Risk Of Postneonatal Mortality Research Articles

Health Insurance and Differences in Infant Mortality Rates in the US

Health insurance status is associated with differences in access to health care and health outcomes. Therefore, maternal health insurance type may be associated with differences in infant outcomes in the US. To determine whether, among infants born in the US, maternal private insurance compared with public Medicaid insurance is associated with a lower infant mortality rate (IMR). This cohort study used data from the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research expanded linked birth and infant death records database from 2017 to 2020. Hospital-born infants from 20 to 42 weeks of gestational age were included if the mother had either private or Medicaid insurance. Infants with congenital anomalies, those without a recorded method of payment, and those without either private insurance or Medicaid were excluded. Data analysis was performed from June 2022 to August 2023. Private vs Medicaid insurance. The primary outcome was the IMR. Negative-binomial regression adjusted for race, sex, multiple birth, any maternal pregnancy risk factors (as defined by the CDC), education level, and tobacco use was used to determine the difference in IMR between private and Medicaid insurance. The χ2 or Fisher exact test was used to compare differences in categorical variables between groups. Of the 13 562 625 infants included (6 631 735 girls [48.9%]), 7 327 339 mothers (54.0%) had private insurance and 6 235 286 (46.0%) were insured by Medicaid. Infants born to mothers with private insurance had a lower IMR compared with infants born to those with Medicaid (2.75 vs 5.30 deaths per 1000 live births; adjusted relative risk [aRR], 0.81; 95% CI, 0.69-0.95; P = .009). Those with private insurance had a significantly lower risk of postneonatal mortality (0.81 vs 2.41 deaths per 1000 births; aRR, 0.57; 95% CI, 0.47-0.68; P < .001), low birth weight (aRR, 0.90; 95% CI, 0.85-0.94; P < .001), vaginal breech delivery (aRR, 0.80; 95% CI, 0.67-0.96; P = .02), and preterm birth (aRR, 0.92; 95% CI, 0.88-0.97; P = .002) and a higher probability of first trimester prenatal care (aRR, 1.24; 95% CI, 1.21-1.27; P < .001) compared with those with Medicaid. In this cohort study, maternal Medicaid insurance was associated with increased risk of infant mortality at the population level in the US. Novel strategies are needed to improve access to care, quality of care, and outcomes among women and infants enrolled in Medicaid.

Association of maternal snuff use and smoking with Sudden Infant Death Syndrome: a national register study

BackgroundThe aim was to study whether non-combustible nicotine (Swedish snuff) use in pregnancy is associated with elevated risk of post neonatal mortality, Sudden Infant Death Syndrome (SIDS), and Sudden Unexpected Infant Death (SUID) and to study how cessation before the antenatal booking influenced these risks.MethodsThis was a population-based register study of all infants with information on tobacco exposure in early pregnancy born in Sweden 1999–2019, n = 2,061,514. Self-reported tobacco use in early pregnancy was categorized as nonuse, snuff use, and moderate and heavy smoking. Multiple logistic regression models were used to estimate crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs).ResultsMaternal snuff use was associated with increased risks of post neonatal mortality, SIDS, and SUID. The risks of snuff use and moderate smoking were of similar magnitude. Heavy smoking was associated with the highest risks. Cessation of smoking and snuff use before the antenatal booking was associated with lower risks of SIDS and SUID compared to that of continuous usage.ConclusionsMaternal snuff use was associated with increased risks of post neonatal mortality, SIDS, and SUID. Nicotine is the common substance in cigarette smoke and snuff. These findings support the hypothesis that nicotine contributes to an elevated risk of SIDS.ImpactMaternal snuff use and smoking in early pregnancy were associated with increased risks of post neonatal mortality, SIDS, and SUID.Cessation of smoking and snuff use before the first antenatal visit was associated with reduced risks of SIDS and SUID.The common substance in cigarette smoke and snuff is nicotine. Our findings suggest that nicotine contributes to an elevated risk of SIDS and SUID.The implication of our findings is that all forms of nicotine should be avoided in pregnancy.

