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 SUID/SIDS Resource Center at Georgetown University. This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html and http://www.mchlibrary.info/suid-sids/alert/archives.html

November 18, 2011

Readers: The next issue of MCH Alert will be published on December 2, 2011; the next issue of MCH Alert: Focus on Infant Mortality will be published on January 27, 2011.

Multimedia Featured Resource: Cultural and Linguistic Competence Self-Assessment for Fetal and Infant Mortality Review (FIMR) Programs was held on October 25, 2011, co-sponsored by the National Center for Cultural Competence and the National Fetal and Infant Mortality Review Resource Center with support from the Health Resources and Services Administration's Maternal and Child Health Bureau. The webinar reviewed the concepts of cultural and linguistic competence as they apply to the FIMR process, the benefits and principals of self-assessment, and approaches to self-assessment as they apply to the FIMR process. The Cultural and Linguistic Competence Organizational Assessment Instrument for FIMR programs was also discussed. The archived webinar is available at http://nccc.georgetown.edu/Webinars.html

  1. Curriculum Focuses on Bereavement Support for African-American Families
  2. Article Compares Effectiveness of Office-Based Care vs Nursing Home Visit
  3. Research Uses Asphyxia-Focused Classification System to Determine Cause of Sudden Unexpected Infant Death
  4. Authors Report on Association Between Maternal Birth Outcomes and Infant Mortality

1. Curriculum Focuses on Bereavement Support for African-American Families

The African American Faith-Based Bereavement Initiative has released a series of online modules to enhance the faith community's support for families who experience pregnancy or infant loss. The initiative was created by the SUID/SIDS Project at the National Center for Cultural Competence at Georgetown University in partnership with the SUID/SIDS Program Support Center at First Candle to respond to the needs of families within their faith communities. The modules were produced with funding from the Health Resources and Services Administration's Maternal and Child Health Bureau and the National Institute for Child Health and Human Development. The modules were designed for use by several audiences and specifically to improve supports for African-American Christian families. Audiences include clergy in churches, those who serve as chaplains in health care settings, and those who serve as pastoral counselors. The modules are also intended for use in seminary courses and seminars to ensure that clergy-in-training are prepared to support the unique bereavement needs of families that experience pregnancy or infant loss. The modules are available at http://nccc.georgetown.edu/AAFBBI/index.html


2. Article Compares Effectiveness of Office-Based Care vs Nursing Home Visit

"The results of this study suggest that HNVs [home nursing visits] are a safe and effective alternative to OBC [office-based care] for the initial outpatient encounter for newborns and mothers after hospital discharge with some modest added benefits to visit timeliness, breastfeeding, and parenting sense of competence," write the authors of an article published in the Archives of Pediatric and Adolescent Medicine online on November 7, 2011. Shorter hospital stays following childbirth in recent decades have increased the likelihood that conditions requiring intervention will go unnoticed. The study described in this article compares the typical OBC model of postnatal/postpartum health care with a model using an HNV as the initial postdischarge encounter for well breastfeeding newborns and mothers.

Study participants included 1,154 postpartum mothers who delivered at the Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania, between September 12, 2006, and August 1, 2009, who intended to breastfeed and their 1,169 newborns of at least 34 weeks' gestation. Participating mothers were randomized to either the OBC or the NHV group. The primary outcome was maternal and infant use of unplanned health care services (inpatient, emergency department [ED], urgent or acute care, primary care, mental health) in the 14 days after delivery. Secondary outcomes included breastfeeding duration and exclusivity, maternal postpartum depression, state anxiety, perceived social support, parenting self-efficacy, and maternal satisfaction with care.

The authors found that

The authors conclude that "especially for hospitals and communities where access to timely postdischarge care is problematic, HNVs should be considered as an option, especially given the potential benefits for breastfeeding and parenting sense of competence."

Paul IM, Beiler JS, Schaefer EW, et al. 2011. A randomized trial of single home nursing visits vs office-based care after nursery/maternity discharge. Archives of Pediatric and Adolescent Medicine [published online on November 7, 2011]. Abstract available at http://archpedi.ama-assn.org/cgi/content/abstract/archpediatrics.2011.198v1

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

- Home Visiting: Resource Brief at
http://www.mchlibrary.info/guides/homevisiting.html


3. Research Uses Asphyxia-Focused Classification System to Determine Cause of Sudden Unexpected Infant Death

"We determined that asphyxia contributed to or caused death in . . . 40-49 [percent] of 83 cases originally designated as SIDS [sudden infant death syndrome]," write the authors of an article published in Forensic Science, Medicine, and Pathology online on November 11, 2011. When undetermined, the cause of death for SUID (sudden unexpected infant death) cases generally defaults to SIDS. The article examines causes of death in a group of SUID cases assigned by multiple reviewers using a recently published classification scheme for SUID based on asphyxia risk at the death scene. The authors also compare the assigned causes of death to the cause originally assigned by the medical examiners of record who performed the autopsies. The researchers hypothesized that multiple reviewers would certify differently causes of death in a group of SUID cases and that the new cause-of-death assignments would result in a reduction in the percentage originally certified as SIDS.

