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2011 BCBS Infant Mortality Best Practices Forum

2011 BCBS Infant Mortality Best Practices Forum. INFANT MORTALITY. Giancarlo Mari, M.D. Professor and Chair Department of Obstetrics and Gynecology University of Tennessee Health Science Center Memphis, TN. Definitions.

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2011 BCBS Infant Mortality Best Practices Forum

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  1. 2011 BCBS Infant MortalityBest Practices Forum INFANT MORTALITY Giancarlo Mari, M.D. Professor and Chair Department of Obstetrics and Gynecology University of Tennessee Health Science Center Memphis, TN

  2. Definitions • Infant mortality – Death of a live-born infant under 1 year of age per 1,000 live births • Neonatal Mortality – Death in the first 28 days of life • Postneonatal Mortality – Death after 28 days of life but before 1 year • Fetal mortality – Fetal weight 350 g or more, or 20 weeks of gestation or more (NCHS 2010) • Preterm Birth – Birth before 37 completed weeks of gestation

  3. Infant mortality, fetal mortality, and preterm birth all represent important health challenges that have shown little recent improvement.

  4. Fetal and Infant Mortality Rates and Percentage of Preterm BirthsUnited States: 1990-2008 MacDorman MF. SeminPerinatol 2011;35(4):200-8.

  5. US Mortality Rates 1940-2006:Infant, Neonatal and Postneonatal

  6. US Infant Mortality Rate Per 1,000 Live Births: 2000-2008

  7. Global Ranking of Mortality Rates1960 vs. 2004

  8. Healthcare Costs • The US spends more than twice the average of other industrialized countries on healthcare : • In 2006, Americans spent $6,714 per capita

  9. The Preterm Birth Connection • Much of the infant mortality rate in the U.S. when compared to other countries is due to the high percentage of preterm births MacDorman MF, et al. NCHF 2009

  10. The Costs of Preterm Birth • Annual costs in the United States related to preterm birth exceed $26 billion annually • $51,500 per preterm infant Dhanireddy R. The Commercial Appeal, November 13, 2010.

  11. Percentage of Live Births and Infant Deaths by Gestational AgeUnited States: 2006 MacDorman MF. SeminPerinatol 2011;35(4):200-8.

  12. Infant Mortality Rates for the 5 Leading Causes of Infant Death by Race and Hispanic Origin of MotherUnited States: 2006 MacDorman MF. SeminPerinatol 2011;35(4):200-8.

  13. Infant Mortality Rate by Race and EthnicityUnited States: 2006 Mathews TJ et al. Pediatrics 2011;127:146-157.

  14. African-American vs. Caucasian Infant MortalityUnited States: 2006 MacDorman MF. SeminPerinatol 2011;35(4):200-8.

  15. Infant Mortality by Location

  16. 2008 Infant Mortality by State • Ranged from 3.95 deaths/1,000 live births in New Hampshire to 9.97 deaths/1,000 live births in Mississippi • Tennessee had 6thhighest infant mortality rate (8.1) Mathews TJ, et al. Pediatrics 2011;127:146-157

  17. Tennessee Infant Mortality by Age at Death1997-2006

  18. Tennessee Infant Mortality by Race1997-2006

  19. Tennessee Infant Mortality by Race and Ethnicity1997-2006

  20. Tennessee Infant Mortality Due to Preterm Birth and Low Birthweight1997-2006

  21. The Regional Medical Center (THE MED)Memphis Preterm Births2006-2010

  22. Tennessee Infant Mortality Due to Accidents1997-2006

  23. Tennessee Infant Mortality Due to Sudden Infant Death Syndrome1997-2006

  24. Tennessee Infant Mortality Due to Congenital Defects1997-2006

  25. Tennessee Infant Mortality by Maternal Age2001-2005

  26. Regional Medical Center at Memphis (The MED)2008-2009 Teenage Pregnancies 2008 2009 (Total of 1217) (Total of 933) AgeTotalAgeTotal 12 1 12 0 13 6 13 4 14 30 14 11 15 84 15 48 16 169 16 120 17 204 17 182 18 318 18 270 19 405 19 298 NICU Admissions: 224 NICU Admissions: 253

