Cause Of Infant Death Research Articles

Platelet-lymphocyte ratio and sepsis outcome in children

Background Sepsis is the most common cause of death in infants and children worldwide. Identification of patients with a high risk of death and accurately anticipating outcomes in the early phase is very important in order to provide adequate intervention to the patient. Predictors and scoring systems have been used to determine the prognosis of sepsis n children. The platelet-lymphocyte ratio (PLR), a newly-used marker for inflammation, has received recent attention, as it can act as an indicator in a variety of diseases, including sepsis.
 Objective o investigate the relationship between PLR and clinical outcomes in pediatric patients with sepsis.
 Methods This study was conducted using an analytic, observational method with a prospective cohort approach in children with sepsis in the Pediatric Intensive Care Unit (PICU) of Prof. Dr. R. D. Kandou Central General Hospital, Manado, North Sulawesi, from February to August 2020. We analyzed patients’ platelet-lymphocyteratio (PLR), mortality rate, and length of stay using SPSS software. The PLR were recorded once within the first 24 hours of PICU admission.
 Results Of 96 PICU patients, 87 patients were eligible for this study. In total, 50 patients (57.47%) died. Mean PLR was 77.53 among sepsis survivors and 157.2 among non-survivors (rpb=0.566, P<0.0001) indicating a strong relationship between PLR and mortality. We also found a strong positive linear relationship between PLR and PICU length of stay.
 Conclusion Platelet-lymphocyte ratio is a predictor of sepsis outcomes that can be easily and inexpensively checked. Thus, it can be used in regions with limited health facilities.

P.112 5q Spinal Muscular Atrophy Canadian Paediatric Surveillance Program - 2020 Results

Background: Spinal muscular atrophy (SMA) is the leading genetic cause of infant death and the second most common autosomal recessive disorder; the majority of cases are due to homozygous deletion of SMN1 gene. Methods: This study uses the Canadian Paediatric Surveillance Program to determine the minimum annual incidence of 5q-SMA from birth to 18 years of age in Canada. The complete protocol can be accessed at www.cpsp.cps.ca/surveillance. Results: Eleven cases were reported in 2020. Five (45%) cases were reported from Ontario and the remaining cases were reported from Atlantic Canada and Western Canada. Their median age was 12 months (IQR 6–21); 64% were male. The most common presenting symptoms were delayed motor milestone and hypotonia in 7 (64%) cases. On average, the diagnosis was delayed after the onset of symptoms by three months for SMA Type 1, by eight months for Type 2, and by 18 months for Type 3. Eight (73%) cases received nusinersen as their first disease-modifying treatment. Conclusions: Early recognition and newborn screening are essential to reduce diagnostic delay and enable timely treatment of SMA. Other data sources including the Canadian Neuromuscular Disease Registry and molecular genetic laboratories will be used to estimate the annual incidence of pediatric SMA in Canada.

Simulation-based assessment of care for an infant with cardiogenic shock in the emergency department.

Congenital heart disease (CHD) is the leading cause of infant deaths associated with birth defects. Neonates with undiagnosed CHD often present to general emergency departments (GEDs) for initial resuscitation that are less prepared than paediatric centres, resulting in disparities in the quality of care. Neonates with undiagnosed CHD represent a challenge; thus, it is necessary for GEDs to be prepared for this population. To evaluate the process of resuscitative care provided to a neonate in cardiogenic shock due to CHD in the GEDs in a simulated setting and to describe the impact of teams and GED variables on the process of care. This is a prospective simulation-based assessment of the process of care provided to a neonate with coarctation of the aorta in cardiogenic shock. Simulation sessions were conducted at participating GEDs utilizing each GED's interdisciplinary team and resources. The primary outcome was adherence to best practice, as measured by a 15-item overall composite adherence score (CAS). In addition, we stratified the overall CAS into CHD-critical items and the general resuscitation items CAS. The secondary outcome was the impact of the team's and GED's characteristics on the scores. This study enrolled 32 teams from 12 GEDs. Among 161 participants, 103 (63.97%) were registered nurses, 33 (20.50%) were physicians, 17 (10.56%) were respiratory therapists, and 8 (4.97%) were other medical professionals. The overall median CAS was 84, with the CHD-critical items having a median CAS of 34.5. The most underperformed tasks are checking pulses on the upper and lower extremities (44%), obtaining blood pressure in the upper and lower extremities (25%), and administering prostaglandin E1 (22%). Using in situ simulation in a set of GEDs, we revealed gaps in the resuscitation care of neonates with CHD in cardiogenic shock. These findings highlight the importance of targeted improvement programs for high-stakes illnesses in GED.

