Preliminary Findings

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Preliminary Findings 2004 Infant Deaths
TFIMR is a collaborative effort of the Tulsa
Health Department, the Oklahoma State Department
of Health, the Tulsa Healthy Start Initiative and
the Tulsa Family Health Coalition.
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Case Selection Criteria

• Infant lt365 days old
• Resident of Tulsa County at birth and death
• Born and died in Tulsa County
• Died from causes other than an accident (infant
  deaths with unsafe sleeping environment are
  eligible for case review)
• Formal legal proceedings beyond initial
  investigations, not initiated
• Mother must have obtained PNC in Tulsa County

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Hospital Abstractions
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Case Review TeamTFIMR 2004 Infant Deaths N46
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Home InterviewsTFIMR 2004 Infant Deaths
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Infant Characteristics and Risk Factors
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Infant Deaths by Month of Occurrence
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Hispanic Ethnicity

• 3 (6.8) Hispanic ethnicity unknown
• 7 (17.1) Hispanic ethnicity
• 34 (82.9) Non-Hispanic ethnicity

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Gestational Age (weeks)

• Term Births 37 weeks 10 (25)
• Preterm lt37 weeks 30 (75)

Birth Weight

• VLBW lt1,500g 22 (55.0)
• LBW 1,500-2,499g 8 (20.0)
• Normal 2,500g-3,900 10 (25.0)

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Grief/Loss Support

• 12 (26) No clear documentation on who if any
  gave grief support to the mother after the infant
  died.
• 13 (28.3) More than one person listed as
  providing grief support.
• 21 (45.7) One person listed as providing grief
  support
• Grief support provided by Social Workers, Clergy,
• Nurses, volunteer pregnancy loss support group.

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Fathers Information
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Fathers Information

• Of the 44 fathers there is no information for 4
  fathers
• Of the data collected, unknown values range from
  22.5 to 40.0 making data reliability very low.

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Mother Maternal Characteristics and Risk Factors
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Mothers Educational Attainment

• Of the 44 mothers who lost infants during 2004
• Educational attainment is unknown for 6 (13.6)
• 6 were over the age of 19 and had less than a
  high school education
• 4 mothers were under the age of 20 and were below
  their expected grade level

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Mothers Educational Attainment
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Mothers Employment

• Employed 20
• Employed, hours worked unknown 14
• Employed full-time 6
• Incarcerated 1
• Student 6
• Unemployed 16
• Unknown 1

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Mothers Primary Language

• English 40 (90.9)
• Spanish 3 (6.8)
• PNC interpreter available for 1 mother, unknown
  if services were available for 2 mothers
• LD interpreter available for 2 mothers, 1 is
  unknown if services were available
• Vietnamese 1 (2.3)
• PNC mother provided her own interpreter part of
  the time, unknown if one was available at any PNC
  visit
• LD hospital provided an interpreter part of the
  time

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Was nutrition discussed and documented in
mothers medical record?

• Yes 18 (26 mothers were under or over ideal body
  weight. Of those nutrition was discussed and
  documented for 12 (46))
• Nutritional risk factors identified and
  documented
• 1 folate deficiency
• 1 calcium, protein deficiency
• 1 caloric deficiency
• 1 PICA (eating non-food items)

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Marital Status

• Married 23 (52.3)
• 16 living with FOB
• 6 unknown living situation
• 1 living with other relatives
• Single 21 (47.7)
• 5 living with FOB
• 3 living with her parent(s)
• 6 living alone or alone with siblings of infant
• 1 other relatives
• 1 incarcerated
• 5 unknown living situation

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Mothers Living Arrangement

• Unknown 11(25)
• Father of the baby 21
• 9 FOB alone
• 12 FOB and siblings
• Significant other 0
• Mothers parents 3
• 2 parents alone
• 1 parents and infants siblings
• Alone 6
• 2 alone
• 4 alone with infant siblings
• Other family 2
• 1 other only
• 1 other and infants siblings
• Incarcerated 1

