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.
February 26, 2010
1. Online Module Focuses on SIDS in Child Care
2. Partnership Provides Free Maternal and Child Health
Information via Text Messages
3. Video Series Addresses Infant Safe Sleep Within the
Family Context
4. Study Examines Maternal and Fetal Outcomes Among Women
with Depression at the Time of Delivery
5. Authors Assess Effect of Newborn Care Training on
Perinatal Mortality in Developing Countries
6. Review of SIDS Cases Reveals that Multiple Risk
Factors are Prevalent
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1. ONLINE MODULE FOCUSES ON SIDS IN CHILD CARE
Reducing the Risk of SIDS in Child Care is designed to teach child care
and health professionals, parents, and other caregivers how to create a
safe sleep environment to reduce the risk of sudden infant death
syndrome (SIDS) and other sleep-related deaths. The online module was
produced by the American Academy of Pediatrics' (AAP's) Healthy Child
Care America with support from the Health Resources and Services
Administration's Maternal and Child Health Bureau. The content is based
on AAP's Reducing the Risk of SIDS in Child Care Speaker's Kit. Topics
include the definition of SIDS, behaviors that increase the risk of
SIDS, common beliefs and misconceptions about SIDS, and resources to
reduce infants' risk of SIDS. More information is available at http://www.healthychildcare.org/pdf/SIDSmoduleflyer.pdf
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2. PARTNERSHIP PROVIDES FREE MATERNAL AND CHILD HEALTH INFORMATION VIA
TEXT MESSAGES
Text4baby is a free mobile information service that provides health
tips timed to a woman's stage of pregnancy or an infant's age. The
National Healthy Mothers, Healthy Babies Coalition program was made
possible through a public-private partnership that includes mobile
service providers; health professionals; and federal, state, and local
agencies. The service enables pregnant women and new parents to receive
health information delivered regularly to their mobile phones via text
message at no charge. Messages are available in English and Spanish and
focus on topics such as immunization schedules, mental health,
nutrition, oral health, safe sleep, seasonal flu prevention and
treatment, and tobacco use. The program also connects participants to
public clinics and support services for prenatal and infant care. More
information is available at http://www.text4baby.org
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3. VIDEO SERIES ADDRESSES INFANT SAFE SLEEP WITHIN THE FAMILY CONTEXT
Infant Safe Sleep Family Voices in Spanish is a video designed to help
expecting and new parents and other caregivers reduce their infants'
risk of sudden death. The video is one in a series produced by
Tomorrow's Child/Michigan SIDS in partnership with the CJ Foundation
for SIDS emphasizing the importance of putting infants to sleep safely.
Other titles include Infant Safe Sleep and Multicultural Family Voices:
Infant Safe Sleep. The series is available on the Tomorrow's Child Safe
Sleep for Babies Channel at http://www.youtube.com/user/SafeSleepForBabies
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4. STUDY EXAMINES MATERNAL AND FETAL OUTCOMES AMONG WOMEN WITH
DEPRESSION AT THE TIME OF DELIVERY
"Women with a diagnosis of depression were consistently 1.2-2.8 times
more likely to experience adverse maternal and fetal outcomes, spend
more time in the hospital, and incur higher hospital charges," state
the authors of an article published in the February 2010 issue of the
Journal of Women's Health. The few studies that have addressed the
relationship between maternal depression and pregnancy outcomes have
yielded conflicting evidence on the presence or absence of an
association with suboptimal birth outcomes. Thus, further examination
of depression and its relationship to pregnancy and obstetric outcomes
is needed. The purpose of the study described in the article was to
provide national estimates of the burden of diagnosed depression among
women residing in the United States at the time of delivery. The
researchers also compared demographics, hospital characteristics,
pregnancy complications, and obstetric outcomes for women with and
without depression who were hospitalized for delivery.
Data for the study were drawn from the 1998-2005 Nationwide Inpatient
Sample (NIS), one of a family of databases and software tools developed
as part of the Healthcare Cost and Utilization Project, sponsored by
the Agency for Healthcare Research and Quality in partnership with
state-level data-collection organizations to provide nationwide
estimates of hospital inpatient care in the United States. The study
sample included all women ages 15-44 with a delivery hospitalization
and concurrent diagnoses at time of delivery for the following:
depression, alcohol or substance abuse, other mental disorders, preterm
labor, preeclampsia or hypertension, cesarean delivery, anemia,
placental abnormalities, genitourinary tract infections, infections
during labor, fetal growth restriction, fetal abnormalities, fetal
distress, or fetal death. The analyses evaluated the likelihood of
pregnancy complications and obstetric outcomes during delivery
hospitalizations by depression diagnosis while adjusting for
sociodemographic and hospital characteristics.
