=24661.

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3. STUDY IDENTIFIES PROMISING DATA ELEMENTS FOR ENVIRONMENTAL PUBLIC HEALTH TRACKING OF REPRODUCTIVE OUTCOMES

"The addition of data elements (e.g., length of maternal residence) to birth and fetal death certificates may be a useful and cost-effective means of enhancing the ability of state health departments to track adverse reproductive outcomes and assess associations with environmental risk factors, if their accuracy and completeness can be demonstrated and they are shown to reduce misclassification of exposure," state the authors of an article published in the November-December 2009 issue of Public Health Reports. Environmental public health tracking (EPHT) is the ongoing collection, integration, analysis, and dissemination of data from environmental-hazard monitoring, human-exposure tracking, and health-effect surveillance. The current EPHT surveillance system depends on birth, fetal death, and death certificates and other health data routinely collected and made available by health departments, registries, and other institutions. The content, format, and standardization of birth and fetal death certificates as well as other vital records are reviewed periodically to help promote a consistent, reliable, and usable source of information nationwide. The focus has been on sociodemographic risk factors and medical and pregnancy histories, but not on items that may be of environmental significance. The article describes a study to inventory and review existing data elements on the birth and fetal death certificates of all 50 U.S. states to identify nonstandard data items that are environmentally relevant, are inexpensive to collect, and might enhance EPHT analyses.

The researchers obtained records from the 50 states and summarized the results in a matrix containing data elements by state. Then, they determined whether each element was synonymous with an element on the current (2003) National Center for Health Statistics' standard for birth and fetal death certificates, different from standard elements but providing similar information, or not included on the standard birth and fetal death certificate.

The authors found that
"If these data elements can be reported completely and accurately, then their addition to birth and fetal death certificates and other health records may be a valuable and cost-effective method for state health departments to improve their capacity to conduct EPHT," conclude the authors.

Fitzgerald E, Wartenberg D, Thompson WD, et al. 2009. Birth and fetal death records and environmental exposures: Promising data elements for environmental public health tracking of reproductive outcomes. Public Health Reports 124(6):825-830. Available to subscribers at http://www.publichealthreports.org/userfiles/124_6/825-830.pdf.

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4. AUTHORS EXAMINE OPPORTUNITIES AND LIMITATIONS IN USING DEATH CERTIFICATES TO CHARACTERIZE SIDS

"Most SIDS [sudden infant death syndrome]-coded deaths (approximately 80 percent) lacked additional information about contributory or possible causal factors, and thus we could not quantify and describe SIDS deaths that may have been affected by modifiable risk factors such as prone sleeping, soft bedding in the sleep environment, and bed-sharing," state the authors of an article published in the Journal of Pediatrics online (ahead of print) on September 26, 2009. A broad range of terms result in a death being assigned the International Classification of Diseases, 10th revision (ICD-10), code of R95 for SIDS. Lack of clarity and reliability are well-documented issues affecting the ability to monitor and understand SIDS trends and, more important, to identify potentially modifiable risk factors associated with these deaths. Beginning in 2003, the National Center for Health Statistics (NCHS) electronically captured all text reported by certifiers in the cause-of-death section of all U.S. death certificates. The article presents findings from a study to examine the actual cause-of-death terminology written on SIDS death certificates and determine the adequacy of these text data to describe more fully the circumstances that may contribute to SIDS.

Data for the analysis was drawn from the 2003 and 2004 NCHS mortality files. The study included all deaths assigned the ICD-10 underlying cause-of-death code for SIDS. For each death, the researchers examined several lines of text from the death certificate's cause-of-death section. Next, they grouped together deaths described with the same terminology, and on the basis of these groupings, divided the SIDS-coded deaths into SIDS-related cause-of-death subcategories. The analysis also grouped records that contained terms related to contributory factors or potential causes of death. Such factors included terms indicating co-morbidities, risk factors, and environmental stressors.

The authors found that
"We need to better understand the variations in terminology, why different terms are used, and how they might be best classified according to the ICD. Such information could be used to inform future revisions to the ICD, resulting in a more accurate and informative estimate of the burden of SIDS and other causes of sudden, unexpected infant death," the authors conclude.

Shapiro-Mendoza CK, Kim SY, Chu SY, et al. 2009. Using death certificates to characterize sudden infant death syndrome (SIDS): Opportunities and limitations. Journal of Pediatrics [published online ahead of print on September 26, 2009]. Available at http://www.jpeds.com/article/S0022-3476(09)00650-7/abstract.

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5. ARTICLE EVALUATES THE RELATIONSHIPS BETWEEN INFANT MORTALITY AND PLACE, POVERTY, AND RACE IN THE LOWER MISSISSIPPI DELTA

"Place, poverty and race are all important factors to consider when evaluating disparities in infant mortality rates," writes the author of an article published in the November 2009 issue of the Maternal and Child Health Journal. One of the major goals of the Healthy People 2010 initiative is to eliminate health disparities in the United States. The creators of this goal define six types of disparities that persist across a range of health outcomes: gender, race or ethnicity, education or income, disability, geographic location, and sexual orientation. The impoverished counties of the Mississippi Delta have experienced chronically higher incidence and prevalence of many types of morbidity and disease-specific mortality than the nation as a whole. The objectives of this study were to explore regional, economic, and racial disparities in infant mortality rates between geographic subregions within the eight states comprising the Delta and to examine the impact of county-level poverty and racial composition on these regional disparities over time.

The study used secondary data analysis and had both cross-sectional and longitudinal components. Models testing the impact of subregional geographic differences, percentage of poverty, percentage of black population, and interaction effects were conducted at three time periods, the late 1970s, late 1980s, and late 1990s.

The authors found that
The authors conclude that "analyses such as this one . . . could assist in maternal and child health policy and program development and help us to better focus our limited resources."

Eudy RL. 2009. Infant mortality in the Lower Mississippi Delta: Geography, poverty and race. Maternal and Child Health Journal 13(6):806-813. Abstract available at http://www.springerlink.com/content/u465316h76352577.

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

- Infant Mortality and Pregnancy Loss: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_infmort.html

- Racial and Ethnic Disparities in Health: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_race.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 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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MCH Alert
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