National Center for Education in Maternal and Child Health

Visit the MCH Alert Home Page at alert

July 21, 2000

1. Infant Mortality Statistics Released; New SIDS Campaign Aimed at African Americans

2. Children's Self-Reports of Psychosocial Problems May Aid Physicians

3. Study Explores Link Between Preterm and Low-Birthweight Rates and Aggressive Management of High-Risk Births

4. Study Compares Screening Methods for Group B Streptococci Infections in Pregnant Women at Delivery

5. CDC Finds Decline in US Adolescent Pregnancy Rates From 1995 to 1997

************************************************************
1. INFANT MORTALITY STATISTICS RELEASED; NEW SIDS CAMPAIGN AIMED AT AFRICAN AMERICANS

Over 28,000 US infants died in their first year of life in 1998, for an overall infant mortality rate that remained the same as it had been the year before (7.2 infant deaths per 1,000 live births), according to a report from the National Center for Health Statistics of the Centers for Disease Control and Prevention. The report presents data for the US and 3-year average infant mortality rates for each state. The data are based on linked birth and death records for infants under 1 year of age who died in 1998.

Findings include the following:

• Infants born to black mothers had the highest infant mortality rate (13.8 per 1,000 live births), while those born to Japanese and Cuban mothers had the lowest rates (3.5 per 1,000 and 3.6 per 1,000, respectively). Other groups' rates per 1,000 live births were as follows: Chinese (4.0), Mexican (5.6), non-Hispanic white (6.0), Filipino (6.2), Puerto Rican (7.8), American Indian (9.3), and Hawaiian (10.0).
• The leading causes of infant mortality were 1) congenital anomalies, 2) disorders related to low birthweight, 3) sudden infant death syndrome (SIDS), 4) maternal complications, and 5) respiratory distress syndrome. The first three causes accounted for almost one-half of all infant deaths in the US. Congenital anomalies were the leading cause of death for all races and ethnic groups, except for infants of black mothers, for whom the leading cause of death was disorders related to low birthweight.
• Infant mortality rates for the period 1996-98 varied among states, ranging from 10.5 in Mississippi to 4.5 in New Hampshire. Among infants of black mothers, rates ranged from 17.1 in Illinois and Nebraska to 10.1 in Massachusetts. Among infants of American Indian mothers, rates ranged from 15.3 in Minnesota to 7.2 in New Mexico.

In related news, a new campaign to prevent SIDS has been launched in response to the results of a national survey showing that African Americans are less likely to put their babies to sleep on their backs, which is the preferred sleeping position to prevent SIDS, according to the US Consumer Product Safety Commission (CPSC) and the American Academy of Pediatrics. A survey of almost 500 parents with children under age 3 found that only 31% of African-American parents surveyed put their babies to sleep on their backs. The "Safe Sleep" campaign is sponsored by CPSC, Gerber Products, the Health Resources and Services Administration's Bureau of Primary Health Care, and Black Entertainment Television.

National Center for Health Statistics. 2000, July 20. Infant mortality statistics show variation by race, ethnicity, and state. News release available at <http://www.cdc.gov/nchs/releases/00facts/infantmo.htm>.

US Consumer Product Safety Commission. 2000, July 19. CPSC, Gerber, BPHC, BET launch campaign to lower African-American SIDS rates: New survey finds African-Americans less likely to place babies to sleep on their backs; SIDS rates twice as high as other groups. Available at <http://www.cpsc.gov/cpscpub/prerel/prhtml00/00144.html>.

************************************************************
2. CHILDREN'S SELF-REPORTS OF PSYCHOSOCIAL PROBLEMS MAY AID PHYSICIANS

Children's perceptions of their own daily functioning could provide physicians with an additional tool for assessing psychosocial problems, states a study in Archives of Family Medicine. The authors evaluated the usefulness of children's reports of their own functioning by comparing their self-reports to physicians' and parents' reports. An accompanying author's note states that "as the findings indicate, even children as young as 5 years can be an excellent source of information about themselves." The research was initiated in response to requests from family physicians who sought a way to screen for psychosocial problems in children without adding unnecessary time or expense to a routine office visit.

The Child Functioning Scale (CFS) is completed by both parents and children to assess the daily functioning of children in many arenas, such as school, family relationships, and health. The children's version is administered orally, and pictures are used to help children respond. The authors compared the CFS (completed by 107 mothers and children) with the physician's Pediatric Symptom Checklist (PSC) and physician reports on the psychosocial status of each child. The children were between the ages of 5 and 12; they attended community-based family medical practices for primary medical care.

Findings include the following:

• Of the children identified by the PSC as having psychosocial problems, physicians identified 20%, while the children's version of the CFS would have identified 53.3%.
• 11.2% of children who did not meet criteria for psychosocial problems on the PSC self-reported problems in daily functioning.
• Low agreement was found between parents and children about the presence of problematic daily functioning. The authors noted that similar findings are well documented in the research literature.