The authors found that
- The overall rate of depression was 7.62 per 1,000 delivery
hospitalizations.
- The rate of depression increased significantly during the 7-year
period, from 2.73 per 1,000 deliveries in 1998 to 14.12 per 1,000
deliveries in 2005.
- After adjusting for age, insurance status, and hospital
characteristics, women hospitalized for a delivery with a depression
diagnosis were more likely to have several adverse maternal outcomes,
including preterm labor, preeclampsia, diabetes, cesarean section,
anemia, and placental abnormalities, as well as infectious
complications, such as genitourinary tract infections and infections
during labor. In addition, women experienced a higher rate of adverse
fetal outcomes, such as fetal growth restriction, fetal abnormalities,
fetal distress, and fetal death.
"This study demonstrates that during hospital delivery, the risk of
maternal and fetal complications is significantly higher among women
diagnosed with depression compared with those without depression," the
authors conclude. "Because of the inherent limitations of hospital
discharge data," they suggest, "future studies with detailed clinical
data are needed to better understand the nature of our findings as well
as to improve management and care of pregnant women with depression."
Bansil P, Kuklina EV, Meikle SF, et al. 2010. Maternal and fetal
outcomes among women with depression. Journal of Women's Health
19(2):329-334. Abstract available at http://www.liebertonline.com/doi/abs/10.1089/jwh.2009.1387
Readers: More information is available from the following MCH Library
resource:
- Depression During and After Pregnancy: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_postpartum.html
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5. AUTHORS ASSESS EFFECT OF NEWBORN CARE TRAINING ON PERINATAL
MORTALITY IN DEVELOPING COUNTRIES
"Training birth attendants [in developing countries] in Essential
Newborn Care was not associated with a reduction in neonatal mortality
but was associated with reduced rates of stillbirth," write the authors
of an article published in the February 18, 2010, issue of the New
England Journal of Medicine. Annually, there are approximately 3.7
million neonatal deaths and 3.3 million stillbirths worldwide. Major
global causes of perinatal mortality are asphyxia at birth, low
birthweight, and prematurity. The study described in this article was
designed to test the primary hypothesis that training birth attendants
in the World Health Organization Essential Newborn Care Course and in a
modified version of the American Academy of Pediatrics Neonatal
Resuscitation Program would reduce the rate of death from all causes in
the first 7 days after birth, among infants with birthweights of at
least 1,500 g who were born in rural communities in developing
countries.
Researchers conducted the study of training in Essential Newborn Care
in rural communities in six countries (Argentina, Democratic Republic
of Congo, Guatemala, India, Pakistan, and Zambia). The contents of the
Essential Newborn Care course included routine neonatal care,
initiation of breathing and resuscitation, thermoregulation, early and
exclusive breastfeeding, kangaroo (skin-to-skin) care, care of small
infants, recognition of danger signs, and recognition and initial
management of complications. After completion of the data-collection
period that followed the Essential Newborn Care course (March 2005
through February 2007), a 3-day course in the Neonatal Resuscitation
Program was conducted in five countries (the same as those in the
Essential Newborn Care study, except for Argentina) from July 2006
through August 2008, only for birth attendants in the birth clusters
that were randomly assigned to the Neonatal Resuscitation Program. A
refresher course was given 6 months later. Contents of the Neonatal
Resuscitation Program course included in-depth hands-on training in
basic knowledge and skills of resuscitation and bag-and-mask
ventilation but did not include training in chest compressions,
endotracheal intubation, or administration of medications. The primary
outcome in both studies was the rate of death from all causes in the
first 7 days after birth.
The authors found that
- Outcome data at 7 days were available for 99.2 percent of the
births.
- The rate of neonatal death in the 7 days after birth did not
decrease significantly after the Essential Newborn Care training in the
overall cohort or in any specified subgroup.
- The overall rate of stillbirth decreased, owing primarily to a
reduction in the rate of fresh stillbirth (defined as the absence of
maceration).
