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.

December 17, 2010

Readers: The next issue of MCH Alert will be published on January 7, 2011. Happy Holidays!

Multimedia Featured Resources: The National Sudden Unexpected Infant-Child and Pregnancy Loss Resource Center's website contains archived and resource materials from the following events:

• Opportunities in Health Reform to Prevent Infant Death. This webinar was held on September 16, 2010, as the third in a series of quarterly webinars to strengthen sudden unexpected infant death, sudden infant death syndrome (SIDS), infant safe sleep, and bereavement services across the United States. The series is co-sponsored by the Association of SIDS and Infant Mortality Professionals (ASIP) and the Association of Maternal and Child Health Programs (AMCHP). Topics included (1) opportunities for maternal and child health under health reform legislation, (2) promoting preconception and interconception health through improved insurance coverage and benefits, (3) optimizing home visiting program investments, and (4) leveraging investments from the Prevention and Public Health Fund. The webinar archive and resources are available at http://www.sidscenter.org/podcasts/2010/asip_amchp/3_webinar.html.
• The archive and resources from the fourth webinar in the ASIP-AMCHP series, Addressing Racial Disparities in Infant Sleep Practice: New Perspectives and Recommendations, held on December 9, 2010, will be available soon at http://sidscenter.org/podcasts/2010/asip_amchp/index.html.
  
• Hot Topics in Infant Safe Sleep: An Interactive Workshop with Rachel Moon, M.D. This video was recorded during a pre-conference workshop held in November 2010 at the International Conference on Perinatal and Infant Death. The video was produced for the resource center's Wisdom from the Field series of video and audio podcasts featuring personal stories from the field. Topics included reflux and car seat sleeping; bed sharing, co-sleeping, and breastfeeding; twin crib-sharing; breastfeeding and sudden infant death syndrome; swaddling; and soft bedding and bumper pads. The podcast is available at http://sidscenter.org/podcasts/ASIP_2010_Safe_Sleep.html.

1. THE OFFICE OF THE SURGEON GENERAL PUBLISHES RESOURCES ON THE SCIENCE OF TOBACCO AND DISEASE

How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease describes the ways tobacco smoke damages organs in the body and causes disease and death. The report, produced by the Office of the Surgeon General, examines how and why smokers become addicted and how nicotine compares with heroin and cocaine in its hold on users and its effects on the brain. In addition, the report discusses how chemicals in cigarette smoke impair the immune system and why smokers are more likely than nonsmokers to suffer from chronic diseases. The report, companion booklets for consumers and clinicians, and additional online resources are available at

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Acueste a Su Bebé Boca Arriba Para Dormir (Helping Baby Back to Sleep) encourages parents to place infants (under age 1) on their backs for sleep and explains why back sleeping helps lower an infant's risk for sudden infant death syndrome. The Spanish-language brochure was produced by the National Sudden and Unexpected Infant-Child Death and Pregnancy Loss Resource Center at Georgetown University. Contents include tips for parents on helping infants fall asleep, what to do when they roll over during sleep, and how to return them to sleep if they awaken during the night. Other tips include how to create a safe sleep environment and the importance of "tummy time" when infants are awake during the day. Contact information for the resource center and partner organizations is provided. The brochure is available at http://sidscenter.org/documents/SIDRC/HelpingBaby_Spanish.pdf.
The brochure (in Spanish and English) can also be ordered in print or downloaded at http://www.sidscenter.org/order/index.html.

"The results of this project demonstrate that sustainable infant safe sleep practices can be consistently and effectively established in the hospital setting," write the authors of an article published in the November-December 2010 issue of the Journal of Obstetric, Gynecologic, and Neonatal Nursing. Infants who sleep on their backs in a safe sleep environment have a decreased risk of dying suddenly and unexpectedly. Back sleep is supported by a substantial body of evidence and is a simple, inexpensive intervention for parents and communities. Nevertheless, it is inconsistently adopted and often rejected by parents with concerns about infant comfort, choking, and inconsistent advice from physicians. Infant death rates for African Americans are much higher than rates for whites. Studies have indicated that parents listen to nurses and model nurses' actions regarding the sleep position of their new infant. This article describes a 4-year demonstration project (2004-2007) to reduce infant deaths related to sleep environments by changing attitudes and practices among nurses who work with African-American parents and caregivers in urban Michigan hospitals. The collaborative effort was initiated by Tomorrow's Child-Michigan SIDS with urban hospitals to improve adoption of evidence about infant safe sleep in routine hospital care of newborns and their mothers and to identify the effects of policy changes on nursing practice. The purpose of the project was to develop a model for creating sustainable changes in nurses' behaviors that could be monitored through quality-improvement processes already established within the hospital organization.

