non-Hispanic White Infants Research Articles

Prevalence and Characteristics of Bed-Sharing Among Black and White Infants in Georgia.

To examine: (1) the prevalence and characteristics of bed-sharing among non-Hispanic Black and White infants in Georgia, and (2) differences in bed-sharing and sleep position behaviors prior to and after the American Academy of Pediatrics' 2005 recommendations against bed-sharing. Georgia Pregnancy Risk Assessment Monitoring System (PRAMS) data were obtained from the Georgia Department of Public Health. Analysis was guided by the socioecological model levels of: Infant, Maternal, Family, and Community/Society within the context of race. Data from 2004 to 2011 were analyzed to address the first objective and from 2000 to 2004 and 2006 to 2011 to address the second objective. Rao-Scott Chi square tests and backward selection unconditional logistic regression models for weighted data were built separately by race; odds ratios (OR) and 95 % Confidence Intervals (CIs) were calculated. A total of 6595 (3528 Black and 3067 White) cases were analyzed between 2004 and 2011. Significantly more Black mothers (81.9 %) reported "ever" bed-sharing compared to White mothers (56 %), p < 0.001. Logistic regression results indicated that the most parsimonious model included variables from all socioecological levels. For Blacks, the final model included infant age, pregnancy intention, number of dependents, and use of Women, Infant and Children (WIC) Services. For Whites, the final model included infant age, maternal age, financial stress, partner-related stress, and WIC. When comparing the period 2000-2004 to 2006-2011, a total of 10,015 (5373 Black and 4642 White cases) were analyzed. A significant decrease in bedsharing was found for both Blacks and Whites; rates of non-supine sleep position decreased significantly for Blacks but not Whites. Continued high rates of bed-sharing and non-supine sleep position for both Blacks and Whites demonstrate an ongoing need for safe infant sleep messaging. Risk profiles for Black and White mothers differed, suggesting the importance of tailored messaging. Specific research and practice implications are identified and described.

Downward economic mobility and preterm birth: an exploratory study of Chicago-born upper class White mothers.

A paucity of published data exists on the factors underlying the relatively poor birth outcome of non-Hispanic White women in the United States. To determine whether downward economic mobility is a risk factor for preterm birth (<37 weeks, PTB) among upper class-born White women. Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational dataset of non-Hispanic White infants (1989-1991) and their women (1956-1976) with appended US census income information. The study sample was restricted to singleton births of Chicago-born upper-class (defined by early-life residence in affluent neighborhoods) non-Hispanic White women. Upper class-born White women (n = 4,891) who did not experience downward economic mobility by the time of delivery had a PTB rate of 5.4 %. Those women who experienced slight (n = 5,112), moderate (n = 2,158), or extreme (n = 339) downward economic mobility had PTB rates of 6.5, 8.5, and 10.1 %, respectively; RR (95 % CI) = 1.2 (1.0-4.0), 1.6 (1.3-1.9), and 1.9 (1.3-2.6), respectively. Maternal downward economic mobility was also associated with an increased prevalence of biologic, medical, and behavioral risk factors. Interestingly, the relationship between moderate to extreme downward mobility and preterm birth was stronger among former low birth weight (<2500 g, LBW) than non-LBW women: 2.8 (1.4-5.8) versus 1.6 (1.3-1.9), respectively. In multilevel logistic regression models, the adjusted odds ratio of preterm birth for former LBW and non-LBW women who experienced any downward mobility (compared to those women with lifelong upper class status) equaled 2.4 (1.1-5.3) and 1.1 (1.0-1.1), respectively. Downward economic mobility is associated with an increased risk of preterm birth among upper class-born White urban women; this phenomenon is strongest among former low birth weight women.

Prevalence of birth defects among American-Indian births in California, 1983-2010.

