INFANT MORTALITY IN OHIO - 2015What Can We Do Locally?

Rebecca (Becky) DershemDirector of Nursing, Allen County Public Health

WHAT IS INFANT MORTALITY?

The death of an infant before reaching their FIRST birthday.

The Leading Cause of Infant Mortality is PREMATURITY (being born before 37 weeks gestation), which includes Low Birth Weight.

Other Causes of Infant Mortality include: SIDS, Birth Defects, and Infections.

Protective factors include: BREASTFEEDING!

215 Iceland 3.15 2014 est.

216 Macau 3.13 2014 est.

217 Hong Kong 2.73 2014 est.

218 Czech Republic

2.63 2014 est.

219 Sweden 2.60 2014 est.

220 Singapore 2.53 2014 est.

221 Bermuda 2.48 2014 est.

222 Norway 2.48 2014 est.

223 Japan 2.13 2014 est.

224 Monaco 1.81 2014 est.

169 United States 6.17 2014 est

How does the U.S. rank in the world?

IN OHIO: 61% OF INFANT DEATHS ARE ATTRIBUTED TO 5 CAUSES:Born too small and TOO EARLY

Maternal complications of pregnancy

Sudden Infant Death Syndrome

Born with a Birth Defect

Injuries such as suffocation

***A hormone suppliment of progesterone can reduce the incidence of preterm birth by as much as 20% in “at risk” mothers.

The Cost of Prematurity……..

IOM report from 2007 associated the cost of a premature birth inUnited States was $26.2 Billion!

Here is how those numbers add up:•$16.9 Billion in Medical & Health Care Costs for the baby•$1.9 Billion in Labor & Delivery Costs for Mom•$611 Million for Early Intervention Services – Birth to 3 years

With disabilities and developmental delays.

• $1.1 Billion for special education services especially designed For children with disabilities ages 3 through 21.

• $5.7 Billion in lost work and pay for people born prematurely

Infant Mortality, Ohio And Allen County, 2003-2012 5 Year Moving Averages By Area of Ohio

Source: Ohio Department Of Health, Community Profiles

THE ROLE OF PUBLIC HEALTH

PREVENT, PROMOTE, PROTECTo Community Needs Assessment – Survey

completed in 2014o www.allencountypublichealth.org

o Go to Vital Statistics, then Community Health Statistics. Select CNA

o County Health Rankings – National state-wide rankings o www.countyhealthrankings.org/ohio

o Select your county & their ranking of the 88 counties. Find the data source for your scores.

o Child Fatality Review Board in each Countyo www.allencountypublichealth.org

o Go to Vital Statistics, then Community Health Statistics. Select Child Fatality Review

Three Birthing Hospitals – Very Diverse

PERINATAL STATS FOR BIRTHS OCCURRING IN ALLEN COUNTY - 2013 & 2014 (Hospital Self -Reported Data)

2013 Bluffton2013 LMH 2013 SRMC 2014 Bluffton

2014 LMH 2014 SRMC

Live Births 245 688 1557 242 673 1497 2013 Total Births: 2404

# of Deliveries (Moms) 242 666 14752014 Total Births: 2410 to 2383 Moms

# < 37 /0 weeks 1.20% 10.80% 8.90% 1.30% 10.80% 9.60%# <35/0 weeks 0 4.10% 2.40% 0 2.80% 3.00%# <32/0 weeks 0 0.60% 0.20% 0 0.40% 0.70%# 37-38/6 weeks 45.60% 57.70% ND 18.30% 34.70% 29.70%

LBW < 2500 Gms 0.80% 7.40% 5.70% 0.40% 7.30% 7.50%

Ages: < 15 yrs 0% 0.20% 0.10%15-17 yrs 1.60% 2.20% 2.20% 0.40% 1.10% 2.30%18-19 yrs 2.00% 8.00% 6.00% 3.30% 6.50% 5.10%20-35 yrs 94% 84.10% 86.50%> 35 yrs 10.20% 5.30% 6.90% 17.20% 8.30% 5.90%

Total C/Births 34.40% 32.20% 29.60% 24.50% 34.80% 27.70%Primary C/B 20% 15.90% 14.50% 9.50% 14% 11.70%Repeat C/B 18% 19.40% 17.80% 15% 20.70% 16%

