Infant Mortality Statistics Research Articles

Why Is End-of-Life Care Delivery Sporadic?

According to the Centers for Disease Control and Prevention Infant Mortality Statistics, 28 384 infants died in the United States in 2005. On examining the state of the science in providing end-of-life care for newborns, it is important to examine the practice of providing compassionate and dignified palliative care at the end of life. The purpose of this research study was to examine the barriers to and facilitators of providing a quality end-of-life care in one large Midwestern tertiary NICU. A convenience sample of 50 NICU registered nurses from a Level III Midwestern Facility participated. A quantitative, prospective, cross-sectional design was used. Data were collected with the Neonatal Palliative Care Attitude Scale questionnaire. Five barriers and 8 facilitators to end-of-life care practice in the NICU were identified. The 5 barriers were the nurses' inability to express opinions values and beliefs regarding palliative care (M = 2.98, SD = 1.30), less than ideal physical environment (M = 2.70, SD = 1.31), technological imperatives (M = 3.22, SD = 1.11), parental demands (M = 3.46, SD = 1.07), and, finally, lack of education (M = 2.86, SD = 1.44). The 8 facilitators were supportive medical staff (M = 3.60, SD = 1.29), parental involvement of decisions (M = 3.76, SD = 1.17), parents informed of options (M = 3.32, SD = 1.22), support from medical team when palliative care is implemented (M = 3.20, SD = 1.28), staffing (M = 3.60, SD = 1.29), time spent with dying baby (M = 3.52, SD = 1.31), policies/guidelines supporting palliative care (M = 3.76, SD = 1.19), and available counseling (M = 3.566, SD = 1.26). Barriers and facilitators continue to exist within neonatal end-of-life care. There is significant importance for NICU nurses to recognize and understand the barriers to and facilitators of providing end-of-life care within their specific unit. Further research is warranted regarding implementation of end-of-life care education in the NICU to improve patient care.

Infant mortality statistics from the 2006 period linked birth/infant death data set.

This report presents 2006 period infant mortality statistics from the linked birth/infant death data set (linked file) by a variety of maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. Descriptive tabulations of data are presented and interpreted. The U.S. infant mortality rate was 6.68 infant deaths per 1,000 live births in 2006, a 3 percent decline from 6.86 in 2005. Infant mortality rates ranged from 4.52 per 1,000 live births for Central and South American mothers to 13.35 for non-Hispanic black mothers. Infant mortality rates were higher for those infants whose mothers were born in the 50 states or the District of Columbia, were unmarried, or were born in multiple deliveries. Infant mortality was also higher for male infants and infants born preterm or at low birthweight. The neonatal mortality rate was essentially unchanged in 2006 (4.46) from 2005 (4.54). The postneonatal mortality rate decreased 4 percent, from 2.32 in 2005 to 2.22 in 2006. Infants born at the lowest gestational ages and birthweights have a large impact on overall U.S. infant mortality. For example, more than half of all infant deaths in the United States in 2006 (54 percent) occurred to the 2 percent of infants born very preterm (less than 32 weeks of gestation). Still, infant mortality rates for late preterm infants (34-36 weeks of gestation) were three times those for term infants (37-41 weeks). The three leading causes of infant death--congenital malformations, low birthweight, and sudden infant death syndrome--taken together accounted for 46 percent of all infant deaths. The percentage of infant deaths that were "preterm-related" was 36.1 percent in 2006. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.4 times higher and the rate for Puerto Rican mothers was 84 percent higher than for non-Hispanic white mothers.

Studying Sudden and Unexpected Infant Deaths in a Time of Changing Death Certification and Investigation Practices: Evaluating Sleep-Related Risk Factors for Infant Death in New York City