Approximately 6.3 million live births and fetal deaths occurred during the ascertainment period in the California Birth Defects Monitoring Program registry. American-Indian and non-Hispanic white women delivered 40,268 and 2,044,118 births, respectively. While much information has been published about non-Hispanic white infants, little is known regarding the risks of birth defects among infants born to American-Indian women. This study used data from the California Birth Defects Monitoring Program to explore risks of selected birth defects in offspring of American-Indian relative to non-Hispanic white women in California. The study population included all live births and fetal deaths 20 weeks or greater from 1983 to 2010. Prevalence ratios and corresponding 95% confidence intervals (CI) were computed using Poisson regression for 51 groupings of birth defects. Prevalence ratios were estimated for 51 groupings of birth defects. Of the 51, nine had statistically precise results ranging from 0.78 to 1.85. The eight groups with elevated risks for American-Indian births were reduction deformities of brain, anomalies of anterior segments, specified anomalies of ear, ostium secundum type atrial septal defect, specified anomalies of heart, anomalies of the aorta, anomalies of great veins, and cleft lip with cleft palate. Our results suggest that American-Indian women having babies in California may be at higher risk for eight birth defect phenotypes compared with non-Hispanic whites. Further research is needed to determine whether these risks are observed among other populations of American-Indian women or when adjusted for potential covariates.

Developing a Maternally Linked Birth Dataset to Study the Generational Recurrence of Low Birthweight in Virginia

This paper examined the generational recurrence of low birthweight (LBW) among first-born singletons using a statewide maternally-linked birth dataset. An intergenerational dataset was created by linking 2005-2009 to 1960-1997 Virginia resident live birth data. Maternal information from the recent birth cohort was linked to infant information in the historic birth file using various combinations of mother's name and birthdate. The linked dataset contained 170,624 records (87 % of all eligible records). The analysis dataset was limited to non-Hispanic black and non-Hispanic white first-born singleton infants linked to their mother's own birth record (n = 69,702). Maternal birthweight was a significant predictor of LBW for first-born singletons. The birthweight distribution for both non-Hispanic black and non-Hispanic white infants was shifted toward lower birthweights for infants whose mothers were born LBW. Even after adjusting for known maternal risk factors in the current pregnancy, non-Hispanic black (AOR = 1.6 [95 % CI 1.4, 1.8]) and non-Hispanic white (AOR = 2.0 [95 % CI 1.8, 2.3]) infants had increased odds of being born LBW if their mother was born LBW. A mother's early life experiences can impact the health of her children. These findings underscore the importance of applying a life course perspective to the prevention of LBW. Routine linkage of maternal and infant birth data is needed to strengthen the evidence base for policies and programs that address issues affecting maternal and child health throughout the life course.

Preterm Birth Among American Indian/Alaskan Natives in Washington and Montana: Comparison with Non-Hispanic Whites

Preterm birth is the single most important cause of perinatal mortality in North America. Given that American Indians/Alaskan Natives (AI/ANs) in the United States continue to have adverse birth outcomes, the purpose of this study is to compare the risk of preterm birth among AI/AN mothers to Non-Hispanic White mothers living in Washington and Montana from 2003 to 2009. A population-based retrospective cohort study was conducted examining the association between AI/AN mothers (self-reported) and the risk of preterm birth (gestational age <37 weeks) using birth certificate data from Washington and Montana. All AI/AN singleton lives births (n = 26,648) from residents of Washington and Montana from 2003 to 2009 were identified and included in our study. An identical number of Non-Hispanic White singleton infants (n = 26,648) born to residents of Washington and Montana were randomly selected as a comparison group and logistic regression was used to analyze the data. AI/AN mothers living in Washington and Montana between 2003 and 2009 were 1.34 times (95 % CI 1.25-1.44) as likely to have a preterm birth compared to Non-Hispanic Whites after adjusting for maternal and paternal characteristics as well as pregnancy risk factors. AI/AN mothers residing in Washington and Montana from 2003 to 2009 were at a significantly increased risk of having a preterm birth compared to Non-Hispanic Whites. Identifying etiologic differences in preterm birth experienced by AI/ANs is essential in targeting future interventions.