Neonatal and Postneonatal Death Clustering Among Siblings in Bangladesh: Evidence from Bangladesh Demographic and Health Survey 2017-2018.

Despite knowledge of neonatal and postneonatal mortality determinants in Bangladesh, some families continue to lose a larger share of children, a phenomenon known as early-life mortality clustering. This study uses the random intercept Weibull survival regression model to explore the correlation of mortality risk among siblings at the family (or, mother) and community levels. Utilizing the Bangladesh Demographic and Health Survey 2017-2018, we found evidence of death scarring, where children whose previous sibling was not alive at the time of conception had significantly higher odds of neonatal mortality. Moreover, the neonatal (and postneonatal) mortality hazard was highest for children with a birth interval of fewer than 19months, corresponding to the preceding sibling. The intraclass correlation coefficient's statistically significant values show that neonatal and postneonatal mortality risk is correlated among children of the same family and community. The findings suggest focusing on high-risk families and communities to reduce the mortality level effectively.

Urban-rural differential in neonatal and post-neonatal mortality clustering among Indian siblings: Evidence from National Family Health Survey 2015–16

It is universally accepted that the first 365 days after birth is a critical period for child survival. The present study explored the phenomenon of neonatal and post-neonatal mortality clustering among Indian siblings and the existing urban–rural differential in the same using birth history data of National Family Health Survey (NFHS) 2015–16. We estimated random-intercept logit models for 1,296,196 and 1,248,535 children born to 474,786 and 456,662 mothers for analysing neonatal and post-neonatal mortality clustering respectively. The effect of scaring and unobserved heterogeneity among mother along with an urban–rural variation on neonatal and post-neonatal mortality of child was examined. Children, whose previous siblings were dead during their conception, had 2.42 [CI: 2.32–2.52] and 2.36 [CI: 2.16–2.58] times higher risk of neonatal mortality in the rural–urban regions respectively. Further, the risk of post-neonatal mortality was 1.60 [CI: 1.51–1.71] and 1.45 [CI: 1.25–1.67] times higher among rural and urban children respectively who had lost their preceding siblings. Moreover, we found a higher clustering of neonatal deaths among urban mothers compared to their rural counterparts. Comparatively, the clustering of post-neonatal deaths was common among rural mothers of India. Even after controlling for relevant covariates, we find the risk of neonatal and post-neonatal mortality varies greatly with the risk variation being slightly higher among urban mothers. The findings point toward targeting high-risk mothers with crucial programme benefits. Additionally, higher mortality clustering within mothers from urban regions means that region-wise interventions are required to tackle neonatal and post-neonatal mortality existing in urban–rural region separately.

The impact of paid community health worker deployment on child survival: the connect randomized cluster trial in rural Tanzania