Analysis of infant mortality caused by sudden infant death syndrome in the Russian Federation

Abstract Background Sudden infant death syndrome (SIDS) is one of the leading causes of infant death and it caused the death of 40 thousand babies around the world in 2017. In the Russian Federation, there are no large and long-term studies of the epidemiology of SIDS. Methods A descriptive study of infant mortality associated with SIDS in the regions of the Russian Federation in 2019 according to the Federal State Statistics Service. Results In 2019, SIDS caused the death of 259 children and ranked 7th in the structure of infant mortality. The infant mortality rate due to SIDS was 0.17 per 1000 live births (median for the regions of the Russian Federation - 0.13, IR 0.0 - 0.27). The infant mortality rate due to SIDS among the rural population was 0.27 per 1000 live birth in the relevant area, among the urban population - 0.14, among boys - 0.20, among girls - 0.15 per 1000 live birth of the corresponding sex. From 2008 to 2019, the indicator in the Russian Federation decreased by 56% (in 2008 - 0.39 per 1000 live birth). The highest infant mortality rate due to SIDS in 2019 was recorded in the Far Eastern Federal District (0.31 per 1000 live births), the lowest was in the Central FD (0.10). SIDS was not recorded in 28 constituent entities, in 4 of them there was not a single case for the period from 2013 to 2019. In 21 regions, the infant mortality rate was higher than 0.27 per 1000 per live birth. The relative risk of SIDS was quite variable across the regions of the Russian Federation. Conclusions The analysis revealed the scatter of the infant mortality rate due to SIDS among the regions of the Russian Federation. It is necessary to study the problem of SIDS at the state level to explain the results. Key messages The development and implementation of programs for the prevention of SIDS should be based on the study of the epidemiology of this pathology in each region separately and in the country as a whole. Significant differences in the infant mortality rate due to SIDS among the regions of Russian Federation require detailed study.

Time to death and its associated factors among infants in sub-Saharan Africa using the recent demographic and health surveys: shared frailty survival analysis

BackgroundGlobally, approximately 4.1 million infants died, accounting for 75% of all under-five deaths. In sub-Saharan Africa (SSA), infant mortality was 52.7/1000 live births in 2018 This study aimed to assess the pooled estimate of infant mortality rate (IMR), time to death, and its associated factors in SSA using the recent demographic and health survey dataset between 2010 and 2018.MethodsData were retrieved from the standard demographic and health survey datasets among 33 SSA countries. A total of 93,765 samples were included. The data were cleaned using Microsoft Excel and STATA software. Data analysis was done using R and STATA software. Parametric shared frailty survival analysis was employed. Statistical significance was declared as a two-side P-value < 0.05.ResultsThe pooled estimate of IMR in SSA was 51 per 1000 live births (95% Confidence Interval (CI): 46.65–55.21). The pooled estimate of the IMR was 53 in Central, 44 in Eastern, 44 in Southern, and 57 in Western Africa per 1000 live births. The cumulative survival probability at the end of 1 year was 56%. Multiple births (Adjusted Hazard ratio (AHR) = 2.68, 95% CI: 2.54–2.82), low birth weight infants (AHR = 1.28, 95% CI: 1.22–1.34), teenage pregnancy (AHR = 1.19, 95 CI: 1.10–1.29), preceding birth interval < 18 months (AHR = 3.27, 95% CI: 3.10–3.45), birth order ≥ four (AHR = 1.14, 95% CI:1.10–1.19), home delivery (AHR = 1.08, 95% CI: 1.04–1.13), and unimproved water source (AHR = 1.07, 95% CI: 1.01–1.13), female sex (AHR = 0.86, 95% CI: 0.83–0.89), immediately breastfeed (AHR = 0.24, 95% CI: 0.23–0.25), and educated mother (AHR = 0.88, 95% CI: 0.82–0. 95) and educated father (AHR = 0.90, 95% CI: 0.85–0.96) were statistically significant factors for infant mortality.ConclusionSignificant number of infants died in SSA. The most common cause of infant death is a preventable bio-demographic factor. To reduce infant mortality in the region, policymakers and other stakeholders should pay attention to preventable bio-demographic risk factors, enhance women education and improved water sources.