Evaluation of genes involved in limb development, angiogenesis, and coagulation as risk factors for congenital limb deficiencies

We conducted a population-based case-control study of single nucleotide polymorphisms (SNPs) in selected genes to find common variants that play a role in the etiology of limb deficiencies (LDs). Included in the study were 389 infants with LDs of unknown cause and 980 unaffected controls selected from all births in New York State (NYS) for the years 1998-2005. We used cases identified from the NYS Department of Health (DOH) Congenital Malformations Registry. Genotypes were obtained for 132 SNPs in genes involved in limb development (SHH, WNT7A, FGF4, FGF8, FGF10, TBX3, TBX5, SALL4, GREM1, GDF5, CTNNB1, EN1, CYP26A1, CYP26B1), angiogenesis (VEGFA, HIF1A, NOS3), and coagulation (F2, F5, MTHFR). Genotype call rates were >97% and SNPs were tested for departure from Hardy-Weinberg expectations by race/ethnic subgroups. For each SNP, odds ratios (OR)s and confidence intervals (CI)s were estimated and corrected for multiple comparisons for all LDs combined and for LD subtypes. Among non-Hispanic white infants, associations between FGF10 SNPs rs10805683 and rs13170645 and all LDs combined were statistically significant following correction for multiple testing (OR = 1.99; 95% CI = 1.43-2.77; uncorrected P = 0.000043 for rs10805683 heterozygous genotype, and OR = 2.37; 95% CI = 1.48-3.78; uncorrected P = 0.00032 for rs13170645 homozygous minor genotype). We also observed suggestive evidence for associations with SNPs in other genes including CYP26B1 and WNT7A. Animal studies have shown that FGF10 induces formation of the apical ectodermal ridge and is necessary for limb development. Our data suggest that common variants in FGF10 increase the risk for a wide range of non-syndromic limb deficiencies.

Impact of fetal death reporting requirements on early neonatal and fetal mortality rates and racial disparities.

Racial disparities in infant and neonatal mortality vary substantially across the U.S. with some states experiencing wider disparities than others. Many factors are thought to contribute to these disparities, but state differences in fetal death reporting have received little attention. We examined whether such reporting requirements may explain national variation in neonatal and fetal mortality rates and racial disparities. We used data on non-Hispanic white and non-Hispanic black infants from the U.S. 2000-2002 linked birth/infant death and fetal death records to determine the degree to which state fetal death reporting requirements explain national variation in neonatal and fetal mortality rates and racial disparities. States were grouped depending upon whether they based the lower limit for fetal death reporting on birthweight alone, gestational age alone, both birthweight and gestational age, or required reporting of all fetal deaths. Traditional methods and the fetuses-at-risk approach were used to calculate mortality rates, 95% confidence intervals, and relative and absolute racial disparity measures in these four groups. States with birthweight-alone fetal death thresholds substantially underreported fetal deaths at lower gestations and slightly overreported neonatal deaths at older gestations. This finding was reflected by these states having the highest neonatal mortality rates and disparities, but the lowest fetal mortality rates and disparities. Using birthweight alone as a reporting threshold may promote some shift of fetal deaths to newborn deaths, contributing to racial disparities in neonatal mortality. The adoption of a uniform national threshold for reporting fetal deaths could reduce systematic differences in live birth and fetal death reporting.

Sudden Infant Death Syndrome: An Update

Sudden Infant Death Syndrome: An Update

Evaluation of Serotype-Specific Immunity to Streptococcus pneumoniae in Pregnant Women and Cord Blood of Infants: Impact of Race and Ethnicity

