May 26, 2006 E-zine
The Georgia SIDS
Project E-Zine is an on-line educational update offered monthly by the Georgia
Sudden Infant Death Information, Referral and Support Project, an affiliate of
First Candle/SIDS Alliance. To comment on this issue, request additional
information, refer families in need of support, make a donation or be added or
removed from the list please contact us at gasids@mindspring.com
or call 678-342-3360 or through Powerline at 1-800-822-2539.
This
publication is made available through the generous donation of friends and
supporters of our program.
Volume 2 - Issue Number 5, May l 2006
1.
Important opportunity to make a
difference in the health of Georgians! Let your voice be heard.
2.
Infant
Mortality Data for 2003. Full report available in PDF format.
3.
The Migrant Clinicians Network model program for prenatal
help begun. See how other communities are planning program efforts
4.
Study
looks at positional plagiocephaly (flat headedness) diagnosis and treatment
5.
Community
study shows adults unaware of smoking impact on child heath
6.
New study reviews effects of prematurity on heart
rate control: implications for sudden infant death syndrome.
7.
Study reviews differences in Infant & Parent Behaviors during
Routine Bed Sharing Compared with Crib Sleeping in the Home Setting.
8.
Review of more data on recommendations for Pacifiers to Prevent SIDS
9.
Bereavement Counseling for SIDS and Infant Mortality: Core
Competencies for the health care professional
10.
Predicting the impact of in vitro fertilization and other assisted
conception on perinatal/infant mortality in England
and Wales:
examining the role of multiplicity.
11.
Status
of newborn screening programs across the U.S. Comprehensive look and
comparisons.
12.
New
a web-based tool for the EPSDT and Title V Collaboration to Improve Child
Health
13.
Fine Particulate Matter (PM2.5) Air Pollution and Selected Causes
of Postneonatal Infant Mortality in California.
14.
New study looks at stillbirth rates and delivering estimates in
190 countries
15.
Prior cesarean delivery is not associated with an increased risk
of stillbirth in a subsequent pregnancy: Analysis of U.S. perinatal mortality
data, 1995-1997.
16.
Effect of neighborhood income, maternal education
and cohabitation status on pregnancy outcomes reviewed.
17.
Are
autopsies of help to the parents of SIDS victims? : A follow-up on SIDS
families in Germany.
1.
Important Opportunity To Impact Health In Georgia. The Board of Human
Resources, which oversees and sets policy for the Georgia Department of Human
Resources (DHR), will seek public input as the agency and its board plan for
the SFY 2008 budget. To accomplish this, the Board will hold a series of
budget hearings during June. This is an opportunity for members of the public
to provide the comments on the services they feel are important for DHR to
provide in SFY 2008.Two upcoming hearings are scheduled: June 6 Atlanta 5 p.m. - 7 p.m. Fulton County
DFACS 1249 Donald Lee Hollowell Pkwy Atlanta,
30318 Deadline for signing up online: 5 p.m., June 5. June 21, Augusta 4 p.m. - 6 p.m. Augusta
Technical School 600 Building Auditorium 3200 Augusta Tech Drive Augusta, 30906
Deadline for signing up online: noon, June 20. Anyone wishing to speak at a
hearing may sign up on arrival, or they may sign up online through dhr.georgia.gov.
Speakers may sign up for only one hearing. Those who sign up online will be
scheduled to speak first, and they will receive confirmation by return email
that they are signed up. All speakers will be limited to three to five minutes depending
on the number of people who participate. Those
who wish to submit written testimony can do it in one of two ways:
electronically through the department's Internet website, or by traditional
mail. To submit written testimony online, go to the DHR Website at
dhr.georgia.gov. Testimony will be accepted through the Internet site until
5 p.m., July 1. Those who wish to use traditional mail may send their testimony
to arrive by 5 p.m., July 1, to Maria Pitts, DHR Office of Planning and Budget
Services, suite 30.270,
2 Peachtree St. Atlanta, 30303. All written testimony received
by 7/1, will be distributed to the DHR Board.
