There were 23,094 natural deaths of children under the age of one in the United States in 2000, excluding SIDS. More than two-thirds of these babies die within the first 28 days of life. Most of these babies are born prematurely (before 37 weeks gestation) and/or are born with a low birth-weight (under five pounds). Prematurity and low birth weight are the greatest predictors of infant mortality.
While vast improvements have been made in treating premature infants, preventing pre-term low birth weight babies is still a great challenge. The rate of pre-term birth has increased 17% in the U.S. since the 1980’s, and the rate of low birth weight has risen 10%. For reasons not fully understood, these problems take a disproportionate toll on black Americans. Nationally, black mothers are twice as likely to give birth pre-term as white mothers.
There are still many gaps in our understanding of why some women go into labor well ahead of schedule. It is believed that cigarette smoking, disorders that raise blood pressure, prior pre-term birth and certain pregnancy complications increase the risk of prematurity. Other significant risks include genital tract infections, stress, anxiety, depression and other psychological factors. Adequate prenatal care is an effective intervention that improves pregnancy outcomes. Early access to quality pre-natal care, including health promotion, risk assessment and appropriate interventions can prevent both pre-term births and ensure that babies are born at normal birth weights.
- Major Risk Factors
- Prior pre-term delivery.
- Previous infant or fetal loss.
- Adequacy of prenatal care (early entry, missed appointments).
- Medical conditions of the mother.
- Maternal age (under 20, over 35)
- Infections, including sexually transmitted
- Poor nutritional status
- Short inter-pregnancy interval
- Substance, alcohol and tobacco use.
- Stressors and lack of social support.
- Less than 12th grade education.
- Unintended unplanned pregnancy.
- Unmarried or lack of male involvement in pregnancy.
- Physical and emotional abuse of mother.
Records Needed for Case Review
- Birth records
- Pediatric records for well and sick visits
- Death certificates
- Prenatal care records
- Hospital birth records
- Emergency Department records
- Any support services utilized, including WIC and Family Planning
- Police reports
- Prior CPS reports on caregivers
- Maternal Home Interview, if available
- Advocating for Folic Acid: A Guide for Professionals
- International Society for the Study and Prevention of Infant Deaths
- March of Dimes
- National Fetal and Infant Mortality Review Program
- Tips on Reviewing Perinatal and Neonatal Deaths: Powerpoint Presentation
- Ensure that all women have available preconception care and counseling and prenatal care that is acceptable, accessible, appropriate and available.
- Ensure that all women have postpartum care options available that include contraception, pregnancy planning, and preconception care.
- Improve local provider knowledge of pre-conception health care issues.
- Improve emergency response and transport systems.
- Foster maternal and infant support services to improve the social/psychological environment for women and families at risk.
- Encourage the comprehensive assessment of risks due to sexually transmitted infection, substance abuse including alcohol, smoking, domestic violence, depression, social support, housing, employment, transportation, etc. by all local providers and perhaps as a local hospital delivery policy.
- Develop and distribute community resource directories to make consumers and providers aware of where to go for help and services.
- Provide mentoring, support, outreach, and advocacy at the community level utilizing paraprofessionals, indigenous health workers, and faith-based initiatives.
- Develop systems to provide transportation and childcare to women seeking prenatal care.
- Coordination of care between programs and parts of the health care system.
- Forums to raise awareness of consumers, providers, and policy makers of infant mortality issues.
- Local community/business/health care partnerships to broaden the number of stakeholders.
- Enhanced community education to include unplanned/unwanted pregnancy prevention, including teen pregnancy prevention services and early detection of signs and symptoms of pre-term labor.
c/o Michigan Public Health Institute, Keeping Kids Alive, Fact Sheet, 2009, http://www.childdeathreview.org/causesNNS.htm