Although invasive pneumococcal disease (IPD) has significantly decreased in children since the introduction of the pneumococcal conjugate vaccine, instances of IPD from non-PCV7 serotypes have increased. Concerns remain regarding the risk for IPD during the neonatal period. Our objective was to measure quantitative antibody levels to 16 serotypes of Streptococcus pneumoniae in pregnant non-Hispanic black, non-Hispanic white, and Hispanic mothers, and in cord blood samples. Antibody levels were evaluated by Luminex assay. Forty-two percent of all mothers had protective (-0.35 microg/mL) antibody levels to 16 serotypes. Hispanic mothers were most likely to possess protective antibody levels for 12 serotypes but were less likely to possess protective antibody levels for serotypes 9V, 12F, and 18C, compared to non-Hispanic white or black mothers. Thirty-three percent of cord blood samples demonstrated protective antibody levels. Hispanic infants had a higher prevalence of protective antibodies to all serotypes except 11A, 14, 18C, and 23F. Non-Hispanic black infants had a higher prevalence of protective immunity to serotypes 11A, 14, and 18C, and non-Hispanic white infants to only serotype 23F. Hispanic mothers and their infants have a higher prevalence of protective immunity to most serotypes of S pneumoniae, compared to white or black mothers/infants. We found no evidence of a lower prevalence of protective immunity to specific serotypes in non-Hispanic black vs. non-Hispanic white infants that might account for the reported higher incidence of IPDs in blacks. Environmental factors in Hispanic mothers may be responsible for their enhanced level of immunity. A significant number of cord blood samples had inadequate levels of protective immunity to a variety of S pneumoniae serotypes.

Annual Summary of Vital Statistics: 2009

The number of births in the United States decreased by 3% between 2008 and 2009 to 4 130 665 births. The general fertility rate also declined 3% to 66.7 per 1000 women. The teenage birth rate fell 6% to 39.1 per 1000. Birth rates also declined for women 20 to 39 years and for all 5-year groups, but the rate for women 40 to 44 years continued to rise. The percentage of all births to unmarried women increased to 41.0% in 2009, up from 40.6% in 2008. In 2009, 32.9% of all births occurred by cesarean delivery, continuing its rise. The 2009 preterm birth rate declined for the third year in a row to 12.18%. The low-birth-weight rate was unchanged in 2009 at 8.16%. Both twin and triplet and higher order birth rates increased. The infant mortality rate was 6.42 infant deaths per 1000 live births in 2009. The rate is significantly lower than the rate of 6.61 in 2008. Linked birth and infant death data from 2007 showed that non-Hispanic black infants continued to have much higher mortality rates than non-Hispanic white and Hispanic infants. Life expectancy at birth was 78.2 years in 2009. Crude death rates for children and adolescents aged 1 to 19 years decreased by 6.5% between 2008 and 2009. Unintentional injuries and homicide, the first and second leading causes of death jointly accounted for 48.6% of all deaths to children and adolescents in 2009.

Comparison of quantitative sweat chloride methods after positive newborn screen for cystic fibrosis

Rapid and reliable confirmatory sweat testing following a positive newborn screen (NBS) for cystic fibrosis (CF) is preferred to allow for early diagnosis and to decrease parental anxiety. The Cystic Fibrosis Foundation (CFF) recently recommended a quantity not sufficient (QNS) rate of ≤ 10% in infants <3 months of age referred for quantitative sweat chloride analysis. Two CFF-approved methods are available by which to quantitatively measure chloride concentration in sweat. Our objective was to compare the performance of the Macroduct® sweat collection system (MSCS) with the Gibson and Cooke technique (GCT) in the acquisition of samples for the determination of sweat chloride concentration in infants with a positive Minnesota State NBS for CF. A retrospective database review of infants referred to the core Minnesota CF Center or its affiliate site for confirmatory sweat testing was performed to compare the QNS rates for the two techniques. Associations between birthweight, age at test, race, and QNS rates were examined. Five hundred sixty-eight infants were referred for 616 sweat tests from March 2006 to January 2010. The mean age was 32.8 days at the initial sweat test. The GCT had a significantly higher QNS rate compared to the MSCS (15.4% vs. 2.1%, P < 0.0001). There was no association between age and the probability of QNS. The probability of QNS decreased as birthweight increased (P = 0.02). After adjusting for age, the odds of QNS using the GCT remained 8.34 (95% CI: 3.72-18.71) times that of the MSCS. Non-White infants had a significantly higher likelihood of QNS compared to non-Hispanic White infants (P = 0.0025). Given the performance of the MSCS, the Minnesota CF Center has implemented the MSCS as its method of choice for diagnostic sweat testing in infants following a positive state NBS.

