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West Virginia’s Infant Mortality Dilemma

West Virginia’s Infant Mortality Dilemma . Jay Bringman, MD Associate Professor and Director of Maternal and Fetal Medicine Outpatient Services, WVU. Infant Mortality Review Committee. Luis Bracero Martha Cook Carter Anne Dacey Jim Kaplan Tom Light Martha Mullett Angelita Nixon

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West Virginia’s Infant Mortality Dilemma

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  1. West Virginia’s Infant Mortality Dilemma Jay Bringman, MD Associate Professor and Director of Maternal and Fetal Medicine Outpatient Services, WVU

  2. Infant Mortality Review Committee Luis Bracero Martha Cook Carter Anne Dacey Jim Kaplan Tom Light Martha Mullett Angelita Nixon Nancy Tolliver Joe Werthammer Jay Bringman

  3. We need to understand definitions Live Birth = breathes, or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles….

  4. Definitions of Infant Mortality • Neonatal death = death to a live born infant at less than 28 days after birth • Post neonatal mortality = death of a live born infant at more than 28 days of after birth • Fetal death means death prior to the complete expulsion or extraction from its mother (WV = over 20 weeks gestation and 350 g)

  5. Questions Raised • Are we misclassifying infant deaths? • Is there Subjectivity in classification? • Are there advantages to classifying as live birth when actually born dead? • Tax deductions for parents • Emotional – • Education

  6. WV Neonatal Causes of Death Marie Frazier, MD, Marshall University School of Medicine 2004-2008

  7. WV Causes of Postneonatal Death

  8. Infant Mortality 1999-2008

  9. Infant Mortality Rates 2007-2008 MR is per 1,000 live births All gestational ages

  10. Viable vs Nonviable Infants

  11. SUID Mortality US and WV 1990-2006

  12. SIDS vs SUIDS Revised nationally in 2006 Broad encompassing term for death that can be identified as environmental to infant This affects data comparison prior to and after that point WV procedures meet CDC guidelines for reporting SUIDS 76% of SUIDS showed bed sharing Differs from co-sleeping Possible that drug use is involved with this Affect ability of infant brain to respond to triggers for breathing

  13. Smoking and WV Infant Mortality • 39% of infant mortality was associated with a mother smoking • 39% of White mothers smoked • 5 % of African American mothers • Approaches would be different depending on race

  14. WV Infant Mortality Review- Next Steps • SUID – Educate ourselves • Bed sharing and co-sleeping • Tobacco Cessation – Become more proactive • Since the beginning of time • 17 hydroxyl progesterone – make more available • WV Medicaid to pay for this medication • Educate hospital personnel – accurate completion of birth certificate • Approximately 31 hospitals deliver babies in WV • Consider legislation to create a WV Infant Mortality Review Board

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