We describe an approach for quantifying and characterizing the extent to which sudden and unexpected infant deaths (SUIDs) result from unsafe sleep environments (e.g., prone position, bedsharing, soft bedding); and present data on sleep-related infant deaths in NYC. Using a combination of vital statistics and medical examiner data, including autopsy and death scene investigation findings, we analyzed any death due to accidental threat to breathing (ATB) (ICD-10 W75 & W84), and deaths of undetermined intent (UND) (Y10-Y34) between 2000 and 2003 in NYC for the presence of sleep-related factors (SRF). Homicide deaths were excluded as were SIDS, since in NYC SIDS is not a certification option if environmental factors were possibly contributors to the death. All 19 ATB and 69 (75%) UND had SRFs as per the OCME investigation. Black infants and infants born to teen mothers had higher SRF death rates for both ATB and UND deaths. Bedsharing was the most common SRF (53%-ATB; 72%-UND deaths); the majority of non-bedsharing infants were found in the prone position (60%-ATB; 78%-UND deaths). We found a high prevalence of SRFs among ATB and UND deaths. This is the first local study to illustrate the importance of knowing how SUIDs are certified in order to ascertain the prevalence of infant deaths with SRFs. Advancing the research requires clarity on the criteria used by local medical examiners to categorize SUIDs. This will help jurisdictions interpret their infant mortality statistics, which in turn will improve education and prevention efforts.

Quality of cause-of-death statements and its impact on infant mortality statistics in Hermosillo, Mexico

This study evaluates the quality (completeness and accuracy) of cause-of-death (COD) statements in infant death certificates as entered into a vital records system and assesses its impact on infant mortality statistics in Hermosillo, Sonora, Mexico. COD statements in a systematic random sample of 200 infant death certificates were compared to their corresponding medical charts. The underlying CODs (UCODs) originally recorded in each death certificate were contrasted with those assigned by an expert reviewer. Coding for the original and "new" UCODs was based on the three-digit category of the International Classification of Diseases, 10th Revision. Measurements of agreement between the two sets of UCODs were calculated and logistic regression was performed to determine factors associated with agreement. Overall agreement between the original and new UCODs was 52%. Agreement was excellent for the group of deaths due to congenital malformations, deformations, and chromosomal abnormalities (kappa = 0.77); substantial for conditions originating in the perinatal period (kappa = 0.74); and poor for certain infectious and parasitic diseases, and respiratory diseases (kappa = 0.35). Overestimation (false-positive reporting) was highest (13%) for perinatal conditions, while underestimation (false-negative reporting) was highest (71%) for certain infectious and parasitic diseases, and respiratory diseases. Agreement was associated with type of UCOD (endogenous versus exogenous) and time of death. More than half (53%) of COD statements in infant death certificates in Hermosillo were inaccurately completed, which may lead to inaccurate interpretation of causes of infant mortality. Systematic assessments of the quality of COD statements may improve the quality of mortality statistics.

State Infant Mortality: An Ecologic Study to Determine Modifiable Risks and Adjusted Infant Mortality Rates

To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization procedures. Final risk adjusted IMR's were standardized and states were compared with the United States adjusted rates. Models for IMR in individual states in 2001 (r2 = 0.66, P < 0.01) and 2002 (r2 = 0.81, P < 0.01) were tested. African-American race, teen birth rate, and smoking during pregnancy remained independently associated with state infant mortality rates for 2001 and 2002. Ninety five percent confidence intervals (CI) were calculated around the regression lines to model the expected IMR. After adjustment, some states maintained a consistent IMR; for instance, Vermont and New Hampshire remained low, while Delaware and Louisiana remained high. However, other states such as Mississippi, which have traditionally high infant mortality rates, remained within the expected 95% CI for IMR after adjustment indicating confounding affected the initial unadjusted rates. Non-modifiable demographic variables, including the percentage of non-Hispanic African-American and Hispanic populations of the state are major factors contributing to individual variation in state IMR. Race and ethnicity may confound or modify the IMR in states that shifted inside or outside the 95% CI following adjustment. Other factors including smoking during pregnancy and teen birth rate, which are potentially modifiable, significantly contributed to differences in state IMR. State risk adjusted IMR indicate that other factors impact infant mortality after adjustment by race/ethnicity and other risk factors.

Infant mortality statistics from the 2004 period linked birth/infant death data set.