BackgroundThis paper reports on a rigorously designed non-masked randomized cluster trial of the childhood survival impact of deploying paid community health workers to provide doorstep preventive, promotional, and curative antenatal, newborn, child, and reproductive health care in three rural Tanzanian districts.MethodsFrom August, 2011 to June 2015 ongoing demographic surveillance on 380,000 individuals permitted monitoring of neonatal, infant and under-5 mortality rates for 50 randomly selected intervention and 51 comparison villages. Over the initial 2 years of the project, logistics and supply support systems were managed by the Ifakara Health Institute. In 2013, the experiment transitioned its operational design to logistical support managed by the Ministry of Health and Social Welfare with the goal of enhancing government operational ownership and utilization of results for policy.ResultsThe baseline under 5 mortality rate was 81.3 deaths per 1000 live births with a 95% confidence interval (CI) of 77.2–85.6 in the intervention group and 82.7/1000 (95% CI 78.5–87.1) in the comparison group yielding an adjusted hazard ratio (HR) of 0.99 (95% CI 0.88–1.11, p = 0.867). After 4 years of implementation, the under 5 mortality rate was 73.2/1000 (95% CI 69.3–77.3) in the intervention group and 77.4/1000 (95% CI 73.8–81.1) in the comparison group (adjusted HR 0.95 [95% CI 0.86–1.07], p = 0.443). The intervention had no impact on neonatal mortality in either the first 2 years (HR 1.10 [95% CI 0.89–1.36], p = .392) or last 2 years of implementation (HR 0.98 [95% CI 0.74–1.30], p = .902). Although community health worker deployment significantly reduced mortality among children aged 1–59 months during the first 2 years of implementation (HR 0.85 [95% CI 0.76–0.96], p = 0.008), mortality among post neonates was the same in both groups in years three and four (HR 1.03 [95% CI 0.85–1.24], p = 0.772). Results adjusted for stock-out effects show that diminishing impact was associated with logistics system lapses that constrained worker access to essential drugs and increased post-neonatal mortality risk in the final two project years (HR 1.42 [95% CI 1·07–1·88], p = 0·015).ConclusionsCommunity health worker home-visit deployment had a null effect among neonates, and 2 years of initial impact among children over 1 month of age, but a null effect when tests were based on over 1 month of age data merged for all four project years. The atrophy of under age five effects arose because workers were not continuously equipped with essential medicines in years three and four. Analyses that controlled for stock-out effects suggest that adequately supplied workers had survival effects on children aged 1 to 59 months.Trial registrationRegistration for trial number ISRCTN96819844 was retrospectively completed on June 21, 2012.

Immigrants' health and socioeconomic inequalities of overall population residing in Italy evaluated through the Italian network of Longitudinal Metropolitan Studies

Describing and monitoring socioeconomic inequalities in health are the prerequisite for planning equity policies. In Italy, some cities have integrated personal information from the municipal registries with Census data and with data from healthcare information systems to set up Longitudinal Metropolitan Studies (LMS). Under the coordination of the Italian National Institute for Health, Migration, and Poverty (NIHMP), six cities in the LMS network have contributed to the present monograph: Turin, Venice, Reggio Emilia, Modena, Bologna, and Rome. MORTALITY RESULTS. Significant socioeconomic differences by level of education were seen in all the participating centres. People who live alone or in single-parent households are more likely to die, as are those living in a substandard dwelling. Immigrants resident in the six cities included in the study showed lower all-cause mortality than Italians (males: MRR 0.83; 95%CI 0.78-0.90 - females: MRR 0.70; 95%CI 0.64-0.77). Sub-Saharan Africans experienced a significant higher mortality than Italians (males: MRR 1.33; 95%CI 1.12-1.59 - females: MMR 1.69; 95%CI 1.31-2.17). Immigrants had a neonatal and post-neonatal mortality risk about 1.5 times higher than Italians (neonatal: OR 1.71; 95%CI 1.22-2.39 - post-neonatal: OR 1.63; 95%CI 1.03-2.57). A difference between Italians and immigrants was also observed for mortality in children aged 1-4 years, though less marked (OR 1.24; 95%CI 0.73-2.11). Excesses concerned particularly immigrants from North Africa and from sub-Saharan Africa as well as those residing in Italy for >5 years. HOSPITALISATION RESULTS. Hospitalisation rates are lower for immigrants than for Italians, except when due to infectious diseases, blood disorders, and, among women, for reasons linked to pregnancy and childbirth. Avoidable hospitalisation rates of adults from low migratory pressure Countries are lower than or equal to those of Italians. On the contrary, adults from low migratory pressure Countries show higher avoidable hospitalisation rates compared to Italians in every cohort, with the exception of Rome (RR 0.81; 95%CI 0.78-0.85), with RR ranging from 1.08 (95%CI 0.96-1.22) in Venice to 1.64 (95%CI 1.47-1.83) in Modena. Maternal and child health is the most critical area of health for immigrant population. Considering the importance that the issue of health equity has taken on in the political agenda, the data presented in this volume are a great asset, particularly in light of the long recession and the social crisis that have impacted the Country.