SMA CLINICAL DATA: EP.250 Description of cardiac involvement in 5q SMA pediatric patients

Spinal muscular atrophy (SMA) is an autosomal recessive inherited neuromuscular disease and is the most frequent genetic cause of death in infancy. SMA is caused by a ubiquitous lack of SMN protein which leads primarily to an irreversible loss of motor neurons, but development or function of other tissues may also be affected. In mouse models the most prominent microscopic findings were myocardial fibrosis, decreased numbers of coronary capillaries, and abnormal expression of postnatal cardiac development markers indicating loss of contractile components.

Plötzlicher Kindstod von zwei Säuglingen in Babytragehilfen.

Sudden unexpected death in infancy (SUDI), previously termed sudden infant death syndrome (SIDS), is the second leading cause of death in infants beyond the neonatal period in Germany, and a major cause of infant mortality in economically well developed countries (OECD Health Statistics, 2019). The risk of SUDI peaks at the age of 2-4 months and then decreases continuously till the end of the first year. A complex multifactorial cause, rather than a single characteristic factor, may cause SUDI within a critical period of infant development (Guntheroth WG et al., Pediatrics 2002; 110: e64-e64). Risk factors include prematurity, male gender, bottle-feeding, prone sleeping position, overheating, as well as exposure to smoke amongst others (Carpenter RG et al., Lancet 2004; 363: 185-191). Thus, health professionals consistently advise and educate parents about avoidable risk factors of SUDI at routine well-baby examinations. Since the advent of SUDI prevention strategies in the 1980s, the incidence has decreased 10fold, from 1,55/1.000 live births in 1991 to 0,15/1000 in 2015. This number seems to have reached a steady state (Statistisches Bundesamt Germany, 2015).

Meta-analyses of maternal exposure to atmospheric particulate matter and risk of congenital anomalies in offspring.

Congenital anomalies are the main causes of infant death and disability. Previous studies have suggested that maternal exposure to particulate matter is related to congenital malformation. However, the conclusions of this study remain controversial. Hence, meta-analyses were performed to assess the relationship between maternal exposure to particulate matter and the risk of congenital anomalies. The Medline, Embase, and Web of Science databases were systemically searched from inception until August 2020 to find articles related to birth defects and particulate matter. The pooled risk estimated for the combination of pollution outcomes was calculated for each study by performing fixed effects or random effects models. The existence of heterogeneity and publication bias in relevant studies was also examined. Thirty studies were included in the analysis. A statistically increased summary risk valuation was found. PM10 exposure was associated with an increased risk of congenital heart disease, neural tube defects, and cleft lip with or without cleft palate (OR per 10 μg/m3 = 1.05, 95% CI, 1.03-1.07; OR per 10 μg/m3 = 1.04, 95% CI, 1.01-1.06; OR per 10 μg/m3 = 1.03, 95% CI, 1.01-1.06). Maternal exposure to particulate matter might be associated with an increased risk of congenital anomalies. Our results indicate the dangers of particulate matter exposure on fetal development and the importance of protection against exposure to such particles during pregnancy. The schematic representation of the association between maternal exposure to PM2.5/PM10 and congenital anomalies in offspring, and geographic distribution of the included reports in the meta-analyses.

Secular trend in infant deaths by congenital malformations in Argentina (1980-2018).

