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.

July 30, 2010

Multimedia Featured Resource: The Juvenile Products Manufacturing Association (JPMA), in collaboration with association, medical, media, and manufacturer partners, has launched a new campaign to educate parents and caregivers about the importance of creating a safe sleep environment for infants and young children. The campaign Web site contains a series of videos demonstrating safe sleep practices; safety tips; news; and brochures and other campaign partner resources on juvenile product safety. Information on crib parts, hardware, and assembly instructions; a list of sleep-related infant product recalls; and recommendations for preventing sudden infant death syndrome and sudden unexpected infant death  are included. The Web site also contains information on Baby Safety Month, which is sponsored annually in September by JPMA. The Web site is available at http://www.cribsafety.org

1. NEW BIBLIOGRAPHY FEATURES ARTICLES ON SUDDEN UNEXPECTED INFANT DEATH

Sudden Unexpected Infant Death: A Selected Annotated Bibliography cites recent journal articles on sudden unexpected (or unexplained) infant death from MEDLINE and other life science journals. The bibliography contains citations from PubMed (a service of the National Library of Medicine) selected by staff of the National Sudden and Unexpected Infant-Child Death and Pregnancy Loss Resource Center. Topics include management and public health issues and causes of sudden infant death that have been identified or hypothesized. The bibliography also includes a tool customized to search PubMed for additional articles on this topic. The bibliography is available at http://www.sidscenter.org/TopicalBib/UnexpectedDeath.html

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• At time 1 (immediately postpartum), approximately 95 mothers (80 percent) had received information on positioning the infant on his or her back while asleep; 19 (15 percent) had received information on positioning the infant on his or her abdomen. Fifty-three (45 percent) had received no information on positioning when the infant was awake and no information on TT.
• Mothers' main source of information on infant positioning was nurses on the postpartum floor, followed by the hospital physician. No mothers noted the Internet as a source of information.
• At time 2 (2 months postpartum), 26.44 percent of the mothers had received information about awake-time infant positioning, compared with 83.72 percent who had received information on sleep-time positioning.
• Main sources of instruction on infant positioning were once again nurses and physicians. Twelve percent of mothers had used the Internet as a source.
• At time 2, most mothers (71 percent) put their infant in TT two times per day or less, and more than half of the infants were in TT for 3 to 5 minutes or less.
• Focus groups identified the following barriers among health professionals to counseling parents about TT: availability of time, confusion about the guidelines, and legal implications. Family barriers to implementing TT were confusion, fear, the infant's frustration with TT, and cultural practices.

The authors conclude that "in addition to highlighting the need for future research on parental understanding about infant positioning, this study also suggests the need for future research to provide an evidence base for TT education for parents of young children and for the possibility of a marketing campaign to better educate parents about this important aspect of infant care."

Koren A, Reece SM, Kahn-D'angelo L, et al. 2010. Parental information and behaviors and provider practices related to tummy time and back to sleep. Journal of Pediatric Health Care 24(4):222-230. Abstract available at http://www.jpedhc.org/article/S0891-5245%2809%2900139-4/abstract

Readers: More information is available from the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University as follows:

- Safe Sleep Environment at
http://www.sidscenter.org/SafeSleep/index.html

- Tummy Time (A-Z Topic) at
http://www.sidscenter.org/AZtopics/T.html#t3

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4. AUTHORS DESCRIBE COMMUNITY-BASED APPROACH TO UNDERSTANDING AND ADDRESSING INFANT MORTALITY

"Since its introduction to US urban communities a decade ago, the PPOR [Perinatal Periods of Risk] approach has become an important component of local MCH [maternal and child health] practice for improving MCH outcomes," state the authors of an article published in the Maternal and Child Health Journal online (ahead of print) on July 3, 2010. To carry out core public health functions, MCH programs need health assessment and planning approaches that help identify gaps, target inquiry, and suggest interventions. Moving from data and analysis to measurably improving perinatal outcomes in urban areas has been hampered in part by insufficient community engagement, limitations of available data, and complexity of the problems being addressed. It can be difficult for some community partners to understand complex public health problems like infant mortality. Public health approaches to reducing infant mortality historically have not fully involved community-based partners in the process of data collection, analysis, interpretation, and dissemination. PPOR offers a comprehensive community-based approach for translating data into strategic actions to improve women’s and infants' health. The article describes the history, purpose, and methods of the PPOR approach.

The authors note that PPOR is based on core principles of full community engagement and equity and follows a six-stage community- based planning process. The six stages of the PPOR approach are as follows:

• In Stage 1, communities are mobilized and engaged, related planning efforts are aligned, and community and analytic readiness are assessed.
• In Stage 2, feto-infant mortality is mapped, excess mortality is estimated, likely causes of feto-infant mortality are determined, and appropriate actions are suggested.
• Stage 3 produces action plans for targeted prevention strategies.
• Stages 4 and 5 include implementation, monitoring, and evaluation.
• Stage 6 fosters political will to sustain efforts.

• There were an estimated 43,562 car-seat-related injuries treated in hospital EDs in the United States during the 5-year period, with an annual estimate of 8,712 injuries.
• The average age of the infants was 4.07 months plus or minus 2.73 months.
• Eighty-five percent of the injuries were related to falls. Of these, 64.8 percent were caused by infants falling out of car seats that were carried or placed on an elevated surface; 14.6 percent of the injuries were caused by car seats falling from elevated surfaces; and 5.6 percent were caused by falls, not specified.
• Head and neck injuries constituted the majority of injuries for the sample.