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.sidscenter.org/alert/archives.html
January 27, 2012
1. Article Describes Pilot Program to Improve Data on Sudden Unexpected Infant Death
The Sudden Unexpected Infant Death Case Registry: A Method to Improve Surveillance describes a multi-state pilot program to enhance knowledge of factors surrounding sudden unexpected infant death (SUID) events and improve investigation practices. The article, published in the February 2012 issue of Pediatrics, begins with an overview of issues related to the difficulties of accurately classifying SUIDs. It then goes on to discuss child death review (CDR) and collaboration between the Centers for Disease Control and the National Center for Child Death Review to build on and enhance CDR. Topics include the program model; case identification, notification, and review; data entry and analysis; dissemination and translation; prevention and intervention activities; evaluation; and progress to date. Abstract available at http://pediatrics.aappublications.org/content/early/2012/01/04/peds.2011-0854.abstract
2. Report Examines Trends in Postneonatal Mortality Among Alaska Native Infants
"Lack of progress in reducing postneonatal mortality, particularly among AN [Alaska Native] infants, indicates a need for renewed emphasis within the Alaska health-care community," state the authors of a report published in the January 13, 2012, issue of Morbidity and Mortality Weekly Report. Alaska's postneonatal mortality rate of 3.4 deaths per 1,000 live births during 2006-2008 was 48 percent higher than the 2007 U.S. rate of 2.3 per 1,000. Among American Indian-Alaska Native (AI-AN) infants, the Alaska rate of 8.0 per 1,000 was 70 percent higher than the U.S. rate of 4.7. The report examines temporal trends in postneonatal mortality in Alaska, specifically in the AN population.
The Alaska Bureau of Vital Statistics provided an electronic file with linked records for the 222,317 recorded live births and 821 postneonatal deaths among infants ages 28-364 days born to Alaska residents during 1989-2009. Potential risk factors for infant mortality that might be determined from information included on birth certificates were identified through prior research and literature review. Those risk factors included infant birthweight and gestational age; maternal race, years of education, age, and prenatal cigarette, smokeless tobacco, and alcohol use; and a composite variable reflecting maternal marital status and presence of a father's name on the birth certificate. Race was categorized as AN, which included all indigenous groups, or non-AN, based on mother's race. Cause of death was obtained from the Alaska Maternal Infant Mortality Review (MIMR), a committee coordinated by the Alaska Division of Public Health comprising private physicians, nurses, and other child health experts. At the time of this report, the MIMR committee had reviewed medical records, autopsy reports, police reports, and other records for more than 99 percent of Alaskan postneonatal deaths that occurred during 1992-2007 and issued findings about causes of the deaths, contributing factors, and preventability recommendations.
The authors found that
The authors conclude that "current initiatives to reduce preventable causes of postneonatal mortality should be evaluated and successful models more widely implemented."
Centers for Disease Control and Prevention. 2012. Postneonatal mortality among Alaska Native infants -- Alaska 1989-2009. Morbidity and Mortality Weekly Report 61(01):1-5. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a1.htm
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
- Racial and Ethnic Disparities in Health: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_race.html
3. Authors Assess Effects of Postnatal Secondhand Smoke Exposure in the Home on SIDS Rates
"The findings of this ecological study indicate a statistical association between the increasing prevalence of smoke-free home rules among homes with infants and decreasing cases of SIDS [sudden infant death syndrome]," state the authors of an article published in the January 2012 issue of Tobacco Control. Several modifiable factors have been associated with SIDS, including postnatal exposure to secondhand smoke (SHS) and infant sleep position. Published data show that the percentage of infants sleeping in the supine position has increased and that declines in SIDS rates have in part been attributed to improved infant sleep position practices. Improvements have also been made since the early 1990s in reducing childhood exposure to SHS, but temporal trends in state-specific prevalence of smoke-free homes with infants have yet to be reported. The article examines the association between changing infantile SHS exposure levels at home with the occurrence of SIDS while controlling for changing patterns in infant sleep position.