2. Infant Mortality
Statistics from the 2003 Period Linked Birth/Infant Death Data Set. National Vital Statistics report,
5/3/06 This report presents 2003 period infant
mortality statistics from the linked birth/infant death data file by a variety
of maternal and infant characteristics. data tables are
presented. The U.S.
infant mortality rate was 6.84 infant deaths per 1,000 live births in 2003, a
return to the rate in 2001, compared with 6.95 in 2002. Infant mortality rates
ranged from 4.83 per 1,000 live births for Asian or Pacific Islander mothers to
13.60 for non-Hispanic black mothers. Among Hispanics, rates ranged from 4.57
for Cuban mothers to 8.18 for Puerto Rican mothers. Infant mortality rates were
higher for those infants whose mothers were born in the US were unmarried, or smoked during pregnancy. Infant mortality was
also higher for male infants, multiple births, and infants born preterm or at
low birth weight. Infants born at the lowest birth weights and gestational ages
have a large impact on overall U.S.
infant mortality. 49% of all infant deaths occurred to the 0.8 percent of
infants whose birth weight was less than 1,000 grams. The 3 leading causes of
infant death—Congenital malformations, low birth
weight, and SIDS— together accounted for 45 percent of all infant deaths. For
infants of non-Hispanic black mothers, the cause-specific infant mortality rate
for low birth weight was nearly four times that for infants of non-Hispanic
white mothers. http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_16.pdf
3.
The Migrant Clinicians Network is
pleased to announce the arrival of the Prenatal Health Network Project. See an example of a model program.
Any prenatal patient who may move out of their area is eligible to be enrolled
in the Health Network. MCN bilingual staff will provide care coordination
throughout the course of her pregnancy until her postpartum visit, to help
ensure that there are no gaps in her health care by assisting as needed with
finding a care provider and transferring her records. For more information
about this program and the enrollment process, see www.migrantclinician.org/network/prenatal,
or contact Candace Kugel, CRNP, CNM;
ckugel@migrantclinician.org;
4. Positional plagiocephaly:
pathogenesis, diagnosis, and management. J Ky Med Assoc.
4/06. Morrison CS,
There has been a steady increase in referrals for positional plagiocephaly
(flat heads) following the release of the AAP recommendation of back sleeping
position to prevent SIDS in 1992, largely because of poor parent education on
the risks of prolonged occipital pressures. While this deformity is fairly easy
to manage when diagnosed early, treatment can become more difficult and
complicated with prolonged course. Because of this, it is essential that
primary care physicians and parents be educated on recognition of positional
plagiocephaly, prevention strategies, and treatment options. In milder cases,
where diagnosis is made early, the deformation can be managed by stretching
exercises and regular prone positioning, while in more
severe cases molding helmets may be needed. Following appropriate treatment,
success rates for acceptable cranial shape may be as high as 92%.
5. Inner-city adults' knowledge about
the effects of cigarette smoking on child health. Parker M,
Clin Pediatr
5/06.Researchers conducted a cross-sectional survey an
inner-city community health center in the Bronx, New York; 684 subjects participated. 21%
were current smokers, 19% had quit, and 60% had never smoked. While the
majority of subjects knew about the effects of smoking on adult health, they
were unaware of the extent to which smoking was harmful to child health.
Notably, 72% did not know that cigarette smoking increased the risk for ear
infections in children, 68% did not know that smoking increased the risk of
colds in children, and 61% did not know that smoking increased the risk of
sudden infant death syndrome. The findings suggest a need for public health
education about the effects of adult smoking on child health.
6. Effects of prematurity on heart rate
control: implications for sudden infant death syndrome. Horne RS. Australia. In Western countries,
5-11% of all infants are born before 37 weeks of gestation, and with
improvements in modern intensive care techniques the number of these preterm
infants that survive continues to increase. Preterm birth is one of the leading
causes of neonatal morbidity and mortality in developed countries, accounting
for 60-80% of infant deaths in those without congenital anomalies. Furthermore,
in the post-neonatal period, preterm infants are at 4-times greater risk of
SIDS. It has been suggested that this increased risk is due to immature
autonomic control. This article provides an overview of studies assessing
autonomic control of the cardiovascular system in preterm infants. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16716094&query_hl=3&itool=pubmed_docsum
7.