Risk of postneonatal mortality, hospitalisation and suboptimal breast feeding practices in low birthweight infants from rural Haryana, India: findings from a secondary data analysis

ObjectivesLow birth weight (LBW) is a risk factor for neonatal mortality and morbidity. It is important to examine whether this risk persists beyond neonatal period. The current secondary data analysis...

Acute exposure to fine and coarse particulate matter and infant mortality in Tokyo, Japan (2002–2013)

Few studies have evaluated the effect of short-term exposure to particulate matter (PM) less than 2.5μm in diameter (PM2.5) or to coarse particles on infant mortality. We evaluated the association between short-term exposure to PM and infant mortality in Japan and assessed whether adverse health effects were observable at PM concentrations below Japanese air quality guidelines. We used a time-stratified, case-crossover design. The participants included 2086 infants who died in the 23 urbanized wards of the Tokyo Metropolitan Government between January 2002 and December 2013. We obtained measures of PM2.5 and suspended particulate matter (SPM; PM<7μm in diameter) from one general monitoring station. As a measure of coarse particles, we calculated PM7–2.5 by subtracting PM2.5 from SPM. We then used conditional logistic regression to analyze the data. Same-day PM2.5 was associated with increased risks of infant and postneonatal mortality, especially for mortality related to respiratory causes. For a 10μg/m3 increase in PM2.5, the odds ratios were 1.06 (95% confidence interval: 1.01–1.12) for infant mortality and 1.10 (1.02–1.19) for postneonatal mortality. PM7–2.5 was also associated with an increased risk of postneonatal mortality, independent of PM2.5. Even when PM2.5 and SPM concentrations were below Japanese air quality guidelines, we observed adverse health effects. This study provides further evidence that acute exposure to PM2.5 and coarse particles (PM7–2.5) is associated with an increased risk of infant mortality. Further, rigorous evaluation of air quality guidelines for daily average PM2.5 and larger particles is needed.

The usefulness of general practice data to describe the mortality risk in children with congenital anomalies: a cohort study

BackgroundMajor congenital anomalies occur in 2·5% of livebirths in the UK and are an important cause of infant death. However, little is known about postneonatal mortality risks for these children because of a lack of long-term follow-up data at a population level. Furthermore, how mortality compares with the general population is underinvestigated. We compared mortality rates of children with and without major congenital anomalies. MethodsA population-based cohort of 334 599 children born 1990–09 was obtained from the Health Improvement Network, a UK database of prospectively collected primary care data. Diagnoses of major congenital anomalies were classified with European Surveillance of Congenital Anomalies criteria. Mortality rates between age 1 month and 5 years were calculated per 1000 person-years for children with any major congenital anomaly and by 15 system-specific subgroups. Cox proportional hazards were used to compare the mortality risk in children with and without major congenital anomalies where the proportional hazards assumption held. FindingsMortality rate was 0·35 per 1000 person-years (95% CI 0·32–0·38) in the general population compared with 2·92/1000 (2·40–3·54) for all children with major congenital anomalies (n=6648). Hazard of death was nine times greater for children with major congenital anomalies than for those without (unadjusted hazard ratio 8·74, 95% CI 7·04–10·87) and 20 times higher for those with congenital heart defects (20·5, 15·1–27·8). In the 81% (269 802/334 559) of the population for whom linked maternal data were available, adjustment for sex, socioeconomic status, year of birth, and maternal age and smoking status did not change hazard estimates. The mortality rate was consistently higher for children with than for those without major congenital anomalies across all system-specific subgroups. InterpretationUse of routinely collected health-care data provides estimates of the relative size of mortality risks for children with major congenital anomalies in direct comparison with the general population. Results are consistent with a previously published study from the USA. Despite variation by system-specific subgroup, children with major congenital anomalies who survive the neonatal period remain at high risk of death. Clinical and social explanations for these differences need further investigation to identify potential opportunities to prevent deaths in such children. FundingRS is supported by a postgraduate scholarship from the Economic and Social Research Council.