The researchers computed live births and SIDS cases for the years 1995 through 2006 using Period Linked Birth-Infant Death Files from the National Vital Statistics System. State-specific percentages of smoke-free homes with a child under age 1 were computed from the Tobacco Use Supplement to the Current Population Survey. The percentage of infants in supine sleep position was calculated from National Infant Sleep Position data. The analyses tested the significance of the independent temporal trends in SIDS rates, smoke-free homes with infants, and supine sleep position. Population estimates were calculated for risk of SIDS from postnatal exposure to SHS. Excess attributable deaths were summed across states to estimate cumulative national SIDS mortality as well as annual rates per 100,000 live births.
The authors found that
"The results suggest that increased voluntary smoke-free home policies among homes with at least one infant may have an important role in reducing the rates of SIDS, the largest cause of infant mortality in the post-neonatal period," conclude the authors.
Behm I, Kabir Z, Connolly GN, et al. 2012. Increasing prevalence of smoke-free homes and decreasing rates of sudden infant death syndrome in the United States: An ecological association study. Tobacco Control 21(1):6-11. Abstract available at http://tobaccocontrol.bmj.com/content/21/1/6.abstract
Readers: More information is available from the following MCH Library resource:
- Smoking/Tobacco Use Prevention: Bibliography of Materials from MCHLine at
http://www.mchlibrary.info/databases/bibliography.php?target=auto_search_smokingprev
4. Study Explores Population-Based Sleep Position Trends by Race
"This study found differing trends in infant sleep positioning from 1996 to 1997 between white and black infants in South Carolina," state the authors of an article published in the February 2012 issue of the Maternal and Child Health Journal. In 1992, the American Academy of Pediatrics (AAP) issued the first in a series of recommendations advocating non-prone infant sleep positioning. Beginning in 2005, responding to new results on the risk of lateral sleeping for sudden infant death syndrome (SIDS), AAP recommended that infants be placed for sleep in the supine position only and explicitly discouraged lateral sleep positioning for the first time. The article presents findings from a population-based survey to examine trends in infant sleep positioning in South Carolina. The authors also explore factors associated with prone and lateral positioning among blacks vs whites.
The researchers used data from the 1996-2007 South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS). The analytic sample included 9,015 mothers (5,028 white; 3,987 black) interviewed from 2000 to 2007. (Results are generalizable only to South Carolina non-Hispanic white and black infants living with their mothers from 1996 to 2007). PRAMS asked mothers, "How do you most often lay your baby down to sleep now?" The answer choices were "on his or her side," "on his or her back," and "on his or her stomach," which correspond to lateral, supine, and prone sleep positioning, respectively. Those selecting more than one sleep position were coded as the riskier sleep position according to this order: prone, lateral, and supine positioning. The following variables were examined as potential predictors of infant sleep positioning: infant's birthweight, gender, gestational age at birth, and age at the time of survey; mother's age, smoking status after pregnancy, parity, and initiation of prenatal care in the first trimester; and household poverty index. Additionally, differences between urban and rural counties were assessed. For all analyses other than trend analysis, infant's year of birth was dichotomized as 2000-2005 compared to 2006-2007 (to evaluate the effect of AAP's infant sleep positioning recommendations published in November 2005).
The authors found that
"The racial differences we observed in trends in infant sleep positioning indicate that additional efforts are necessary to increase the proportion of black mothers who adhere to infant sleep positioning recommendations, while still communicating these recommendations effectively to white mothers," conclude the authors.
Smith MG, Liu J-H, Helms KH, et al. 2012. Racial differences in trends and predictors of infant sleep positioning in South Carolina, 1996-2007. Maternal and Child Health Journal 16(1):72-82. Abstract available at http://www.springerlink.com/content/m24t0156253rthh7
Readers: More information is available from the National SUID/SIDS Center Resource Center as follows:
- Safe Sleep at
http://www.sidscenter.org/SafeSleep/index.html
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