This report presents 2004 period infant mortality statistics from the linked birth/infant death data file by a variety of maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. Descriptive tabulations of data are presented and interpreted. Excluding rates by cause of death, the infant mortality rate is now published with two decimal places. The U.S. infant mortality rate was 6.78 infant deaths per 1000 live births in 2004 compared with 6.84 in 2003. Infant mortality rates ranged from 4.67 per 1,000 live births for Asian and Pacific Islander mothers to 13.60 for non-Hispanic black mothers. Among Hispanics, rates ranged from 4.55 for Cuban mothers to 7.82 for Puerto Rican mothers. Infant mortality rates were higher for those infants whose mothers were born in the 50 states and the District of Columbia, were unmarried, or were born in multiple births. Infant mortality was also higher for male infants and infants born preterm or at low birthweight. The neonatal mortality rate declined from 4.63 in 2003 to 4.52 in 2004 while the postneonatal mortality rate was essentially unchanged. Infants born at the lowest gestational ages and birthweights have a large impact on overall U.S. infant mortality. More than one-half (55 percent) of all infant deaths in the United States in 2004 occurred to the 2 percent of infants born at less than 32 weeks of gestation. Still, infant mortality rates for late preterm (34-36 weeks of gestation) infants were three times those for term (37-41 week) infants. The three leading causes of infant death-Congenital malformations, low birthweight, and SIDS-taken together accounted for 45 percent all infant deaths. Results from a new analysis of preterm-related causes of death show that 36.5 percent of infant deaths in 2004 were due to preterm-related causes. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.5 times higher, and the rate for Puerto Rican mothers was 75 percent higher than for non-Hispanic white mothers.

Fetal Alert Network: Surveying congenital anomalies

Fetal Alert Network: Surveying congenital anomalies

An Assessment of Completeness and Accuracy of Underlying Cause-of-Death Statements and its Impact on the Infant Mortality Statistics in Hermosillo, Mexico

An Assessment of Completeness and Accuracy of Underlying Cause-of-Death Statements and its Impact on the Infant Mortality Statistics in Hermosillo, Mexico

Maternal–fetal risk assessment

In first-world countries, maternal and infant mortality has significantly decreased over the past 50 years due to factors such as skilled pregnancy care practitioners, aseptic hospital births, antibiotics, safe blood transfusions, and oxytocin. However, international maternal and infant mortality statistics from underdeveloped countries remain high. Pregnancy risk management requires implementation of risk-reduction strategies that have been proven to be effective. Marked physiological alterations in biochemical indices that occur in pregnancy require that laboratories participating in the evaluation of new interventions in pregnancy must ensure that tests are compared to appropriate gestation-specific reference intervals.

Commentary

Commentary

Maternal health care at a Japanese American relocation camp, 1942-1945: a historical study.

From late summer of 1942 until the fall of 1945, approximately 120,000 ethnic Japanese were confined behind barbed wire within 10 relocation camps in the United States. Although histories have been written about the relocation camps, little data are available about women's lives. This study explored women's lives and experiences with pregnancy, childbirth, and child care in a Japanese-American relocation camp. Twenty women who were ages 18 to 31 years at the time of internment at Heart Mountain, Wyoming Japanese American Relocation Camp, and one caucasian nurse who worked in the obstetric unit of the camp's hospital were interviewed. Archival, demographic, and historical data, including some prenatal records, provided information about maternity and public health care for pregnant women and new mothers. Obstetric hospital practices were typical of the 1940s in the United States. Community public health services for new mothers included formula kitchens and well-baby clinics. Infant mortality statistics from 1942 to 1945 at Heart Mountain were comparatively better for the same time period than for the state of Wyoming or the United States. These outcomes may have reflected the camp's extensive social and family support, adequate housing and food, and universal access to maternity services. The Heart Mountain internment provides a story about how women's lives are impacted by war. Since World War II, civilians, especially women and children, have increasingly been targeted during wars with profound impact upon the health of mothers and babies.

Maternal Health Care at a Japanese American Relocation Camp, 1942–1945: A Historical Study

Background: From late summer of 1942 until the fall of 1945, approximately 120,000 ethnic Japanese were confined behind barbed wire within 10 relocation camps in the United States. Although histories have been written about the relocation camps, little data are available about women's lives. This study explored women's lives and experiences with pregnancy, childbirth, and child care in a Japanese‐American relocation camp. Methods: Twenty women who were ages 18 to 31 years at the time of internment at Heart Mountain, Wyoming Japanese American Relocation Camp, and one caucasian nurse who worked in the obstetric unit of the camp's hospital were interviewed. Archival, demographic, and historical data, including some prenatal records, provided information about maternity and public health care for pregnant women and new mothers. Results: Obstetric hospital practices were typical of the 1940s in the United States. Community public health services for new mothers included formula kitchens and well‐baby clinics. Infant mortality statistics from 1942 to 1945 at Heart Mountain were comparatively better for the same time period than for the state of Wyoming or the United States. These outcomes may have reflected the camp's extensive social and family support, adequate housing and food, and universal access to maternity services. Conclusions: The Heart Mountain internment provides a story about how women's lives are impacted by war. Since World War II, civilians, especially women and children, have increasingly been targeted during wars with profound impact upon the health of mothers and babies. (BIRTH 24:3, September 1997)