Temperature and Risk for Post-Neonatal Mortality in California

Temperature and Risk for Post-Neonatal Mortality in CaliforniaAbstract Number:2050 Dharshani Pearson*, Rupa Basu, Brian Malig, and Rachel Broadwin Dharshani Pearson* California Environmental Protection Agency/ Office of Environmental Health Hazard Assessment, United States, E-mail Address: [email protected] Search for more papers by this author , Rupa Basu California Environmental Protection Agency/ Office of Environmental Health Hazard Assessment, United States, E-mail Address: [email protected] Search for more papers by this author , Brian Malig California Environmental Protection Agency/ Office of Environmental Health Hazard Assessment, United States, E-mail Address: [email protected] Search for more papers by this author , and Rachel Broadwin California Environmental Protection Agency/ Office of Environmental Health Hazard Assessment, United States, E-mail Address: [email protected] Search for more papers by this author AbstractBackground: Infants have limited ability to adapt to temperature extremes because they lack well-developed thermoregulatory response mechanisms. However, very few studies of temperature and adverse health outcomes have focused on infants. Aim: To examine the relationship between apparent temperature, a combination of heat and humidity, and mortality among infants between 28 and 365 days old (post-neonatal period).Methods: Using California death certificates from 1999 to 2011, we used a case-crossover analysis to investigate the effects of mean daily apparent temperature on post-neonatal mortality. First, we identified post-neonates who died in California from May through October. We then combined these data with mean daily apparent temperature gathered from meteorological monitors located within 20 kilometers of each mother’s residential zip code to comprise our final study population of 3,398 cases. We examined deaths from circulatory causes (International Classification of Disease [ICD]-10 No. I00-I99), respiratory causes (ICD J00-J98) and sudden infant death syndrome (SIDS [ICD R95]), in addition to all-cause mortality (ICD A00-Y899). Overall, mean daily apparent temperature was associated with post-neonatal deaths related to circulatory causes (excess risk: 36.9% per 5.6°C (10°F)); 95% confidence interval: -0.7, 88.8). We found this effect to be larger in non-coastal areas (43.5%; 2.0, 101.8). When stratifying by race/ethnicity, we noted that Hispanics (46.4%; -6.8, 129.8) and Whites (73.6%,-5.5, 218.9) both showed elevated mortality associated with circulatory causes.Conclusions: Our findings suggest that parents of children under one year of age, especially those with known preexisting circulatory conditions, should receive advance warning of potential harmful health outcomes associated with high outdoor temperature.

Racial/ethnic disparities in timing of death during childhood among children with congenital heart defects

Infants with congenital heart defects (CHD) have increased risk of morbidity and mortality. Little is known about racial/ethnic differences in timing of death during childhood. Our intent was to investigate racial/ethnic differences in mortality for CHDs during specific time periods in childhood. Texas Birth Defect Registry data were used for a retrospective cohort study with 30,015 singleton infants with a CHD, born January 1, 1999, to December 31, 2007, to non-Hispanic (NH) white, NH-black, or Hispanic women. Texas Birth Defect Registry data were linked to Texas death records to ascertain death. Kaplan-Meier survival probabilities and multivariable Cox-proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. NH-blacks and Hispanics with specific CHDs had increased mortality during the postneonatal period and early childhood. NH-blacks had increased postneonatal mortality compared with NH-whites for transposition of the great arteries (HR = 2.4; 95% CI, 1.5-4.0), pulmonary valve atresia without ventricular septal defect (HR = 4.1; 95% CI, 1.7-9.7), Ebstein's anomaly (HR = 8.6; 95 CI, 1.2-61.1), hypoplastic left heart syndrome (HR = 2.1; 95% CI, 1.2-3.7), coarctation of the aorta (HR = 2.1; 95% CI, 1.2-3.5), ventricular septal defect (HR = 2.1; 95% CI, 1.6-2.8), and atrial septal defect (HR = 1.4; 95% CI, 1.1-1.8). Hispanics had increased postneonatal mortality risk for tetralogy of Fallot (HR = 2.0; 95% CI, 1.1-3.5). Racial/ethnic increases in mortality risk were also observed during infancy and childhood. Racial/ethnic differences in mortality were most notably observed during the postneonatal period and early childhood. Future studies should assess factors associated with this disparity in mortality risk for infants with CHDs.