Ambient Air Pollution and Birth Weight in Full-Term Infants in Atlanta, 1994–2004

BackgroundAn emerging body of evidence suggests that ambient levels of air pollution during pregnancy are associated with fetal growth.ObjectivesWe examined relationships between birth weight and temporal variation in ambient levels of carbon monoxide, nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone, particulate matter ≤ 10 μm in diameter (PM10), ≤ 2.5 μm (PM2.5), 2.5 to 10 μm (PM2.5–10), and PM2.5 chemical component measurements for 406,627 full-term births occurring between 1994 and 2004 in five central counties of metropolitan Atlanta.MethodsWe assessed relationships between birth weight and pollutant concentrations during each infant’s first month of gestation and third trimester, as well as in each month of pregnancy using distributed lag models. We also conducted capture-area analyses limited to mothers residing within 4 miles (6.4 km) of each air quality monitoring station.ResultsIn the five-county analysis, ambient levels of NO2, SO2, PM2.5 elemental carbon, and PM2.5 water-soluble metals during the third trimester were significantly associated with small reductions in birth weight (−4 to −16 g per interquartile range increase in pollutant concentrations). Third-trimester estimates were generally higher in Hispanic and non-Hispanic black infants relative to non-Hispanic white infants. Distributed lag models were also suggestive of associations between air pollutant concentrations in late pregnancy and reduced birth weight. The capture-area analyses provided little support for the associations observed in the five-county analysis.ConclusionsResults provide some support for an effect of ambient air pollution in late pregnancy on birth weight in full-term infants.

054 Another Hispanic paradox? The health benefits of Hispanic communities for non-Hispanic mothers and infant

Background and ObjectivesIn the US, Hispanic mothers have rates of infant mortality and low birthweight that are comparable to non-Hispanic White mothers despite being more likely to live in socio-economically...

Annual Summary of Vital Statistics: 2007

The number of births in the United States increased between 2006 and 2007 (preliminary estimate of 4,317,119) and is the highest ever recorded. Birth rates increased among all age groups (15 to 44 years); the increase among teenagers is contrary to a long-term pattern of decline during 1991-2005. The total fertility rate increased 1% in 2007 to 2122.5 births per 1000 women. This rate was above replacement level for the second consecutive year. The proportion of all births to unmarried women increased to 39.7% in 2007, up from 38.5% in 2006, with increases noted for all race and Hispanic-origin groups and within each age group of 15 years and older. In 2007, 31.8% of all births occurred by cesarean delivery, up 2% from 2006. Increases in cesarean delivery were noted for most age groups and for non-Hispanic white, non-Hispanic black, and Hispanic women. Multiple-birth rates, which rose rapidly over the last several decades, did not increase during 2005-2006. The 2007 preterm birth rate was 12.7%, a decline of 1% from 2006. The low-birth-weight rate also declined in 2007 to 8.2%. The infant mortality rate was 6.77 infant deaths per 1000 live births in 2007, which is not significantly different from the 2006 rate. Non-Hispanic black infants continued to have much higher rates than non-Hispanic white and Hispanic infants. States in the southeastern United States had the highest infant and fetal mortality rates. The United States continues to rank poorly in international comparisons of infant mortality. Life expectancy at birth reached a record high of 77.9 years in 2007. Crude death rates for children aged 1 to 19 years decreased by 2.5% between 2006 and 2007. Unintentional injuries and homicide were the first and second leading causes of death, respectively, accounting for 53.7% of all deaths to children and adolescents in 2007.