Perinatal and infant mortality statistics

Perinatal and infant mortality statistics

The impact of extreme prematurity and congenital anomalies on the interpretation of international comparisons of infant mortality

To identify the potential impact that different definitions of live births and practice patterns have on infant mortality rates in England and Wales, France, Japan, and the United States. United States data were obtained from the 1986 linked national birth-infant death cohort, and those for the other countries came from either published sources or directly from the Ministries of Health. In 1986 in the United States, infants weighing less than 1 kg accounted for 36% of deaths (32% white and 46% black); 32% resulted from fatal congenital anomalies. These rates were much higher in both categories than in England and Wales in 1990 (24 and 22%, respectively), France in 1990 (15 and 25%, respectively), and Japan in 1991 (9% for infants weighing less than 1 kg, percentage of fatal congenital anomalies unknown). These cases are more likely to be excluded from infant mortality statistics in their countries than in the United States. In 1990, the United States infant mortality rate was 9.2 per 1000 live births, ranking the United States 19th internationally. However, infant mortality provides a poor comparative measure of reproductive outcome because there are enormous regional and international differences in clinical practices and in the way live births are classified. Future international and state comparisons of reproductive health should standardize the definition of a live birth and fatal congenital anomaly, and use weight-specific fetal-infant mortality ratios and perinatal statistics.

Validity of the Maternal and Child Health Services Block Grant as an Indicator of State Infant Mortality Reduction Initiatives

Since state Maternal and Child Health Services Block Grant applications represent the most comprehensive source of information about community and state needs assessment, policy development, and program assurance for the population of mothers and children, these documents have the potential to play a central role in state accountability to Congress and the Maternal and Child Health Bureau. To measure the validity of block grant applications as a reporting mechanism, we assessed the sensitivity of the applications from seven states to strategies for reducing infant mortality. We used the independent coding of infant mortality strategies from the Healthy Futures/Healthy Generations Program intensive evaluation as the standard. Overall, the sensitivity of the block grant applications was only 45%. Since the open-ended design of the block grant applications does not appear to reflect the extent of state activity in infant mortality reduction, a uniform application should be adopted that will facilitate clear and systematic reporting of state activities.

International infant mortality rates: bias from reporting differences.

International infant mortality statistics have caused concern in the United States, since the US ranking relative to other developed countries has declined since World War II. This paper suggests that there may be international differences in reporting of very-low-birthweight infants and perinatal deaths and that such reporting differences bias comparisons of national perinatal and infant mortality rates. Efforts must be made to adopt standard conventions for the inclusion of small, early infants and fetal deaths in rate calculations.

Infant Mortality Statistics Do Not Adequately Reflect the Impact of Short Gestation

To determine the accuracy of National Center for Health Statistics cause-specific infant mortality data. The National Center for Health Statistics compiles these data by applying World Health Organization (WHO) selection rules to death certificate data. The WHO rules arrange medical entities into a hierarchical order and select a single underlying cause of death (ULCD). A comparison was made between ULCD assigned to a cohort of 335 infant death certificates by (1) a neonatologist panel, and (2) application of WHO selection rules by the Florida State Office of Vital Statistics (OVS). Among the 146 infants with birth weights 1500 to 4649 g, agreement between neonatologists and OVS was 88%, while among the 189 infants with birth weights 0 to 1499 g (very low birth weight), agreement was just 41%. Neonatologists selected short gestation as the underlying cause of death for 82% of very low birth weight infant records, vs 25% by OVS. Due to the application of specific WHO selection rules, OVS frequently selected immediate causes of death, such as "cardiac arrest," as the ULCD, even when the medical certifier had indicated short gestation as the ULCD. In vital statistics reports, many of these immediate causes are reported as "other respiratory conditions of newborn," or "all other perinatal conditions." WHO ULCD selection rules should be modified to allow short gestation to have a higher priority over immediate causes of infant death.