Subtypes of Preterm Birth and the Risk of Postneonatal Death

To examine the differences in postneonatal death risk among 3 clinical subtypes of preterm birth: preterm premature rupture of membranes (PROM), indicated preterm birth, and spontaneous preterm labor. We analyzed the 2001-2005 US linked birth/infant death (birth cohort) datasets. The preterm birth subtypes were classified using information on the birth certificate: reported PROM, induction of labor, cesarean section, and complications of pregnancy and labor. Cox proportional hazard models were used to estimate covariate-adjusted hazard ratios and 95% CIs for postneonatal death (from days 28 to 365). Estimation was given for preterm birth subtypes in a week-by-week analysis. Causes of death were analyzed by preterm birth subtype and then separately at 24-27, 28-31, and 32-36 weeks of gestation. For the total of 1895350 singleton preterm births who survived the neonatal period, the postneonatal mortality rate was 1.11% for preterm PROM, 0.78% for indicated preterm birth, and 0.53% for spontaneous preterm labor. Preterm PROM was associated with significantly higher risk of postneonatal death compared with spontaneous preterm labor in infants born at 27 weeks gestation or later. Similarly, indicated preterm birth was associated with a significantly higher risk of postneonatal death than spontaneous preterm labor in infants born at 25 weeks gestation or later. Preterm PROM and indicated preterm birth were associated with greater risk of death in the postneonatal period compared with spontaneous preterm labor, irrespective of the cause of death. Subtypes of preterm birth carry different risks of postneonatal mortality. Prevention of preterm-related postneonatal death may require more research into the root causes of preterm birth subtypes.

Twins born over weekends: are they at risk for elevated infant mortality?

To assess the impact of the day of birth on twin mortality in a population sample. We analyzed weekend versus weekday twin births from the United States national twin birth data for the periods 1989-2002. We computed adjusted hazard ratios (HR) and 95% confidence intervals (CI) to assess the association between infant mortality and weekday of birth using the Cox proportional hazards model. The crude rates for all types of mortality were found to be significantly higher for twins born on weekends than on weekdays. After adjustment, only post-neonatal mortality risk was higher on weekends as compared to weekdays [Hazards ratio (HR)=1.19, CI: 1.04, 1.36]. Twins of white mothers were at greater risk for neonatal death (HR=1.16, CI: 1.08, 1.24) but were less likely to experience post-neonatal death (HR=0.68, CI: 0.64, 0.76) as compared to twins of black mothers. We found an interaction between maternal age and weekday of birth. Twins born on weekends to teenage mothers (age<18) had a 35% greater risk for neonatal death (HR=1.35, CI: 1.06, 1.71) while those born on weekends to older mothers did not show elevated risk for any of the mortality indices. Increased risks for post-neonatal death are significantly higher amongst twins born on weekends as compared to weekdays. Further research is required to identify the detailed differences in structure and procedures that result in the disadvantage associated with weekend birth.

How long after a miscarriage should women wait before becoming pregnant again? Multivariate analysis of cohort data from Matlab, Bangladesh

ObjectiveTo determine the optimum interpregnancy interval (IPI) following a miscarriage.DesignMultivariate analysis of population-based, prospective data from a demographic surveillance system.SettingPregnancies in Matlab, Bangladesh, between 1977 and 2008.Participants9214 women with 10...