From Paradox to Disparity: Trends in Neonatal Death in Very Low Birth Weight non-Hispanic Black and White Infants, 1989-2004

To examine temporal trends in race-specific neonatal death in California to determine whether the overall decline in mortality attenuated the paradoxical survival advantage of very low birth weight (VLBW; birth weight < 1500 g) non-Hispanic black infants relative to VLBW non-Hispanic white infants. The data set comprised the California birth cohort file on non-Hispanic black and non-Hispanic white VLBW neonatal mortality for 1989-2004. Logistic regression methods were used to control for potentially confounding maternal characteristics. In 1989 and 1990, non-Hispanic black VLBW infants demonstrated a paradox of lower neonatal mortality (adjusted odds ratio [aOR] = 0.84; 95% confidence interval [CI] = 0.75-0.94). This survival advantage disappeared after 1991, however. In 2003 and 2004, the incidence of neonatal mortality increased in non-Hispanic black VLBW infants but decreased in non-Hispanic white VLBW infants, resulting in a racial disparity (aOR = 1.34; 95% CI = 1.14-1.56). An initial survival paradox transformed into a disparity. The magnitude of this non-Hispanic black/non-Hispanic white VLBW disparity rose to its highest levels in the last 2 years of the study period. Moreover, the steady mortality increase in VLBW non-Hispanic black VLBW infants since 2001 reversed the secular decline in neonatal mortality in this population. Our findings underscore the need to augment strategies to improve the health trajectory of gestation in non-Hispanic black women.

Is the Prevalence of Specific Types of Congenital Heart Defects Different for Non-Hispanic White, Non-Hispanic Black and Hispanic Infants?

Our purpose was to determine the prevalence of specific types of CHD among non-Hispanic (NH)-Black, NH-White, and Hispanic infants. We conducted a retrospective cohort study with 9,352 singleton infants diagnosed with conotruncal, right or left obstructive or septal CHDs from the Florida Birth Defects Registry, born 1998-2003 to resident NH-White, NH-Black, and Hispanic women aged 15-49. Defect-specific prevalence rates, prevalence ratios and P-values were calculated for each type of CHD and by number of defects for each racial/ethnic group. Compared to NH-Whites, NH-Blacks had higher rates of pulmonary valve atresia/stenosis but lower frequency of aortic valve atresia/stenosis and ventricular septal defect. Hispanics had lower rates of aortic valve atresia/stenosis and atrioventricular septal defects than NH-Whites. Although few racial/ethnic differences in prevalence are present among infants with major CHD, observed differences are clinically meaningful. However, the underlying etiologies for the observed differences remain unknown.

Economic Antecedents of Prone Infant Sleep Placement among Black Mothers

Black infants die from sudden infant death syndrome at twice the incidence observed among non-Hispanic white infants. Explanations for this disparity include a two-fold greater prevalence of prone (i.e., stomach) infant sleep placement among black caregivers. I test the hypothesis that the contraction of state economies may contribute to this disparity by increasing the risk of prone infant sleep placement among black mothers. I retrieved data from the Bureau of Labor Statistics employment series and 33,518 black mothers in 26 states participating in the 1996-2002 Pregnancy Risk Assessment Monitoring System. I use weighted multivariable analyses to control for individual characteristics and state and time trends. Black mothers exhibit an elevated risk of reporting prone placement one month following statewide declines in employment (adjusted odds ratio for a one percent decline = 1.11, 95% CI 1.01 to 1.22). This risk remains elevated after control for individual variables. In contrast, I find no association between the economy and prone placement among white mothers. Statewide economic decline may reduce adherence to the recommended non-prone infant sleep position among black, but not white, mothers. Additional research among black caregivers should determine which mechanisms connect economic downturns to prone infant sleep placement.

Neonatal circumcision in Maryland: A comparison of hospital discharge and maternal postpartum survey data

Objective To study circumcision rates in Maryland using hospital discharge and maternal survey data in order to provide healthcare providers, parents and policy makers with more accurate and comprehensive information about this common yet controversial procedure. Methods Secondary data analyses were performed using Maryland hospital discharge data files containing records of 96,457 male newborns, and postpartum survey data collected from 4273 mothers through the Maryland Pregnancy Risk Assessment Monitoring System. Results Hospital discharge data showed that 75.3% of male infants were circumcised, and survey data showed that 82.3% of male infants were circumcised. The circumcision rate among infants weighing <1500 g at birth was 38.9% using hospital discharge data and 74.5% using maternal survey data. Both sources revealed lower circumcision rates among Asian and Hispanic infants than among non-Hispanic white and non-Hispanic black infants. Conclusions Despite reports of decreasing circumcision rates nationally, rates remain high in Maryland. In addition to providing for the inclusion of circumcision procedures that may not have been coded properly in hospital discharge records and procedures that were performed after hospital discharge, maternal survey data provide more comprehensive information than hospital discharge data about parental characteristics and factors relevant to the circumcision decision-making process.