The authors highlighted the following study limitations: 1) the study uses a new, nonstandardized measure of child functional status (yet reliability and validity data supports its appropriateness for the research); 2) participants were mostly white and from similar socioeconomic status, with most having private insurance; 3) study physicians had all completed residency training and had been practicing in the community for many years; and 4) the study relied solely on paper-and-pencil measures and primarily on maternal report.

An accompanying article concludes that "the results of the research emphasize the need to both systematically screen for behavioral and emotional problems in children and value the input of the child. They are the patients and may have something important to say."

Wildman BG, Kinsman A, Smucker WD. 2000. Use of child reports of daily functioning to facilitate identification of psychosocial problems in children. Archives of Family Medicine 9(7):612-616.

Wildman BG. 2000. Author's comment. Archives of Family Medicine 9(7):616.

*****************************************************
3. STUDY EXPLORES LINK BETWEEN PRETERM AND LOW-BIRTHWEIGHT RATES AND AGGRESSIVE MANAGEMENT OF HIGH-RISK BIRTHS

A study in this week's Journal of the American Medical Association explores the rise in the incidence of preterm and low-birthweight births that is occurring even as more women are receiving prenatal care. The authors studied twin births (a high-risk group) using data from 1981 to 1997 from the National Center for Health Statistics of the Centers for Disease Control and Prevention.

Though it may seem that the incidence of preterm and low-birthweight births should decrease with increased prenatal care, the lead author states in a Health Resources & Services Administration press release that "by studying this high-risk group, the research shows that some of the rise in the pre-term birth rates may [actually] be due to more aggressive management of high-risk births" and that "how prenatal care affects birth outcomes may be far more complex than was previously thought." The study also found that twin infant mortality was lowest for those women who received intensive prenatal care during the study period.

Study findings include the following:

• The preterm birth rate for twins increased by 34% between 1981 and 1997 (from 40.9 to 55 per 100 live births).
• Women who had the most prenatal care visits had the steepest increase in preterm births from 1981 to 1997. Yet their infants were also least likely to die, with the twin infant mortality rate for women who received intensive prenatal care declining from 27.6 per 1,000 live births in 1983-84 to 17.8 per 1,000 live births in 1995-96.
• The rate of twin preterm deliveries involving either induction or first cesarean delivery also increased from 21.9% in 1989-91 to 27.3% in 1995-97. Women who received intensive prenatal care had higher levels of induction and first cesarean deliveries ( 23.2% in 1989-91 and 29.7% in 1995-97).

The authors conclude that "an apparent increase in medical interventions in the management of twins may result in the seeming incongruity of more prenatal care and more preterm births; however, these data suggest that women with intensive prenatal care utilization also have a lower infant mortality rate."

Health Resources and Services Administration. 2000, June 18. Study links increased preterm birth, lower infant mortality and aggressive prenatal care for women carrying twins. Press release available at <http://www.hrsa.gov/newsroom/releases/2000%20Releases/pretermbirths.htm>.

Kogan MD, et al. 2000. Trends in twin birth outcomes and prenatal care utilization in the United States, 1981-1997. Journal of the American Medical Association 284(3).

*****************************************************
4. STUDY COMPARES SCREENING METHODS FOR GROUP B STREPTOCOCCI INFECTIONS IN PREGNANT WOMEN AT DELIVERY

A study in this week's New England Medicine compares tests for group B streptococci infection, a leading cause of sepsis (blood poisoning), meningitis, and death among newborns in Western countries. The authors note that detecting this treatable infection in pregnant women at the time of delivery is highly desirable, since infants typically acquire the infection through genital tract contact with the mother during birth. Furthermore, it notes that 80% of all group B strep infections in infants occur within 1 week of birth, and detection at delivery would allow for the rapid treatment of newborns. The study compares DNA-based tests with the more standard approach of taking a culture, and finds that the DNA-based tests can identify group B streptococcus (strep) infection "rapidly and reliably."

The researchers evaluated the speed and accuracy of the standard culture method for detecting the group B strep (which requires at least 36 hours to process) and two DNA-based tests (a conventional polymerase-chain-reaction [PCR] test and a rapid PCR test) in pregnant women at the time of delivery. The study included 112 women who had been hospitalized for delivery.

Among the researchers' findings:

• Overall, the PCR tests detected group B strep slightly more often than the standard culture;
• The length of time required to obtain results was 30 to 45 minutes for the rapid PCR test, 100 minutes for the conventional PCR test, and at least 36 hours for a standard culture; and
• Whether the pregnant woman's membranes had ruptured before a specimen was collected did not significantly influence the ability of the PCR tests to identify carriers of group B strep.

