Postneonatal Mortality in Alaska What MCH Epidemiology can tell us

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Post-neonatal Mortality in AlaskaWhat MCH
Epidemiology can tell us
Margaret Blabey MCH Epidemiology Unit Section of
Womens, Childrens, and Family Health
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How Alaska compares to national rates and Healthy
Alaskan 2010 goals
Source Alaska Bureau of Vital Statistics
National Center for Health Statistics
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Maternal, Infant Mortality and Child Death Review
(MIMR-CDR)

• Ongoing and systematic
• Collection, review, analysis, and interpretation
  of information surrounding deaths, resulting in
  public health recommendations
• Information collected from
• birth and death certificates
• maternal and infant medical records
• first responder reports
• autopsy reports
• other sources as appropriate

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MIMR cause of death compared with Vital Records

• Death Certificate
• SIDS
• pneumonia
• chorioamnionitis

• MIMR Committee
• probable child abuse
• asphyxia with co-sleeping
• preterm birth, infection, neglect, substance
  abuse, domestic violence

MIMR Gold Standard
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Top causes of post-neonatal mortality in Alaska,
1994-2003
Note allowing for multiple causes of death per
infant
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Sudden unexpected infant deaths by data source
for cause of deathAlaska, 1992-2003
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Trends in post-neonatal mortality by race
Source Alaska Bureau of Vital Statistics
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Why do Alaska Natives have increased risk?

• This association is almost entirely accounted for
  by
• Lower maternal education,
• More prenatal substance use, and
• Higher likelihood of being unmarried and lacking
  a fathers name on the birth certificate.

Blabey M, Gessner B. Three Maternal Risk Factors
Associated with Elevated Risk of Postneonatal
Mortality Among Alaska Native Population. Mat
Child Health J 2008
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Known risk factors dramatically increase
post-neonatal mortality
Source Alaska Bureau of Vital Statistics,
1992-2004 death cohort
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Additional behaviors that increase the risk of
post-neonatal mortality

• Prone sleep
• 11.8 of mothers of newborns in 2005 most often
  placed their infant to sleep prone
• Abuse and neglect (related to substance abuse,
  mental health, domestic violence)
• Bed sharing?

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Is bed sharing a risk factor?

• 2005 AAP Policy Statement task
  force...recommends that infants not bed share
  during sleep.
• In Alaska, 38 of mothers of infants born
  1996-2003 said their baby always or almost always
  shared a bed.

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Do bed sharing deaths occur in the absence of
other risk factors?
Risk factors found among all 126 Alaskan infant
deaths that occurred while bed sharing, 1992-2004

• 94 of the deaths had at least one of these risk
  factors
• Almost no bed sharing deaths occurred in the
  absence of any known risk factor
• This occurred despite many women reporting
  frequent bed sharing and no risk factors (PRAMS)

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Alaska Surveillance of Child Abuse and Neglect
(Alaska SCAN)

• Ongoing systematic collection and unification of
  existing data
• 9 data sources to date
• Apply standardized public health definitions and
  data elements developed by CDC
• Two main phases of implementation
• Mortality
• Morbidity
• Purpose is to identify risk/protective factors
  offer recommendations

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Abuse and neglect mortality rates comparing
death certificates and Alaska SCAN data Alaska,
1992-2003
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Summary

• Alaska has a high and stable post-neonatal
  mortality rate.
• gt20-fold difference in post-neonatal mortality
  rates exists between highest and lowest risk
  groups.
• Most post-neonatal mortality is preventable!
• Identified risk factors
• poor maternal education
• substance use
• lack of social support
• Bed sharing is not an independent risk factor.
• Abuse and neglect appear to be under-documented.
• Surveillance programs like MIMR-CDR and Alaska
  SCAN can provide us with comprehensive data on
  causes of death.

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Recommendations

• Cessation programs for tobacco and other
  substances are still needed, especially among
  pregnant women
• Programs that promote education and delayed child
  bearing likely will have a large impact
• Novel interventions are needed for prevention of
  child maltreatment
• Bed sharing should not be discouraged except in
  specific high risk situations

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The primary care council could advocate for...

• Revised Medicaid fee schedule for tobacco
  cessation counseling
• More substance abuse treatment programs for
  prenatal and postnatal women
• Increased funding for safe sleep education and
  training
• Continued promotion of programs already in place
  (Tobacco Quit Line, Back to Sleep)
• Statewide use of a standardized death scene
  investigation form and training for lay people to
  use it
• More training for people who fill out birth and
  death certificates

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Safe Infant Sleep Project

• Develop safe infant sleep recommendation
• Convene Safe Infant Sleep Task Force
• Solicit input on messaging and marketing
• Design education campaign and materials
• Launch campaign at Safe Infant Sleep Summit,
  October 2009
• Conduct ongoing outreach and integration

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How you can help our programs

• Serve on the MIMR-CDR committee Attend the Alaska
  SCAN MIMR-CDR annual meeting in January 2009
• Participate on the Safe Infant Sleep Task Force
• Promote the Safe Infant Sleep Summit (October
  2009)
• Identify potential sponsors for a statewide Safe
  Infant Sleep Campaign

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Contact information

• MCH Epidemiology Unit, WCFH
• Phone [phone]
• Suite 424 in the Frontier Building
• Margaret Blabey MIMR-CDR Epidemiologist
• Brad Gessner, MD - Unit Manager
• Mike Valiquette MIMR-CDR Manager
• Jared Parrish Alaska SCAN Director
• Debbie Golden Perinatal Nurse Consultant