Differences in Infant
and Parent Behaviors during Routine Bed Sharing Compared with Cot (Crib) Sleeping
in the Home Setting. Baddock SA et al. Pediatrics. 5/06 The purpose of this study
was to observe the behavior of infants sleeping in the natural physical
environment of home, comparing the 2 different sleep practices of bed sharing
and cot sleeping quantifying to factors that have been identified as potential
risks or benefits. 40 routine bed-sharing infants, aged 5-27 weeks were matched
for age and season with 40 routine cot-sleeping infants. Overnight video and
physiologic data of bed-share infants and cot-sleep infants were recorded in
the infants' own homes. Sleep time, sleep position, movements, feeding, blanket
height, parental checks, and time out of the bed or cot were logged. The total
sleep time was similar in both groups (bed-sharing median: 8.6 hours;
cot-sleeping median: 8.2 hours). Bed-sharing infants spent most time in the
side position (median: 5.7 hours, 66% of sleep time) and most commonly woke at
the end of sleep in this position, whereas cot-sleeping infants most commonly
slept supine (median: 7.5 hours, 100%) and woke at the end of sleep in the
supine position. Prone sleep was uncommon in both groups. Head covering above
the eyes occurred in 22 bed-sharing infants and 1 cot-sleeping infant. Five of
these bed-sharing infants were head covered at final waking time, but the
cot-sleeping infant was not. Bed-sharing parents looked at or touched their
infant more often (median: 11 vs 4 times per night)
but did not always fully wake to do so. Movement episodes were shorter in the
bed-sharing group as was total movement time (37 vs
50 minutes respectively), whereas feeding was 3.7 times more frequent in the
bed-sharing group than the cot-sleeping group.
8.
Should Pacifiers Be
Recommended to Prevent Sudden Infant Death Syndrome? Mitchell EA, et al
Pediatrics 5/06. This study reviewed the evidence for a reduction in the risk
of sudden infant death syndrome (SIDS) with pacifier ("dummy" or
"soother") use, to discuss possible mechanisms for the reduction in
SIDS risk, and to review other possible health effects of pacifiers. There is a remarkably consistent reduction of
SIDS with pacifier use. The mechanism by which pacifiers might reduce the risk
of SIDS is unknown, but several mechanisms have been postulated. Pacifiers
might reduce breastfeeding duration, but the studies are conflicting. Based on these findings it seems appropriate
to stop discouraging the use of pacifiers. Whether it is appropriate to
recommend pacifier use in infants is open to debate.
9.
Bereavement Counseling
for SIDS and Infant Mortality: Core Competencies for the health care professional is available for no cost in a pdf format from the Association of SIDS and Infant
Mortality Programs. Go to: http://www.sidsprojectimpact.com/_assets/documents/pdf/BerCouns--CoreComp.pdf
10.
Predicting the impact of
in vitro fertilisation and other forms of assisted
conception on perinatal and infant mortality in England
and Wales:
examining the role of multiplicity. Oakley L, Doyle P, BJOG. 6/06 The
increased risk of perinatal and infant mortality observed among in vitro fertilisation (IVF) births and other assisted conception
births is thought to be largely attributable to multiplicity. Using mortality
statistics and estimates of the proportion of births following infertility
treatment, we predicted the excess stillbirths and infant deaths associated
with twins and higher order births resulting from assisted conception in England and Wales. According to our results,
approximately 73 deaths could have been avoided in 2001 if all IVF infants had
been born as singletons or as naturally occurring monozygotic twins, equating
to a population attributable risk fraction of around
1% for perinatal and infant deaths. If we include all types of assisted
conception, this figure was estimated to be around 4% of deaths-more than 220
perinatal and infant deaths in 2001. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1471-0528.2006.00942.x
11.
Status of Newborn
Screening Programs in the United
States Therrell BL, et al Pediatrics.
5/05 Newborn screening programs have expanded over the years; currently, many
programs screen for dozens of congenital conditions that, if not detected and
treated early, could result in catastrophic health consequences, including
death. Some programs, however, still require universal newborn screening for
only a few conditions. Although all US programs have statutory
screening requirements and similarities exist in many parts of the different
screening systems, the enabling statutes, rules, regulations, protocols, and
financing strategies vary dramatically. Consequently, there is a significant
lack of equity in newborn screening services across the country. The authors
investigated program variations existing in and around January 2005 and provide
baseline information with which future program comparisons can be made. Program
surveys, electronic searches of legislation, and individual input (validation)
from program decision-makers were used to create a reservoir of program information. The study includes a compilation of pertinent
newborn screening statutes, information from genetic privacy statutes that
potentially affects newborn screening programs, and a review of state laws that
affect specimen and information retention. In addition, program policies
related to the use of residual newborn screening blood spots are reviewed,
along with the developmental processes affecting program informational
brochures, including the information contained and the strategies for brochure
dissemination. Building on a progressive and successful history, newborn
screening continues as an example of an essential population genetic screening
program. As the intricacies of screening systems have increased in complexity,
so have the policy issues that shape program successes and failures. The
summary information in this article provides a basis for national and
individual program evaluation.