Since normal labor and delivery generally takes 2 to 18 hours, the PCR tests should allow the detection of group B strep quickly enough for antibiotics to be given to an infant before birth, according to the research findings. The study points out that recommended early screening (at 35 to 37 weeks) does not necessarily identify women with the infection at the time of delivery.

The study concludes that the PCR test is a rapid and reliable tool for screening for group B strep in newborns. The authors state that "the use of this test at the time of delivery . . . may eventually result in a reduction in morbidity and mortality due to group B streptococcal infections in both mothers and their infants."

Bergman MG, et al. 2000. Rapid detection of group B streptococci in pregnant women at delivery. The New England Journal of Medicine 343(3):175-179.

***********************************************************
5. CDC FINDS DECLINE IN US ADOLESCENT PREGNANCY RATES FROM 1995 TO 1997

A report published in last week's Morbidity and Mortality Weekly Report finds a decline in national and state-specific pregnancy rates for adolescents 19 or under from 1995 to 1997 and a downward trend that began in the early 1990s. The article notes that each year in the US 800,000 to 900,000 adolescents ages 13 to 19 become pregnant and that "adolescent pregnancy and childbearing have been associated with adverse health and social consequences for young women and their children."

From 1995 to 1997, among females ages 15 to 19, the national number of pregnancies (the sum of live births, legally induced abortions, and estimated fetal losses) declined by 3.1%, and the national pregnancy rate (number of pregnancies per 1,000 females) declined by 7.8%, from 98.3 per 1,000 in 1995 to 90.7 in 1997.

In 1995 state-specific pregnancy rates per 1,000 females ages 15 to 19 ranged from 56.3 in North Dakota to 117.1 in Nevada; in 1996 they ranged from 53.9 in North Dakota to 114.1 in Texas; and in 1997 they ranged from 48.2 in North Dakota to 127.8 in Delaware. According to the article, during this period statistically significant declines occurred in 34 states; the declines ranged from 1.9% in Ohio to 19.8% in Maryland.

The article notes that the national number of abortions among females ages 15 to 19 declined by 2.7% from 1995 to 1997 and that the national abortion rate decreased by 7.4% during this period, falling from 26.6 per 1,000 in 1995 to 24.6 per 1,000 in 1997.

An accompanying editorial note states that the lack of age-specific abortion data and adequate race-specific abortion data for some states limited the estimation of national and state-specific adolescent pregnancy and abortion rates. Also, the lack of adequate age-specific abortion data by Hispanic ethnicity in at least half of the states means that "state-by-state comparisons of pregnancy rates for whites for states with large Hispanic populations should be interpreted with caution."

The editorial concludes, "Sustaining the downward trend in adolescent pregnancy will require addressing complex individual and community-level factors. . . . .Community- and school-based programs designed to reduce adolescent pregnancy that address risk factors and specific skills to postpone sexual experience and increase contraceptive use may be more effective in reducing adolescent pregnancy than programs focusing exclusively on change in sexual beliefs or behavior."

Behavioral Epidemiology and Demographic Research Br and Statistics and Computer Resources Br, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. 2000. National and state-specific pregnancy rates among adolescents--United States, 1995-1997. Morbidity and Mortality Weekly Report 49(27):605-611. Available at < <http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4927a1.htm>.

*************************************************************

To subscribe to the MCH Alert, send an email message to MCHALERT@LIST.NCEMCH.ORG, with SUBSCRIBE in the subject line. You do not need to enter any text in the body of the message.

To unsubscribe from the MCH Alert, send an email message to MCHALERT@LIST.NCEMCH.ORG, with UNSUBSCRIBE in the subject line. You do not need to enter any text in the body of the message.

************************************************************

The MCH Alert is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. In accordance with accepted publishing standards, the National Center for Education in Maternal and Child Health (NCEMCH) requests acknowledgment, in print, of any information reproduced in another publication.

Please include the following citation when reproducing sections of the MCH Alert in electronic or paper form:

MCH Alert. 2000. Arlington, VA: National Center for Education in Maternal and Child Health. <alert>.

We welcome your submissions, suggestions and questions. Please contact us at the address below.

SENIOR EDITOR: Jessica Grumet
EDITORIAL STAFF: Ruth Barzel
CONTRIBUTING STAFF: Beth DeFrancis
FOUNDING EDITOR: Laura Kavanagh

National Center for Education in Maternal and Child Health
2000 15th Street North, Suite 701
Arlington, VA 22201
(703) 524-7802
(703) 524-9335 FAX
Email: jgrumet@ncemch.org
http://www.ncemch.org

The MCH Alert is produced by the National Center for Education in Maternal and Child Health under its cooperative agreement (MCU-119301) with the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.

************************************************************