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Infant Mortality

Infant Mortality. William C. VanNess II, MD State Health Commissioner April 4, 2014. Indiana State Department of Health. ISDH Mission: To promote and provide essential public health services ISDH Vision: A healthier and safer Indiana. ISDH- Top Priorities.

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Infant Mortality

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  1. Infant Mortality William C. VanNess II, MD State Health Commissioner April 4, 2014

  2. Indiana State Department of Health • ISDH Mission: • To promote and provide essential public health services • ISDH Vision: • A healthier and safer Indiana

  3. ISDH- Top Priorities • Governor Pence “Good to Great” book • National Health Rankings has placed Indiana 41st least healthy out of 51 (D.C.) • After extensive review of our priorities, ISDH named the following public health needs as the top 3 priorities for Indiana for the nextfour years: #1. Reduction in Infant Mortality rates #2. Reduction in Adult Obesity rates #3. Reduction in Adult Smoking rates

  4. Good to Great 2014 Top Priorities • Reduce Infant Mortality (#1 priority) • Defined as the death of a baby before first birthday • Infant Mortality Rate (IMR) is an the number of infant deaths for every 1,000 live births • Infant Mortality is the #1 indicator of health status in the world! • Indiana: • In 2011 final results, Indiana had 7.68 deaths/1000 • In 2011, USA had 6.05 deaths/1000 • Indiana rankings for 2011= 45th/51 (D.C.) • Indiana consistently one of the worst in USA • Indiana only <7.0 once in 113 yrs!! • 6.945 in 2008 • Preliminary” 2012 = 7.3* • 600 Infant Deaths/82,251 Births • “Real Time” 2013 = 7.27* • 595 Infant Deaths/81,810 Births

  5. What are the general risk factors? 1. Born with a serious birth defect 2. Born too small or too early • Pre-term • < 39 weeks • Low birth weight infant (LBW) • weigh less than 5 lbs 8 ounces (2500 grams) at birth • Very low birth weight infant (VLBW) • less than 3 pounds, 5 ounces (1500 grams) at birth 3.Sudden Infant Death Syndrome (SIDS) 4. Affected by maternal complications of pregnancy • Diabetes, Hypertension, Obesity, etc 5. Victims of injuries (e.g. suffocation deaths) Source: Centers for Disease Control and Prevention, http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/InfantMortality.htm

  6. Indiana top 5 causes of IM in 2011(643 deaths) 1. Perinatal Risks=45.7% (294 deaths) • Examples include..Pre-term, LBW, VLBW, placental complications, premature rupture of membranes, bacterial sepsis, respiratory conditions, etc 2. Congenital malformations=26.3% (169) 3. SIDS/SUIDS/Accidents=15.6% (95) • 51 SIDS • accidental suffocations=28 • accidents= 16 4. Assault/Neglect=1.4% 5. All Other=11% (71)

  7. Factors in Indiana • Prematurity & Low Birth Weight Causes • Smoking (ISDH #3 priority) • 16.6% pregnant mothers in Indiana smoke • 30% Medicaid Mom’s smoke while pregnant!!! • 50% of deliveries in Indiana are Medicaid • Indiana is 6th most smoking state in US • Obesity (ISDH #2 priority) • Obese=25% chance prematurity • Morbidly Obese= 33% prematurity • Indiana is 8th most Obese state in US • Elective deliveries before 39 weeks gestation • Racial/Ethnic • Black IM • 2006 was 18.1deaths/1000 • 2011 was 12.3 deaths/1000!! • White IM • 2008 was 5.5 deaths/1000 • 2011was 6.9 deaths/1000

  8. Factors (Con’t) • Limited Prenatal Care • Only 68.1% pregnant mothers in Indiana receive PNC in 1st trimester • Unsafe Sleep (15.6% deaths 2011) • Socio-economic • Poverty • Can affect access to prenatal care • Lower income people tend to smoke more which is a leading cause to LBW and prematurity • Tend to have less safe sleeping environments which can lead to more suffocations • e.g. co-sleeping with parent • Limited breastfeeding in Indiana • Breastfeeding at hospital discharge was 74% in 2011 • Every day after Mom/Baby leaves the hospital, the number tends to decrease

  9. PLAN • Decrease smoking among pregnant mothers • ISDH is partnering with Indiana Medicaid • “Safe Sleep” • “Back to Sleep” campaign • 1994 • Reduced SIDS by 50% • “Safe to Sleep” campaign • Expansion of “Back to Sleep” • Describes actions parents/caregivers can take to reduce the risk of other sleep-related causes of infant death, e.g. accidental suffocation • “Hard Stop” hospital policies on preventing elective deliveries occurring before 39 weeks • 7/1/14 Medicaid not pay for Early Elective Deliveries prior to 39 weeks! • Anthem considering the same

  10. PLAN (Con’t) • Decrease obesity among pregnant mothers • ISDH Division of Nutrition & Physical Activity • Encourage hospitals to become certified as “Baby Friendly” by W.H.O. to increase breastfeeding • Certification of OB & NICU’s to ensure they meet designated level of care • 27% increase in death within 1st hour after delivery from 2010 to 2011 • Analyze data, convert to useful info & distribute back to: • Regional partnerships which include the following members: • Hospitals, LHD’s, CHC’s, Minority Health Coalitions, March of Dimes, etc

  11. PLAN (Con’t) • Public/Private Collaboration • “Sister” state agencies • FSSA, Medicaid, DOE, DCS, etc • Anthem • Fairbanks School of PH • Learn from areas/regions/states that have been successful in improving their infant mortality • Share with regional coalitions • Home Visiting Programs • Regionalization (S.C.) • Medicaid not paying for Early Elective Deliveries (e.g. TX & GA)

  12. Go Out and Make a Difference! Questions...

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