Trends in Intussusception Hospitalizations Among US Infants, 1993–2004: Implications for Monitoring the Safety of the New Rotavirus Vaccination Program

In 2006, a new rotavirus vaccine was recommended for routine immunization of US infants. Because a previous rotavirus vaccine was withdrawn in 1999 after it was associated with intussusception, monitoring for this adverse event with the new vaccine is important. The objectives of this study were to assess intussusception hospitalizations trends among US infants for 1993 to 2004; provide estimates of hospitalization rates for intussusception for 2002-2004; and assess variations in background rates by age, race/ethnicity, and surgical management. By using the Healthcare Cost and Utilization Project's State Inpatient Database that captures US hospital discharges from 16 states representing 49% of the birth cohort during 1993-2004 and from 35 states representing 85% of the birth cohort in 2002-2004, we examined hospitalizations among infants (<12 months of age) with an International Classification of Disease, Ninth Revision, Clinical Modification code for intussusception (560.0). Incidence rates were calculated by using census data, and rate ratios with 95% confidence intervals were calculated by using Poisson regression data. Annual intussusception hospitalization rates declined 25% from 1993 to 2004 but have remained stable at approximately 35 cases per 100,000 infants since 2000. Rates were very low for infants younger than 9 weeks (<5 per 100,000) then increased rapidly, peaking at approximately 62 per 100,000 at 26 to 29 weeks, before declining gradually to 26 per 100,000 at 52 weeks. Compared with rates among non-Hispanic white infants (27 per 100,000), rates were greater among non-Hispanic black infants (37 per 100,000) and Hispanic infants (45 per 100,000); however, rates did not differ by race/ethnicity for infants who were younger than 16 weeks. This assessment of US hospitalizations provides up-to-date and nationally representative prevaccine rates of intussusception. Because rates varied almost 12-fold by week of age and to a lesser extent by race/ethnicity during the age of vaccination, adjusting baseline rates to reflect the demographics of the vaccinated population will be crucial for assessing risk for intussusception after rotavirus vaccination.

Annual Summary of Vital Statistics: 2006

US births increased 3% between 2005 and 2006 to 4,265,996, the largest number since 1961. The crude birth rate rose 1%, to 14.2 per 1000 population, and the general fertility rate increased 3%, to 68.5 per 1000 women 15 to 44 years. Births and birth rates increased among all race and Hispanic-origin groups. Teen childbearing rose 3% in 2006, to 41.9 per 1000 females aged 15 to 19 years, the first increase after 14 years of steady decline. Birth rates rose 2% to 4% for women aged 20 to 44; rates for the youngest (10-14 years) and oldest (45-49) women were unchanged. Childbearing by unmarried women increased steeply in 2006 and set new historic highs. The cesarean-delivery rate rose by 3% in 2006 to 31.1% of all births; this figure has been up 50% over the last decade. Preterm and low birth weight rates also increased for 2006 to 12.8% and 8.3%, respectively. The 2005 infant mortality rate was 6.89 infant deaths per 1000 live births, not statistically higher than the 2004 level. Non-Hispanic black newborns continued to be more than twice as likely as non-Hispanic white and Hispanic infants to die in the first year of life in 2004. For all gender and race groups combined, expectation of life at birth reached a record high of 77.9 years in 2005. Age-adjusted death rates in the United States continue to decline. The crude death rate for children aged 1 to 19 years decreased significantly between 2000 and 2005. Of the 10 leading causes of death for children in 2005, only the death rate for cerebrovascular disease was up slightly from 2000, whereas accident and chronic lower respiratory disease death rates decreased. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.