Breast-Feeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-Analysis

Breast-feeding is associated with a reduced risk of postneonatal mortality. It is unclear whether breast-feeding also lowers the risk of sudden infant death syndrome (SIDS). The results of a large number of epidemiologic studies investigating the possible protective effect of breast-feeding against SIDS have been conflicting. A meta-analysis published in 2007 reported a protective effect against SIDS among infants who were ever breast-fed compared with infants who were never breast-fed. This meta-analysis tested the hypotheses that breast-feeding decreases the risk of SIDS and that breast-feeding for longer duration and exclusive breast-feeding are associated with a greater reduction in risk. A total of 288 studies with data on breast-feeding and SIDS were identified through a Medline search of articles published between1966 and 2009 (n = 265) and a search of review articles and meta-analyses (n = 23). Among the 288 studies, 24 original case-control studies were identified that provided data on the relationship between breast-feeding and risk of SIDS. The quality of each of the 24 studies was independently evaluated by 2 teams of reviewers according to preset criteria for inclusion; this resulted in a total of 18 case-control studies for analysis. To assess the different associations between breast-feeding and SIDS, univariable and multivariable odds ratios were extracted from each study, and a summary odds ratios (SOR) was calculated using the fixed-effect and random-effect inverse-variance methods of meta-analysis. Heterogeneity was analyzed with the Breslow-Day test. Univariable analysis showed that compared with no breast-feeding, there was a statistically significant lower risk of SIDS among infants who received any amount of breast milk for any duration; the SOR was 0.40, with a 95% confidence interval (CI) of 0.35 to 0.44. The association remained statistically significant after multivariable analysis (adjusted SOR, 0.55; 95% CI, 0.44–0.69). Among infants with any breast-feeding at 2 months of age or older, the univariable SOR was 0.38, with a 95% CI of 0.27 to 0.54. With univariable analysis, the protective effect was greater in infants who received exclusive breast-feeding of any duration (SOR, 0.27; 95% CI, 0.24–0.31). These findings show that breast-feeding to any extent and of any duration is protective against SIDS. The investigators recommend that, when possible, breast-feeding should be exclusive for at least 4 to 6 months and continued until at least 1 year of age.

SP4-28 Childbearing during adolescence and offspring mortality: comparison of three population based cohorts in southern Brazil

ObjectiveTo assess the association between childbearing age and risk of offspring mortality in three birth cohort studies.SettingPelotas, Southern Brazil.MethodsAll hospital births which occurred in 1982 (n=6011), 1993 (n=5304) and 2004...

Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis

Benefits of breastfeeding include lower risk of postneonatal mortality. However, it is unclear whether breastfeeding specifically lowers sudden infant death syndrome (SIDS) risk, because study results have been conflicting. To perform a meta-analysis to measure the association between breastfeeding and SIDS. We identified 288 studies with data on breastfeeding and SIDS through a Medline search (1966-2009), review articles, and meta-analyses. Twenty-four original case-control studies were identified that provided data on the relationship between breastfeeding and SIDS risk. Two teams of 2 reviewers evaluated study quality according to preset criteria; 6 studies were excluded, which resulted in 18 studies for analysis. Univariable and multivariable odds ratios were extracted. A summary odds ratio (SOR) was calculated for the odds ratios by using the fixed-effect and random-effect inverse-variance methods of meta-analysis. The Breslow-Day test for heterogeneity was performed. For infants who received any amount of breast milk for any duration, the univariable SOR was 0.40 (95% confidence interval [CI]: 0.35-0.44), and the multivariable SOR was 0.55 (95% CI: 0.44-0.69). For any breastfeeding at 2 months of age or older, the univariable SOR was 0.38 (95% CI: 0.27-0.54). The univariable SOR for exclusive breastfeeding of any duration was 0.27 (95% CI: 0.24-0.31). Breastfeeding is protective against SIDS, and this effect is stronger when breastfeeding is exclusive. The recommendation to breastfeed infants should be included with other SIDS risk-reduction messages to both reduce the risk of SIDS and promote breastfeeding for its many other infant and maternal health benefits.