Seven hospitals in three geographically diverse urban regions of Michigan and with high disparities in death rates between African-American and white infants participated in the project. A total of 635 staff nurses who worked with new mothers and their infants across the seven hospitals completed a questionnaire assessing their knowledge of risk factors for SIDS and of infant safe sleep practices; they also completed in-service trainings. Cribs were audited, and a total of 2,678 mothers of newborns were asked to answer three questions during their post-delivery hospital stays (whether they had received infant sleep information, had a crib at home, and were planning on using a crib).

The authors found that

• At the beginning of the project, none of the hospitals had nursing policies that met established criteria for adequate safe sleep practice. Each hospital drafted new model policies. There was a small but significant increase in the number of safe sleep items that nurses correctly identified after the education program. There was no significant change in nurses' ability to identify SIDS risk factors before vs. after the program.
•  Following the project, significantly more nurses held the opinion that back sleep was safest and also knew that back sleep was recommended by the American Academy of Pediatrics.
•  Among infants who were in their cribs at the time of crib audits, there was a significant increase in the percentage of infants on their backs from pre- to post-policy change.
•  There was a significant increase in the percentage of mothers who had been told about infant safe sleep (from 62.7 percent to 91.4 percent). At both pre- and post-audits, nearly all mothers indicated that they had cribs at home and planned to use them.
  

The authors conclude that "education may change knowledge; but change in practice requires authority and infrastructure."

Shaefer SJM, Herman SE, Frank SJ, et al. 2010. Translating infant safe sleep evidence into nursing practice. Journal of Obstetric, Gynecologic, and Neonatal Nursing 39(6):618-626. Abstract available at http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2010.01194.x/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

"These findings support the hypothesis that both income and income inequality affect infants' health outcomes," state the authors of an article published in the December 2010 issue of Pediatrics. The impact of income inequality on infant and child health is a particularly pressing question in the United Sates, because the gap between individuals with high incomes and those with low incomes in this country has increased significantly in the past 40 years. A significant portion of the increase in the Gini coefficient (a widely accepted statistical measure of income disparity) for U.S. households occurred recently; however, most published studies that examined infant and child health and income inequality within the United States do not include data from the current decade. The article examines the associations of both income and income inequality with neonatal and infant health by focusing on four key indicators: the preterm rate, the proportion of infants with low birthweight, the proportion of infants with very low birthweight, and the infant mortality rate (IMR) during the period 2000-2004.

The researchers obtained data on health indicators, family income, and children living in poverty from the Annie E. Casey Foundation Kids Count Data Center website. Income first was evaluated using median family income. Then, to delineate the impact of increasing amounts of poverty on health, children living in poverty were stratified into four groups on the basis of family income. Income inequality was measured using the Gini coefficient for each state for the period 2000-2004 (obtained directly from the U.S. Census Bureau Current Population Survey). The analyses evaluated associations between the proportion of children living in poverty and the four neonatal and infant health indicators, as well as associations between the health indicators, median income, poverty, and income inequality.

The authors found that

• Median family income was found to explain a significant proportion of the variance in rate for each of the outcomes, with decreasing income levels being associated with worse health outcomes for neonates and infants with respect to all four outcomes.
•  Income inequality also explained a significant proportion of the variance in rate for each outcome.
•  The poorest infants' health was affected more by poverty than by income inequality. This trend gradually reversed for infants living in lesser degrees of poverty.

"The results of this study document that the health of the poorest infants in our country is affected more by absolute income than by relative income," conclude the authors, adding that "ensuring health care access for all may not be sufficient; it also may be necessary to focus on interventions that address poverty and decrease income inequality to make significant improvements in infant health outcomes in this country."

Olson ME, Diekema D, Elliott BA, et al. 2010. Impact of income and inequality on infant health outcomes in the United States. Pediatrics 126(6):1165-1173. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/126/6/1165.

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

- Infant Mortality and Pregnancy Loss: Resources for Families at