Congenital malformations (CM) represent the second cause of infant death in Argentina. To analyze the secular trend (1980-2018) of infant deaths due to CM at the regional and provincial level. The data come from the DEIS (Ministry of Health) and include the absolute number of deaths and live births and deaths by CM coded according to ICD-10 (Codes Q00-Q99). Infant mortality rate due to CM (IMR-CM) (number of deaths due to congenital malformations / number of newborns) and the proportion of deaths from CM (PD-CM) (percentage of deaths from congenital malformations / deaths from all causes) were calculated by regions (Center, NOA, NEA, Cuyo and Patagonia) and provinces. The period was divided into 7 subgroups of five years and one of 4. Secular trend was analyzed using a Poisson model. A line and bar graph were used to represent graphically the differences in the IRM-CM and PD-CM at the regional level. At the country level, there was a pattern characterized by the significant decrease and increase of the IMR-CM and PD-CM respectively. This pattern is repeated in the Central, Cuyo and Patagonia regions and in the provinces of Buenos Aires, Santa Fé, Entre Ríos, Neuquén, La Pampa, Mendoza and Santa Cruz. In the remaining regions and provinces, the IMR-CM exhibits a heterogeneous behavior. To analyze the secular trend (1980-2018) of infant deaths due to CM at the regional and provincial level.

Risk Factors for Respiratory Syncytial Virus-Associated Community Deaths in Zambian Infants.

BackgroundRespiratory syncytial virus (RSV) is a major cause of infant deaths. Its epidemiology in low- and middle-income countries is poorly understood. Risk factors associated with RSV-associated infant deaths that occur in community settings are incompletely known.MethodsCommunity deaths for infants aged 4 days to 6 months were identified during a 3-year postmortem RSV prevalence study at the main city morgue in Lusaka, Zambia, where 80% of deaths are registered. This analysis focuses on the subset of deaths for which an abbreviated verbal autopsy was available and intended to sort deaths into respiratory or nonrespiratory causes by clinical adjudication. Posterior nasopharyngeal swab samples were collected within 48 hours of death and tested for RSV using quantitative reverse-transcription polymerase chain reaction. Associations between potential risk factors were determined as relative risks with 95% confidence intervals (CIs).ResultsWe prospectively enrolled 798 community infant deaths with verbal autopsies and RSV laboratory results, of which 62 results were positive. The mean age of the infants was 10 weeks, and 41.4% of them were male. Of all deaths, 44% were attributed to respiratory causes. RSV was detected in 7.8% of the community infants and was significantly associated with respiratory deaths (risk ratio, 4.0 [95% CI, 2.2–7.1]). Compared with older infants, those aged 0–8 weeks had a 2.83 (95% CI, 1.30–6.15) increased risk of dying with RSV. The risk of RSV for the 0–8-week age group increased to 5.24 (1.56–33.14) with adjustment for demographics, parental education, and geography. RSV deaths were increased with domiciliary overcrowding and were concentrated in poor and dense neighborhoods in Lusaka (risk ratio, 2.00 [95% CI, 1.22–3.27]).ConclusionRSV is a significant contributor to community respiratory deaths in this population, particularly in the first 3 months of life and in the more poor and dense parts of Lusaka.

Maternal Age, the Disparity across Regions and Their Correlation to Sudden Infant Death Syndrome in Taiwan: A Nationwide Cohort Study.

Sudden infant death syndrome (SIDS) has always been a regrettable issue for families. After sleeping in the supine position was proposed, the incidence of SIDS declined dramatically worldwide. However, SIDS still accounts for the top 10 causes of infant deaths in Taiwan. Recognizing the risk factors and attempting to minimize these cases are imperative. We obtained information on cases with SIDS from the National Health Insurance Research Database in Taiwan and interconnected it with the Taiwan Maternal and Child Health Database to acquire infant–maternal basal characteristics between 2004 and 2017. The SIDS subjects were matched 1:10 considering gestational age to normal infants. After case selection, a total of 953 SIDS cases were included. Compared with healthy infants, SIDS infants had younger parents, lower birth weight, and lower Apgar scores. After adjusting for potential confounders, infants with mothers aged <20 years had 2.81 times higher risk of SIDS. Moreover, infants in the non-eastern region had a significantly lower risk of SIDS than those in the eastern region. We concluded that infants of young mothers (especially maternal age <20 years) and infants in the eastern region of Taiwan had a higher risk of SIDS than their counterparts.