Breastfeeding and reduced risk of Sudden Infant Death Syndrome: A meta-analysis

Introduction: The benefits of breastfeeding include lower risk of postneonatal mortality. It is unclear whether breastfeeding specifically affects SIDS risk. Aim: A meta-analysis was undertaken to measure the association between breastfeeding and SIDS. Method: We identified 285 studies with data on breastfeeding and SIDS through a Medline search (1966–2009), review papers and meta-analyses, of which 31 were original case-control studies. Two teams of 2 reviewers independently evaluated study quality according to preset criteria. Univariate and multivariate odds ratios (ORs) were extracted. A summary OR (SOR) was calculated for the univariate and multivariate ORs using the fixed effect and random effect inverse-variance methods of meta-analysis. The Breslow-Day test for heterogeneity was calculated, with a p-value &lt;0.05 indicating that heterogeneity was present. Results: For infants who received any amount of breast milk for any duration, univariate SOR (95% confidence interval [CI]) was 0.49 (0.45, 0.53); multivariate was 0.68 (0.58, 0.80). For any breastfeeding for &gt;2 months, univariate SOR was 0.32 (0.26, 0.40) and multivariate was 0.55 (0.28, 1.07). The univariate SOR for exclusive breastfeeding of any duration was 0.32 (0.28, 0.36); there were no studies reporting multivariate analyses for exclusive breastfeeding. Heterogeneity was present for all analyses, except multivariate analysis of breastfeeding &gt;2 months. Conclusion: Breastfeeding was protective against SIDS. The protective effect was stronger for exclusive breastfeeding and for longer duration of breastfeeding. The recommendation to breastfeed infants should be included with other SIDS risk reduction messages to both reduce the risk of SIDS and to promote breastfeeding for its many other infant and maternal health benefits.

799 Molecular subgroups of breast cancer show distinct genomic profiles and different clinical courses: a novel definition of disease subclasses

Objectives: To examine the utility of a risk-approach model in identifying infants at greater risk of postneonatal mortality (PNM) and to determine whether there is a relationship between PNM and linkage of at-risk infants to primary health care. Methods: The Sheffield Birth Score instrument was applied to 90,846 newborn infants to determine high-score (HS) and low-score (LS) infant risk groups. Health care visit data were collected on all HS infants who were referred for primary pediatric care. Mortality rates were calculated for both HS and LS infant groups and for HS infants who were linked and not linked to care. Results: The HS infant group was at significantly greater risk of PNM (p < 0.0001). The linked group had a lower PNM rate (p < 0.05), and linked/not-linked group differences were noted for 11 of 20 variables. When these 11 variables and the linked/not-linked variable were entered into a logistic regression analysis, linkage was the only significant variable (p < 0.01) in predicting PNM. Conclusions: The Sheffield Birth Score differentiated at birth those infants who were at greater risk of PNM. The lower incidence of PNM among linked HS infants suggests a promising argument for early pediatric intervention. Further research to clarify specific factors that influence health care participation decisions is suggested. (J Pediatr 1998;132:822-6)

Racial/ethnic disparities in infant mortality

This study examines predictors of neonatal and postneonatal mortality among infants born to black, white, and Hispanic women. Linked birth/infant death records from North Carolina for the period 1999-2007 were the source of data. Logistic regression models were constructed to estimate the effect of maternal and infant characteristics on neonatal (<28 days) and postneonatal (28-364 days) mortality. Analyses revealed no racial/ethnic differences in neonatal mortality, but increased risk among black infants for postneonatal death. Inadequate prenatal care was associated with an increased risk for neonatal mortality across all three racial/ethnic groups. Younger maternal age and lower educational levels were associated with postneonatal deaths for black and white women, but not Hispanic. A previous child loss, being unmarried and labor/delivery complications increased the risk for postneonatal mortality only among white women. Black infants had higher rates of death attributed to sudden infant death syndrome (SIDS), infections, low birth weight (LBW)/prematurity, respiratory conditions, and injuries. Early initiation of prenatal care, access to risk-appropriate obstetric and neonatal services, and participation in intervention programs that support parenting of LBW/preterm infants throughout the first year of life are likely to yield the greatest impact in reducing infant mortality.