12.
The EPSDT and Title V Collaboration
to Improve Child Health has a web-based tool designed to help Medicaid and state maternal and
child health (MCH) agencies identify opportunities for working together to ensure
children's access to and receipt of the full range of Early and Periodic
Screening, Diagnosis and Treatment (EPSDT) program services.
The Web
site provides information about how Medicaid's EPSDT program works with public
health, families, managed care organizations, pediatricians, and other health
professionals to finance appropriate and necessary pediatric services.
Information about the role of MCH programs in fulfilling the potential of
EPSDT, family support strategies, data monitoring, and policy and legislative
issues is also included. The Web site is available at http://www.hrsa.gov/epsdt.
13. Fine Particulate Matter (PM2.5) Air Pollution and Selected
Causes of Postneonatal Infant Mortality in California. Woodruff TJ ,et al Environ Health Perspect.
5/06. Studies suggest that airborne particulate matter (PM) may be associated
with postneonatal infant mortality, particularly with respiratory causes and
sudden infant death syndrome (SIDS). To further explore this issue, we examined
the relationship between long-term exposure to fine PM air pollution and
postneonatal infant mortality in California.
We linked monitoring data for PM and found a significant relationship. Full-text
downloading at: http://www.ehponline.org/members/2006/8484/8484.pdf
14.
Stillbirth rates:
delivering estimates in 190 countries. Stanton C, et al Lancet. 5/06 While information about 4 million neonatal
deaths worldwide is limited, even less information is available for stillbirths
(babies born dead in the last 12 weeks of pregnancy) and there are no
published, systematic global estimates. Authors sought to identify available data and
use these to estimate the rates and numbers of stillbirths for 190 countries
for the year 2000, and provide uncertainty estimates. The authors assessed
three sources of stillbirth data according to specified inclusion criteria:
vital registration; demographic and health surveys (DHS), based on a new
analysis of contraceptive calendar data; and study reports that include
published studies identified through systematic literature searches of more
than 30,000 abstracts and unpublished studies. A random effects regression model
was developed to predict national stillbirth rates and associated uncertainty
intervals. Data from 44 countries with vital registration (71,442 stillbirths),
30 DHS surveys from 16 countries (2989 stillbirths), and 249 study populations
from 103 countries (93,023 stillbirths) met the inclusion criteria. Model-based
estimates were used for 128 countries. The resultant stillbirth rates ranged
from five per 1000 in rich countries (Georgia
reported 8.7 per 1,000 deaths for stillbirths defined as >20 weeks gestation
in 2000) to 32 per 1000 in south Asia and sub-Saharan Africa.
The estimated number of global stillbirths is 3.2 million (uncertainty range
2.5-4.1 million). In light of the data limitations and the conservative
approach taken, the real number might be higher than this. The numbers of
stillbirths are high and there is a dearth of usable data in countries and regions in which most stillbirths occur, with
under-reporting being a major challenge. Although our estimates are probably
underestimates, they represent a rigorous attempt to measure the numbers of
babies dying during the last trimester of pregnancy. Improving stillbirth data
is the first step towards making stillbirths count in public-health action.
15.
Prior cesarean delivery
is not associated with an increased risk of stillbirth in a subsequent
pregnancy: Analysis of U.S.
perinatal mortality data, 1995-1997. Bahtiyar Moet al Am J Obstet
Gynecol. 5/06; An association between cesarean delivery and an increased
risk of stillbirth in a subsequent pregnancy has been reported in the United Kingdom.