Trends and Characteristics of Mortality Associated with Congenital Anomalies in Korean Children under 5 Years of Age

Purpose: Studies have been conducted on the prevalence and infant mortality rate of congenital anomalies; however, studies on child mortality are rare. Therefore, we evaluated the characteristics of deaths associated with congenital anomalies among children born in Korea who died within 5 years of age.Methods: Birth-to-death cohort linked data of children under the age of 5 years from 2010 to 2013, and statistical data on the cause of death by age from 1999 to 2019, both provided by the Korea National Statistical Office's Microdata Integrated Service, were retrospectively investigated. We investigated the trends and characteristics of mortality associated with congenital anomalies.Results: Among 1,858,945 children, 6,510 children who died were under 5 years of age, and among them, 1,229 deaths were associated with congenital anomalies, while 5,281 deaths were due to other causes. Deaths associated with congenital anomalies accounted for 18.9% of all deaths. When comparing congenital anomalies by systems, anomalies of the cardiovascular system (52.6%) were the most common. The mortality rate associated with congenital anomalies and those of other causes showed similar declining trends in 21 years.Conclusion: The mortality rate of congenital anomalies during the first 5 years of life did not increase differently from the prevalence of congenital anomalies but rather decreased. Deaths associated with congenital anomalies accounted for 20.5% of all infant deaths and 12.1% of child deaths, since the major causes of death in infants and children are slightly different, continuous and careful monitoring is required.

The Platelet-to-lymphocyte ratio, PELOD-2 score, and mortality rate in pediatric sepsis

Background Sepsis is life-threatening organ dysfunction caused by a regulated immune response to infection. Sepsis remains the most common cause of death in infants and children worldwide. The Pediatric Logistic Organ Dysfunction (PELOD-2) score, one of the most widely used scoring systems in pediatric sepsis patients, has been shown to be accurate in predicting mortality. The platelet-to-lymphocyte ratio (PLR) is a new clinical indicator of inflammation in a variety of diseases including sepsis.&#x0D; Objective To investigate the relationship between PLR, PELOD-2 score, and clinical outcomes in pediatric patients with sepsis.&#x0D; Methods This retrospective cohort study was conducted in the Pediatric Intensive Care Unit (PICU), Prof R.D. Kandou Hospital, Manado, North Sulawesi, from February to August 2020. Subjects’ PELOD-2 score and PLR were recorded once within the first 24 hours of PICU admission. We analyzed patients’ PELOD-2 score, PLR, and mortality rate, with 95% confidence interval (CI) for each value.&#x0D; Results Of 96 children with sepsis admitted to the PICU during the study period, 87 patients (46 boys; 52.9%) met the inclusion criteria. In total, 50 (57.47%) patients were non-survivors. Mean PLR values among survivors [77.54 (SD 50.08)] was significantly lower compared to the values among non-survivors [157.13 (SD 67.38)]; as well as the PELOD-2 score in the survivors group [12 (SD 1.32)] was significantly lower than its value in the non-survivors [14.65 (SD 2.09)]. Spearman’s analysis showed a moderately positive correlation between PLR and PELOD-2 score (r=0.444; 95%CI 0.44 to 1; P&lt;0.01). Biserial point correlation analysis revealed a significant association between PLR and mortality rate (rpb=0.566; P&lt;0.0001),with elevated PLR related to an increased risk of mortality.&#x0D; Conclusion There are positive correlations between PLR, PELOD-2 score, and mortality rate in pediatric patients with sepsis. Higher PLR and PELOD-2 score are associated with higher mortality.

The imperfections in statistics: Interpretations of causes of infant death in the Netherlands, 1875–1899

Summary Mortality research benefits greatly from current digitisation efforts to make historical cause-of-death statistics available on a large scale. However, the use of these sources is notoriously difficult. Reclassification systems based on the present-day standard of the International Classification of Diseases have made the comparison of causes of death over space and time considerably easier. Yet they do not necessarily uncover the imperfections hidden in the original sources. In this study, a data set on causes of death amongst infants, based on recently digitised Dutch municipal cause-of-death registers published during the period between 1875 and 1899, takes centre stage. This study explores this unique source, its origins and the potential limitations its use may have for historical research on mortality in general and infant mortality, in particular, emphasising the ongoing need to carefully consider the historical context of these sources, particularly when they are used in quantitative studies.

