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.

September 25, 2009

1. PROGRAM SUPPORT AND TRAINING RESOURCE POSTED ONLINE

Helping Babies, Healing Families: A Program Manual and Trainer's Guide for Sudden and Unexpected Infant/Child Death and Pregnancy Loss supports state and local program staff in providing comprehensive risk reduction and bereavement services to families and their extended support networks, including health professionals. The online resource was adapted from a 2006 print document developed by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Program Support Center and funded by the Maternal and Child Health Bureau (MCHB). Topics include what is sudden infant death syndrome, risk-reduction education, bereavement-support services, training, program expansion, research and statistics, partnerships and collaborations, public relations and the media, and fundraising and development. Information on how to conduct trainings, presentations, and informational sessions with public health nurses, first responders, child care providers, community groups, and others is included. The resource is available at http://www.programmanual.info

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• The proportion of preterm birth was 10.3 percent (0.8 percent preterm PROM, 3.7 percent indicated preterm birth, and 5.8 percent preterm labor).
• The neonatal death risk was 2.7 percent for preterm PROM, 1.8 percent for indicated preterm birth, and 1.1 percent for preterm labor.
• The effects of preterm birth subtypes differed by gestational age. Preterm PROM and indicated preterm birth had higher risk of neonatal death than preterm labor after 28 weeks of gestation. The increased risk was not limited to early neonatal death in the first 7 days.
• When causes of neonatal death were separated, preterm birth subtypes had different associations with these causes. At 24-27 weeks, indicated preterm births tended to have a higher risk of neonatal death from respiratory distress syndrome and respiratory conditions and birth defects. At 28-36 weeks, preterm PROM also had higher risk of neonatal death from these two conditions. Indicated preterm birth had higher risk of neonatal death from all causes at 32-36 weeks.

• A total of 526 pictures from 34 issues were included in the analysis.
• Of the 122 pictures of sleeping infants, 33 portrayed infants being held by an adult or in a sitting position in a car seat, carrier, or swing. Of the infants not being held, 57 (64 percent) were in the supine position, and 32 (36 percent) in the side or prone position. Ten of the sleeping infants were swaddled.
• The location where an infant was sleeping was identifiable in 31 pictures. Sleeping infants were most likely to be in slings or backpacks (9 pictures), adult beds (7 pictures), cribs (5 pictures), sofas (4 pictures), or car seats, carriers, or swings (3 pictures).
• Infants were pictured sleeping with blankets (26 pictures), pillows (10 pictures), stuffed toys (2 pictures), and wedges (1 picture), and on soft surfaces (15 pictures).
• Of the 99 pictures of sleep environments that did not have an infant visible, only 36 (36.4 percent) portrayed a safe sleep environment as recommended by AAP.

• The stillbirth hazard was highest at 20-23 weeks and 39-41 weeks of gestation.
• Increased hazard was observed at every gestation interval for blacks compared with the other racial-ethnic groups. The black-white disparity in cumulative hazard was highest at 20-23 weeks (relative risk, 2.75) and declined with increasing gestation, reaching the lowest value at 39-40 weeks (relative risk, 1.57), and then increasing slightly at 41 weeks.
• The stillbirth hazard for white women with 12 years or more of education was 30 percent lower than the hazard for white women with 12 years or less of education. The influence of higher educational level on reducing cumulative hazard of stillbirth was much less for blacks (relative risk, 0.91) and not significant for Hispanics.
• The greatest contribution of pregnancy conditions to stillbirth hazard occurred at less than 27 weeks of gestation.
• The contribution of any maternal condition (reported medical, pregnancy, and labor conditions combined) to stillbirth hazard was 19.56 percent for non-Hispanic whites, 19.28 percent for Hispanics, and 30.9 percent for blacks.
• The contribution of small for gestational age and congenital anomalies to stillbirth hazard was greater for whites compared with blacks at preterm gestations, especially between 20-27 weeks, but similar at 37-41 weeks.