This study investigated the association between prior cesarean delivery and
unexplained intrauterine fetal demise at term in the US. Authors conducted a
cross-sectional study using the U.S.
perinatal mortality data (1995 to 1997). Women aged 15-44 years with singleton
term (37 weeks +) pregnancies were included in the analysis. Study groups were
defined as pregnant women with a prior cesarean delivery and women with no
prior cesarean delivery. Adjustments were made for maternal age, race,
underlying medical conditions, and fetal congenital abnormalities. A total of 11,061,599 deliveries of singleton
pregnancies were recorded in the US from 1/1/95, to 12/31/97. The
cesarean delivery rate was 19.6%. The intrauterine fetal demise rate was 1.5
per 1000 births for no cesarean delivery and 1.3 per 1000 births for prior
cesarean delivery. After correction for parity greater than 1, congenital
anomalies, and underlying maternal medical conditions, term intrauterine fetal
demise rates were 0.6 and 0.4 per 1000 births for no cesarean delivery and
prior cesarean delivery, respectively. US data indicates a prior cesarean
delivery is not associated with an increased risk of stillbirth in a subsequent
pregnancy.
16. Effect of neighborhood income and
maternal education on birth outcomes: a population-based study And Disparities
in pregnancy outcomes according to marital and cohabitation status.
Fetal
and Infant Health Study Group of the Canadian Perinatal Surveillance System.
CMAJ 05/06
Maternal socioeconomic status (SES) is an important
determinant of inequity in maternal and fetal health. Authors sought to
determine the extent to which associations between adverse birth outcomes and
SES can be identified using individual-level measures (maternal level of
education) and community-level measures (neighborhood income). In Quebec, we identified
all births from 1991 to 2000. Using maternal postal codes linked to census
areas, we determined neighborhood income levels that reflect SES. Lower levels
of both maternal education and neighborhood income were associated with
elevated crude risks of preterm birth, small-for-gestational-age (SGA) birth,
stillbirth and neonatal and postneonatal death. The effects of maternal
education were stronger than, and independent of, those of neighborhood income.
Compared with women in the highest neighborhood income quintile, women in the
lowest quintile were significantly more likely to have a preterm birth, SGA or
stillbirth compared with mothers who had completed community college or at least
some university, mothers who had not completed high school were significantly
more likely to have a preterm birth SGA birth
or stillbirth. Individual and, to a lesser extent, neighborhood-level
SES measures are independent indicators for subpopulations at risk of adverse
birth outcomes. The second study assessed the risks and trends of adverse
pregnancy outcomes among mothers in common-law unions versus traditional
marriage relationships. Authors conducted a birth cohort-based study of all
720,586 births registered in Quebec
for the years 1990 to 1997. The proportion of births to common-law mothers more
than doubled from 20% in 1990 to 44% in 1997. Preterm birth, low birth weight,
small for gestational age, and neonatal and postneonatal mortality rates
increased progressively from mothers legally married, to common-law unions, to
lone mothers with father information, to lone mothers without father
information on birth registrations. Pregnancy outcomes are worse among mothers
in common-law unions versus traditional marriage relationships but better than
among mothers living alone. Modest disparities in pregnancy outcomes in
common-law versus traditional marriage relationships have persisted despite the
striking rise in common-law unions.
17. Are autopsies of help to the parents of SIDS victims? : A follow-up on
SIDS families. Vennemann MM,et al.
Int J Legal Med. 2006 May 10; Little is
known about what bereaved parents feel about the autopsy performed on their
child. A multi-centre case control study of sudden infant death syndrome (SIDS)
victims was carried out in Germany
between 1998 and 2001, in which all infants had been autopsied. Authors
performed a follow-up study 4-7 years after the parents had lost their child. A
total of 141 parents filled in the questionnaire, which were sent to them by the study
centre. Of these, 71% had had another child after the SIDS/SUIDS. The majority
(83%) of the participating parents found the autopsy helped them to cope better
with the death. A large proportion (46%) did not want any professional help
after the death, and 55% did not wish to have any contact with a self-help
group. We conclude that the autopsy is helpful to the majority of bereaved
parents. Professional help and self-help groups should be offered to the
parents even if the majority in our study did not want to use either. Assuring
that autopsy results are explained and reviewed with parents in an appropriate
manner is an area for further study in the context of how this information is
handled in America.
www.sidsga.org
2300 Henderson Mill Rd., Suite 410
Atlanta, Georgia 30345
678-342-3360 or Powerline 1-800-822-2539 FAX 770-451-2466
-mail: gasids@mindspring.com