Forensic Autopsy Findings in Sudden Infant Death Syndrome: A Study in a Tertiary Care Hospital, Rajshahi, Bangladesh

Introduction: Sudden Infant Death Syndrome (SIDS) is the general diagnosis given when it is not possible to identify the cause of infant death, even after a complete forensic study and death site investigation. SIDS is a term that was first proposed in 1969 for a distinctive subgroup of unexpected infant deaths that occurred during the postneonatal period with relatively consistent clinical, epidemiological, and pathological features. SIDS remains a diagnosis of exclusion, according to the definition proposed in 1969. Although this syndrome has several distinctive features, including age distribution such as only affecting those younger than 1 year of age, and apparent occurrence during sleep, there has been reluctance to include these features in the definition. The aim of this study was to research the findings of SIDS in infants after a detailed forensic autopsy, and determine the importance of forensic autopsy. Methods: This cross-sectional analytical study conducted at Emergency and the department of Orthopaedic Surgery, Rajshhi Medical College Hospital, Rajshahi, Bangladesh during the period from January 2019 to December 2019 with a sample size of 75. Data were analyzed using statistical software SPSS. Study taken permission from the guardians of the infants. Result: Over half of the study population was male and 43% were female. 60% of the patients died at home. For 56% of the cases no information was available regarding their activity at the time of death. Of the available information, 26.67% died while sleeping, 14.67% were involved in other activities at home, and 2.66% were involved with some other form of activity. Post analysis showed that 48% were natural death. 38.67% of cases were still under study at the time of data collection. After a proper autopsy, 76% of the cases were ruled with SIDS as the cause of death. SIDS was determined as the cause of death in 57 out of 75 cases. 82.46% of the 57 cases had no available history. 8.77% had a history .....

Identification of candidate congenital heart defects biomarkers by applying a random forest approach on DNA methylation data

Background and Aims: Congenital Heart Defects (CHDs) are the most common type of birth defects, representing 0.8% of infants at birth and one of the leading causes of infant death. Although the exact etiology remains a significant challenge, epigenetic modifications, such as DNA methylation, are thought to contribute to the pathogenesis of CHDs. The present study employed a machine learning technique to analyse genome-wide methylation data in children with and without CHDs with the aim to find methylation biomarkers for CHDs.

Risdiplam for the Use of Spinal Muscular Atrophy.

Spinal muscular atrophy (SMA) is one of the leading causes of death in infants related to the degeneration of neurons. Currently, there are no curative treatment options for SMA, and many options available may not be feasible. This review presents the background, clinical studies, and indications for the use of Risdiplam in treating SMA. SMA causes a decrease in the production of survival motor neuron proteins (SMN) and current treatments target to increase the expression of SMN. Risdiplam is the first and only oral medication to be approved to treat SMA. As an SMN2 splicing modifier, it has provided stronger systemic therapies than previous intrathecal and gene replacement therapies. There have been many efforts to treat SMA with multidisciplinary approaches. These include intrathecal injections to gene replacement therapies. However, these have been faced with limitations such as reaching a good therapeutic dose in systemic tissues, route of administration, and price. Risdiplam is currently the only orally administered drug approved by the FDA for the treatment of SMA. It not only provides a good therapeutic window to systemic tissues but allows for a non-invasive approach in infants. Further investigation and comparison on the safety profile of Risdiplam due to its broader systemic effect should be considered with other available therapies.

