| Natural Deaths to
Infants Excluding SIDS
| There were 23,094 natural deaths of children
under the age of one in the United States in 2000, excluding
SIDS. More than two-thirds of these babies die within the first 28
days of life. Most of these babies are born prematurely (before 37
weeks gestation) and/or are born with a low birth-weight (under five
pounds). Prematurity and low birth weight are the greatest predictors
of infant mortality.
While vast improvements have been made in treating premature infants,
preventing pre-term low birth weight babies is still a great challenge.
The rate of pre-term birth has increased 17% in the U.S. since the
1980’s, and the rate of low birth weight has risen 10%. For reasons not
fully understood, these problems take a disproportionate toll on black
Americans. Nationally, black mothers are twice as likely to give birth
pre-term as white mothers.
There are still many gaps in our understanding of why some women go
into labor well ahead of schedule. It is believed that cigarette
smoking, disorders that raise blood pressure, prior pre-term birth and
certain pregnancy complications increase the risk of prematurity. Other
significant risks include genital tract infections, stress, anxiety,
depression and other psychological factors. Adequate prenatal care is
an effective intervention that improves pregnancy outcomes. Early
access to quality pre-natal care, including health promotion, risk
assessment and appropriate interventions can prevent both pre-term
births and ensure that babies are born at normal birth weights.
- Prior pre-term delivery.
- Previous infant or fetal loss.
- Adequacy of prenatal care (early entry, missed
- Medical conditions of the mother.
- Maternal age (under 20, over 35)
- Infections, including sexually transmitted
- Poor nutritional status
- Short inter-pregnancy interval
- Substance, alcohol and tobacco use.
- Stressors and lack of social support.
- Less than 12th grade education.
- Unintended unplanned pregnancy.
- Unmarried or lack of male involvement in
- Physical and emotional abuse of mother.
for Case Review
- Birth records
- Pediatric records for well and sick visits
- Death certificates
- Prenatal care records
- Hospital birth records
- Emergency Department records
- Any support services utilized, including WIC
and Family Planning
- Police reports
- Prior CPS reports on caregivers
- Maternal Home Interview, if available
- Ensure that all women have available
preconception care and counseling and prenatal care that is acceptable,
accessible, appropriate and available.
- Ensure that all women have postpartum care
options available that include contraception, pregnancy planning, and
- Improve local provider knowledge of
pre-conception health care issues.
- Improve emergency response and transport
- Foster maternal and infant support services to
improve the social/psychological environment for women and families at
- Encourage the comprehensive assessment of
risks due to sexually transmitted infection, substance abuse including
alcohol, smoking, domestic violence, depression, social support,
housing, employment, transportation, etc. by all local providers and
perhaps as a local hospital delivery policy.
- Develop and distribute community resource
directories to make consumers and providers aware of where to go for
help and services.
- Provide mentoring, support, outreach, and
advocacy at the community level utilizing paraprofessionals, indigenous
health workers, and faith-based initiatives.
- Develop systems to provide transportation and
childcare to women seeking prenatal care.
- Coordination of care between programs and
parts of the health care system.
- Forums to raise awareness of consumers,
providers, and policy makers of infant mortality issues.
- Local community/business/health care
partnerships to broaden the number of stakeholders.
- Enhanced community education to include
unplanned/unwanted pregnancy prevention, including teen pregnancy
prevention services and early detection of signs and symptoms of