No Prenatal Care 0.07% 1.20% 0.60% 0 0.60% 0.60%1-3 Prenatal Vs 0 1% 0,8% 0.00% 0.50% 2.00%

Tobacco Use 12.60% 23.10% 17.30% 19.80% 23.10% 17% ETOH use 2.50% 0 0.40% 0 0.20% 1.90%Drug Hx 0.00% 1.60% 0.80% 0.80% 2.90% 1%

# Chose Breastfeeding 84% 70.00% 56.90% 86.60% 69.40% 64.70%#BF Exclusively Del-D/C ND 70% 17.60% 37.50% 69.40% ND

ND = No Data

ALLEN COUNTY DATAINFANT MORTALITY REVIEW

Child Fatality Review of 10 Year Data: 2005-2014 Total Children (0-17 years) reviewed: 155

Infants (<1yr): 98 or 63.2% Premature (<37 wks): 60 infants or 61.2%Low Birth Weight (<2500 Gms): 58 infants or 59.1%

Intrauterine Smoke Exposure: 37 or 37.7% Intrauterine Drug Exposures: 3 or 3.1% No ETOH Exposures

Late of NO Prenatal Care: 6 infants or 6.1%

Child Fatality Review of 5 Year Data: 2010-2014 Total Children (0-17 years) reviewed: 57 Infants (<1yr): 39 or 68.4% Premature (<37 wks): 60 infants or 66.7%

Low Birth Weight (<2500 Gms): 58 infants or 61.5%

Intrauterine Smoke Exposure: 15 or 38.5% Intrauterine Drug Exposures: 1 or 2.6% No ETOH Exposures

Late of NO Prenatal Care: 2 infants or 5.1%

CONCLUSION: Prematurity & Low Birth Weight has INCREASED in the last 5 years!

TWO STATE – WIDE EFFORTS TO SHARE:

Ohio Collaborative to Prevent Infant Mortality – AKA: OCPIMDr. Arthur James - SpokespersonMembers include: Hospitals, Health Systems, Insurance

Companies, State Health Officials, Academia, Public Health

Meets: Quarterly

Two Infant Mortality Summits in December (every other year – even years). Last one: December 2014 Title: “Step up to catch up!”March of Dimes has an annual conference every other year in odd years.

Ohio Perinatal Quality Collaborative – AKA: OPQCDr. Jay Iams – Spokesperson for ProgesteroneMembers include: Multiple providers from Academia &

Private Providers, Hospitals, Insurers, State Health Officials, Public Health

1. Progesterone Project – Protocol for giving between the 16-36th week of pregnancy for mothers with an identified short cervix.

2. Neonatal Abstinence Syndrome – NASReducing infant withdrawal from Opiates

Bringing the Progesterone Project to Allen County…..

Garnering Support from local hospitals –

Met with the VP of Medical Affairs at the two larger facilities to garner support

Engaging the Health Department Medical Director in Conversations

Data sharing from local hospitals – extremely helpful!Breast feeding initiation rates, <39 week elective

inductions,Cesarean delivery rates, No Prenatal Care, Tobacco use,ETOH & Drug Use

Provider Participation in Planning –

Meeting Date Selection – OB/Neonatal Meeting

Moving meeting earlier in day to accommodate providers

PUBLIC HEALTH AS THE CATALYST

Public Health organized the event and coordinated the effort following:

Identifying “neutral location” for all concerned, with free parking!

Continental breakfast for those attending

Coordinated office visits to each OB practice who participated so the OPQC staff could meet those working with progesterone issues in the office.

The Ongoing Public Health Effort…..

Current Infant Mortality Efforts:

Caring For Two – Grant funded program to combat Black infant mortality in the 45801 & 45804 zip codes.

Safe Sleep Initiative – Free Pack ‘N Play units Funded by The Ohio Department of Health

Breast Feeding Coalition – Coordinated through Activate Allen County

Breast Feeding Friendly Businesses – Facility, Policy/Procedures

Maternal Infant Task Force“Baby Basic” curriculum to all “at risk” mothers during prenatal care (addressing tobacco, drug, & ETOH use, physiological changes to expect) Utilizing SW students as curriculum mentors for the connection to local resources.Identifying a program to be offered in the community to improve the pre-conceptual health of women prior to pregnancy.Resources for mothers suffering with addiction to: Tobacco, Opiates, or Alcohol.