  27. Tennessee Infant Mortality by Maternal Marital Status2001-2005

  28. Memphis • Number of children under 18 in the city: 167,968 • Number living in a "husband-wife family": 56,158 • Number living in a family with a female householder, no husband present: 66,682 • Number living in a family with a male householder, no wife present: 10,656 • Number living with grandparents: 22,599 • Number living with other relatives: 8,255 • Number living with non-relatives: 3,034. Charlier T. The Commercial Appeal; August 29, 2011

  29. Tennessee Infant Mortality by Maternal Education2001-2005

  30. Tennessee Infant Mortality by Household Income2004-2005

  31. Tennessee Infant Mortality by Maternal Tobacco Use2001-2005

  32. Tennessee Infant Mortality by Adequacy of Prenatal Care2001-2005

  33. Shelby County Infant Mortality Year Total Caucasian Black 2006 13.8 6.8 19.0 2007 12.7 5.8 17.8 2008 12.3 4.7 17.6

  34. “No child should die in the dawn of life.” -Danny Thomas, Founder of St. Jude Children’s Research Hospital

  35. Interventions • Prevention • Primary: Avoid the development of disease or condition; health promotion activities • Secondary: Diagnose and treat disease or condition in its early stages before it results in significant morbidity • Tertiary: Reduce the negative impact of established disease or condition by reducing disease or condition-related complications

  36. 2007 Newborn Center MortalityInborn and Outborn (Courtesy- R. Dhanireddy)

  37. Interventions • BLUES Project • Dr. Linda Moses, Project Director • Ms. Teresa Franklin, Project Coordinator

  38. Building Lasting Unshakable Expectations into Successes The BLUES PROJECT

  39. The BLUES Project • The Blues Project (BLUES) is a community service project that provides education, counseling, social support and community resources referrals to participants during pregnancy until the child’s second birthday. BLUES is funded by Blue Cross Blue Shield of Tennessee Health Foundation.

  40. Risk Factors • Contributing social and economic factors: • Race • Poverty • Low parental education • Single parenthood • Limited access to care • Lack of insurance • Transportation barriers

  41. The Mission • The mission of The BLUES Project is to help families have full term healthy babies. • We assist parents in identifying a strong support system. • We empower mothers to establish and achieve attainable life goals.

  42. The BLUES Holistic Approach

  43. Benefits and Services • Healthier mothers – (physically, mentally, intellectual and emotionally. • Increased social support • Comprehensive psycho-social screening, diagnosis, referrals, and treatment for mental and/or behavioral health services • Increased empowerment and self-sufficiency • Healthier families and communities.

  44. The BLUES Path to Success

  45. Current Participants Memphis Chattanooga There are 75 women actively participating • There are 131 women actively participating

  46. The BLUES PROJECT Building Lasting Unshakable Expectations into Successes The BLUES Family Dr. Linda Moses, Director Teresa Franklin, Program Coordinator Netasha Bower, Health Educator Annteshae Maddox, Health Educator Rebecca Perez, Health Educator Toni Hampton, Outreach Specialist Ann Collins, Outreach Specialist

  47. Interventions • Education and improvement of living conditions: • Delay 1st pregnancy • Increase Interpregnancy Interval • Prenatal care • Smoking cessation • Decrease drug use

  48. Why is the US Different? • A 2009 CDC report stated that US rates were affected by high prematurity rate compared to European countries • Reporting differences may also play a role, as France, the Czech Republic, Ireland, the Netherlands, and Poland do not report live births of babies <500 g and/or <22 weeks’ gestation CDC. November 2009. Behind international rankings of infant mortality: how the United States compares with Europe.

  49. WHO Definition • The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat • Many countries, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers appear somewhat lower

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