- The rate of perinatal death did not decrease significantly after
Essential Newborn Care training.
- Despite an increased use of bag-and-mask ventilation in the
intervention clusters, rates of neonatal death from all causes,
stillbirth, and perinatal death in the 7 days after birth in the
Neonatal Resuscitation Program clusters did not differ significantly
from rates in control clusters.
The authors conclude that "these data suggest that training in basic
neonatal care may have a role in improving perinatal outcomes in the
developing world, although more work is needed to further reduce
perinatal mortality."
Carlo WA, Shivaprasad SG, Jehan I, et al. 2010. Newborn-care training
and perinatal mortality in developing countries. New England Journal of
Medicine 362(7):614-623. Free full-text available at http://content.nejm.org/cgi/content/full/362/7/614.
Readers: More information is available from the National Sudden and
Unexpected Infant/Child Death and Pregnancy Loss Resource Center at
Georgetown University as follows:
- Stillbirth at
http://sidscenter.org/AZtopics/S.html#s15
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6. REVIEW OF SIDS CASES REVEALS THAT MULTIPLE RISK FACTORS ARE PREVALENT
"We found that (1) SIDS [sudden infant death syndrome] in the absence
of risk was rare, even when risk factors were limited to those
described as being modifiable, (2) multiple concurrent risks
characterized the majority of cases, and (3) nonmodifiable risks were
commonly accompanied by modifiable ones," according to the authors of
an article published in Pediatrics (ahead of print) on February 15,
2010. Despite improved education on safe sleep practices, infants are
still exposed to multiple risks associated with SIDS, and variability
among health professionals with respect to the knowledge of risks and
in the provision of education to parents and other caregivers remains.
The article presents findings from a study to document the frequency
and co-occurrence of risks in SIDS cases and characterize the
combinations of risk. The goal of the study was to promote
comprehensive education of parents and other caregivers on methods for
reducing the risk of SIDS and to give physicians and other health
professionals a context for reviewing the thoroughness of their
educational initiatives.
The researchers conducted a population-based, retrospective database
review of all deaths in New Jersey that were coded as being caused by
SIDS for the period 1996-2000. The analyses determined the percentage
of cases with modifiable risks (nonsupine placement at last sleep,
maternal and paternal smoking, bed-sharing with an adult, and scene
risks [use of sofas, quilts, blankets, or pillow or the presence of
other children]) and those with two risks that are not directly
modifiable (prematurity and upper-respiratory infection) as reported by
the caregiver or medical examination. The analyses also determined the
number and type of concurrent risks and the number of cases with
risk-free status.
The authors found that
- When calculated as a ratio of all 244 cases, the percentage of
positive findings for each risk ranged from 70.5 percent for the
position risk (nonsupine sleep placement or discovery prone after
supine placement) to 25.4 percent for prematurity.
- One to seven risks were reported as being present in 96.3 percent
of all 244 cases; in 78.3 percent of cases there were between two and
seven concurrent risks present.
- Nine of the 244 cases (3.7 percent) had no positive risk factors.
However, seven were missing data on two to five risks per case,
precluding a definitive exclusion of risk. Thus, on the basis of
complete data, only two cases (0.8 percent of all 244) were free of
risk.
"These findings underscore the importance of providing comprehensive
risk-reduction education to parents and other caregivers. Future
studies are needed to assess trends in the patterns of risk in SIDS
cases as the AAP [American Academy of Pediatrics] guidelines,
risk-reduction campaigns, death-scene-investigation techniques, and
diagnostic criteria evolve. Case-control studies are also needed to
assess the relative risk not only of single risks but also of
combinations of risk," conclude the authors.
Ostfeld BM, Esposito L, Perl H, Hegyi T. 2010. Concurrent risks in
sudden infant death syndrome. Pediatrics [published online ahead of
print on February 15, 2010]. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-0038v1?papetoc
Readers: More information is available from the National Sudden and
Unexpected Infant/Child Death and Pregnancy Loss Resource Center at
Georgetown University at:
- Infant Mortality and Pregnancy Loss: Knowledge Path at
http://sidscenter.org/infant_mortality.html
- Risk Reduction at
http://sidscenter.org/AZtopics/R.html#r5
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MCH Alert © 1998-2010 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
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Health
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MCH Alert
Maternal and Child Health Library
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