Underlying and Multiple Causes of Death in Preterm Infants

A limited number of studies have utilized multiple causes of death to investigate infant mortality patterns. The purpose of the present study was to examine the risk distribution of underlying and multiple causes of infant death for congenital anomalies, short gestation/low birth weight (LBW), respiratory conditions, infections, sudden infant death syndrome and external causes across four gestational age groups, namely ≤ 23, 24 − 30, 31 − 36, ≥ 37, and determine the extent to which mortality from each condition is underestimated when only the underlying cause of death is used. The data were obtained from the North Carolina linked birth/infant death files (1999 to 2003) and included 4908 death records. The findings of this study indicate that infants born less than 30 weeks old are more likely (odds ratio ranging from 1.99 to 6.03) to have multiple causes recorded when the underlying cause is congenital anomalies, respiratory conditions and infec tions in comparison to infants whose gestational age is at least 37 weeks. The underlying cause of death underestimated mortality for a number of cause specific deaths including short gestation/LBW, respiratory conditions, infec tions and external causes. This was particularly evident among infants born preterm. Based on these findings, it is recommended that multiple causes, whenever available, should be studied in conjunction with the underlying cause of death data.

Changing Systems That Influence Birth Outcomes in Marginalized Zip Codes.

* Abbreviations: ECEP — : early childhood education provider FIMR-CAT — : Fetal and Infant Mortality Review Community Action Team GMCHL — : grassroots maternal and child health leader HP — : Healthy People IMR — : infant mortality rate MCH — : maternal and child health SDOH — : social determinants of health SSWG — : Safe Sleep Work Group Indiana’s government is prioritizing the reduction of the state’s persistently high infant mortality levels. Despite improvements in overall state and Black infant mortality rates, high rates persist within Indianapolis zip codes, characterized by multigenerational poverty and underrepresented minorities (Table 1). These rates occur in the presence of high-quality health care and home-visiting programs working to address the leading causes of infant death (birth defects, preterm birth and low birth weight, maternal pregnancy complications, and sudden unexpected infant death).1 Numerous studies, however, link infant mortality to underlying root causes associated with the social determinants of health (SDOH).2–4 Addressing the SDOH requires sustainable improvements in social systems that influence women’s health and birth outcomes. Our work complements the work of health care by building the capacity of individuals and organizations within targeted zip codes to remove social inequities that impact birth outcomes. View this table: TABLE 1 Indiana Urban Zip Codes With Persistently High Infant Mortality Rates, 2014–2018 Our work with families motivated and informed our approach. First, many families have experienced infant mortality across multiple generations. Second, even with public communication campaigns focused on prenatal care, safe sleep practice, and women’s health, many residents are unaware of the leading and root causes of poor birth outcomes. Third, residents are not aware of the linkages between social demographics and poor birth outcomes. Fourth, neighborhood networks within communities are often insular; likewise, policy-making networks are insular. There is a need to merge community and policy networks to facilitate dialogue and share realities and solution strategies. Finally, … Address correspondence to Nancy L. Swigonski, MD, MPH, MBA, FAAP, Department of Pediatrics, School of Medicine, Indiana University, 410 W 10th St, Suite 2000, Indianapolis, IN 46202. E-mail: nswigons{at}iu.edu

The Effectiveness of Giving a Combination of Oxytocin Massage and Breast Care on Milk Expenditure at Hapsah Hospital, Bone Regency

In Indonesia, the coverage of exclusive breastfeeding in 2013 was 30.2% and increased in 2018 to 37.3%. Thus, the prevalence of exclusive breastfeeding is still below the achievement target of the 2021 RPJMN (45%) (Ministry of Health Republic of Indonesia, 2020). Indonesia has the highest infant mortality rate in Southeast Asia. The main causes of infant death include diarrhea, malnutrition and infection. This morbidity and mortality can be prevented and overcome by exclusive breastfeeding which is a natural process that can have a positive impact on mothers and babies, because without exclusive breastfeeding babies are more susceptible to various diseases that increase morbidity and mortality. The purpose of this study was to determine the effectiveness of oxytocin massage and breast care on the lactation of postpartum mothers. The research method is quasi-experimental research using a two group pre and post test design, with a total sample of 30 samples which are divided into 2 groups, namely the control group and the experimental group. The results of the study after oxytocin massage and breast care for 3x1 for 3 days, an increase in the number of respondents who experienced an increase in smooth milk production, namely 14 (93.3%), almost one hundred percent of respondents experienced smooth breastfeeding and only 1 experienced substandard milk production. (6.7) % with a p_Value value of 0.000 which means (p &lt;0.005). So oxytocin massage therapy and breast care are effective in smoothing out milk in post partum mothers.