Pathologists reviewed narrative death scene and autopsy reports of 117 cases drawn from a database containing all SUID cases undergoing postmortem examination by the San Diego Medical Examiner's office from 1991 to 2008. For this study, the reviewers used the San Diego SIDS definition, a widely accepted and used definition that includes the criterion "with [the] onset of the fatal episode apparently occurring during sleep." They defined asphyxia as "interference with the intake or use of oxygen combined with failure to eliminate carbon dioxide." Cases with suspected or confirmed inflicted injuries were excluded from the study. Each reviewer assigned a diagnostic category using the following classification: (A) SIDS; (B) unclassified, possibly asphyxia-related; (C) unclassified, non-asphyxia-related; (D) unclassified, other; (E) unclassified; and (F) known cause of death, either natural or unnatural manner.

The authors found that

"Our findings suggest that currently widely adopted SIDS definitions may be suboptimal in capturing and focusing specifically upon the potential role of asphyxia in SUID," the authors conclude.

Randall B, Donelan K, Koponen M, et al. 2011. Application of a classification system focusing on potential asphyxia for cases of sudden unexpected infant death. Forensic Science, Medicine, and Pathology [published online on November 11, 2011]. Abstract available at http://www.springerlink.com/content/xu34681218307t3g

Readers: More information is available from the National SUID/SIDS Resource Center as follows:

- Responding to Sudden Infant Death: First Responders at
http://www.mchlibrary.info/suid-sids/firstresponders.html


4. Authors Report on Association Between Maternal Birth Outcomes and Infant Mortality

"This study reported a statistically significant association between infant mortality, maternal birth weight and gestational age. The study also showed a racial difference in this association," state the authors of an article published in the November 2011 issue of the Maternal and Child Health Journal. Although studies have examined the association between maternal and infant birth outcomes, few have examined the association between maternal birth outcome (i.e., whether women themselves were born with low birthweight [LBW] or with normal weight) and infant mortality. The article examines the influence of maternal LBW and preterm birth on infant mortality (death of a live born infant occurring before the first birthday).

The study used 1997-2001 birth and infant death registry data collected by the Virginia Division of Health Statistics. All infant deaths (cases) and randomly selected infant births (controls) occurring during this time were linked to maternal birth registry data. The grandmother's demographic and pregnancy history was obtained from the mother's birth registry data. The study excluded multiple plurality births (n=270 infants) and mothers who were not born in Virginia or whose birth record was not found in the Virginia Birth Registry (n=1,319). The final sample included 414 singleton infant deaths and 328 live infants whose data were linked to the maternal birth registry dataset. Covariates examined included race and ethnicity, age, education, marital status, adequacy of prenatal care, tobacco use during pregnancy, and methods of payment.

The authors found that

These findings "suggest that there exists a strong fetal component associated with African American LBW mothers that contributes to the racial disparity in subsequent infant LBW, prematurity and death," conclude the authors.

Masho SW, Archer PW. 2011. Does maternal birth outcome differentially influence the occurrence of infant death among African Americans and European Americans? Maternal and Child Health Journal 15(8):1249-1256. Abstract available at http://www.springerlink.com/content/w50nx1766m2h2340

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

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

- Life Course and Social Determinants: Resource Brief at
http://www.mchlibrary.info/lifecourse/index.html


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MCH Alert © 1998-2011 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 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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The Maternal and Child Health Library Team

Ruth Barzel, M.A., Senior Editor
Jolene Bertness, M.Ed., MCH Alert Editor
Beth DeFrancis, M.L.S., Associate Librarian
Tracy Lopez, M.S.L.S., Associate Librarian
Susan Lorenzo, M.L.S., Associate Librarian
Rochelle Mayer, Ed.D., NCEMCH Director
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Olivia Pickett, M.A., M.L.S., Director of Library Services
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Michael Wilkinson, Technology Developer

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