Validez de las Estadístlcas de Mortalidad Infantil en Navarra

In order to explore the validity of official infant mortality statistics, the number of infant deaths registered in the cohort of live births and resident in Navarra (Spain) from 1985 to 1989, according to data supplied by the Department of Statistics of Navarra, has been compared with that obtained in a retrospective search into the information of the hospitals. Among 24,383 live births of the cohort, 291 were certified as infant deaths. An over-register of 13 cases (4.5%) and an under-register of 26 cases (8.9%) was detected. By excluding those live births with less than six months of gestation, as done by the National Institute of Statistics, the validity is altered, because apart from the errors mentioned, one must add those resulting from the incorrect filling-in of the "number of weeks pregnant"= variable. When correcting these deficiencies, the final statistics (Infant Mortality Risk = 11.17 per 1000 live births) did not differ much from the official figures (IMR = 11.48 per 1000 live births).

The 1990s and Beyond: Determining the Need for Community Health and Primary Care Nurses for Rural Populations*

Increased numbers of primary care and advanced practice nurses with unique generalist skills will be required to meet the accelerating physiologic and sociocultural health care needs of rural populations. Several factors have been identified that will influence the demands and position of community-based nurses in rural practice settings during the next decade. A back-to-basics type of health care offered out of a growing elderly population; technological breakthroughs that make it possible for more chronically ill patients to live at home; serious substance abuse and other adolescent problems; AIDS; and high infant morbidity and mortality statistics are only some of the concerns that will demand nursing intervention. These changes speak to the need for improved nursing coordination, stronger collegial relationships, and better communication between physicians and nurses. Health care is moving in new directions to offer more efficient and technologically sophisticated care. These changes enhance the need for clinically expert educators who teach and jointly practice in programs with a rural focus. Telecommunications, and heightened computer literacy, will play a major role both in nursing education and clinical practice. The goals of kindergarten through 12th grade health promotion and disease prevention strategies in school health will be the norm and will require better prepared, and positions for, school nurses. More midwives and public health nurses will be needed to care for the growing population of sexually active adolescents who are in need of family planning and prenatal care. Underinsured and indigent populations will continue to fall within the purview of midlevel practitioners, as will providing anesthesia services in small rural hospitals. The transition of some rural hospitals into expanded primary care units (e.g., EACHs and RPCHs), and new models of case management will greatly influence nursing demands. This paper will further identify critical areas of advanced practice nursing within community settings, including new relationships with other health care providers, and will introduce strategies upon which rural health policy recommendations for the 1990s can be addressed.

The 1990s and Beyond: Determining the Need for Community Health and Primary Care Nurses for Rural Populations*

ABSTRACT: Increased numbers of primary care and advanced practice nurses with unique generalist skills will be required to meet the accelerating physiologic and sociocultural health care needs of rural populations. Several factors have been identified that will influence the demands and position of community‐based nurses in rural practice settings during the next decade. A back‐to‐basics type of health care offered out of a growing elderly population; technological breakthroughs that make it possible for more chronically ill patients to live at home; serious substance abuse and other adolescent problems; AIDS; and high infant morbidity and mortality statistics are only some of the concerns that will demand nursing intervention. These changes speak to the need for improved nursing coordination, stronger collegial relationships, and better communication between physicians and nurses. Health care is moving in new directions to offer more efficient and technologically sophisticated care. These changes enhance the need for clinically expert educators who teach and jointly practice in programs with a rural focus. Telecommunications, and heightened computer literacy, will play a major role both in nursing education and clinical practice. The goals of kindergarten through 12th grade health promotion and disease prevention strategies in school health will be the norm and will require better prepared, and positions for, school nurses. More midwives and public health nurses will be needed to care for the growing population of sexually active adolescents who are in need of family planning and prenatal care. Underinsured and indigent populations will continue to fall within the purview of midlevel practitioners, as will providing anesthesia services in small rural hospitals. The transition of some rural hospitals into expanded primary care units (e.g., EACHs and RPCHs), and new models of case management will greatly influence nursing demands. This paper will further identify critical areas of advanced practice nursing within community settings, including new relationships with other health care providers, and will introduce strategies upon which rural health policy recommendations for the 1990s can be addressed.