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Mothers Health Insurance

• Medicaid 24 (54.6)
• 91.7 of the black mothers had Medicaid as their
  primary insurance
• 33.3 of the white mothers had Medicaid as their
  primary insurance
• Private 16 (36.4)
• Only 1 black mother had her private insurance as
  her primary insurance
• 51.9 of the white mothers had private insurance
  as their primary insurance
• Self-pay 3 (6.8)
• 100 of the self-pay mothers were of Hispanic
  ethnicity, 2 were not born in the U.S., 1
  birthplace was unknown, all had Spanish as their
  primary language
• Medicaid private 1 (2.3)

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Mothers Tobacco Use

• Unknown tobacco use 3 (6.8)
• No tobacco use 24 (58.5)
• Smoked during pregnancy 17 (41.5)
• 8 smoked 10 or fewer cigarettes per day
• 6 smoked 1 pack of cigarettes per day
• 2 smoked, unknown amount
• 1 smoked cigars

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Mothers Alcohol Use

• Three mothers admitted to alcohol use at PNC
  visits or at the hospital yet there was no
  documentation that they received a referral or
  education on the dangers of drinking during
  pregnancy
• Alcohol use unknown 7 (15.9)

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Mothers Drug Use

• Marijuana use was unknown for 6 (13.6) mothers.
• 5 mothers admitted marijuana use at either PNC
  visits or at the hospital but only 1 referral was
  documented. Of these 5 mothers, 3 were given
  drug screens, all were negative.
• No documentation was found for drug screens for
  32 mothers
• Of the 12 drug screens administered
• 8 were negative
• 4 were positive
• 3 were positive for marijuana (1 positive for
  THC, opiates, barbiturates)
• 1 positive for cocaine and opiates
• No referrals were noted in the medical records
  for any of these positive drug screens.

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Prenatal Care

• 31 (70.5) mothers began PNC during their 1st
  trimester of pregnancy
• 11 (25) mothers began PNC during their 2nd
  trimester of pregnancy
• 1 (2.3) attended PNC but it is unknown the week
  gestation she began PNC
• 1 (2.3) mother did not receive PNC

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Missed PNC Appointments
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Method of Delivery

• Spontaneous vaginal 27 (58.7)
• Primary C-section 13 (28.3)
• Repeat C-section 3 (6.5)
• Vaginal breech 2 (4.3)
• Forceps 1 (2.2)

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Indications for C-Section

• Fetal Indications 6
• 3 Footling breech
• 3 Fetal indications unspecified
• Maternal Indications 9
• 3 Hemorrhage
• 2 Previous C-section
• 2 Chorioamnionitis
• 1 Pre-eclampsia
• 1 Failure to progress
• Unknown Indications 1

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Conditions Noted at Birth

• Amniotic fluid 7
• 3 Bloody
• 3 Foul odor
• 1 Bloody and foul odor
• 1 Cloudy
• 1 Meconium stained
• Abruptions
• Placental infection 1

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Placental Exams

• No placental exams 9 (20.)
• Placental exams 35 (79.5)
• 23 (65.7) Chorioamnionitis, Funisitis, Villitis
• 20 (57.1) Chorioamnionitis
• 8 (22.9) Funisitis
• 5 (14.3) Villitis

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Maternal Infections

• Infection Present 19 (43.2)
• Sexually Transmitted Infection present 15 (34.1)
• Other Infection Present 10 (22.7)
• Group B Strep 11 (25)
• Chlamydia 7 (15.9)
• Bacteriodes fragilis 4 (9.1)
• Trichomonas 2 (4.6)
• E. coli 2 (4.6)
• One each of the following 7 (15.9)
• Herpes, syphilis, gonorrhea, bacterial vaginosis,
  yeast, diptheriodes and prevotella, coccal
• UTI-organism not specified

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Maternal Infections cont.

• No Placental exams - 9
• 2 GBS positive
• Placental Exams - 35
• No Chorio/funisitis/villitis present - 13
• 2 Chlamydia present
• 1 E.coli
• 1 GBS, Trichomonas, Yeast
• 1 E. coli, Chlamydia
• Chorio/funisitis/villitis present - 22
• 1 GBS, bacteriods, Chlamydia
• 1 GBS, syphilis
• 3 GBS
• 2 Bacteroides
• 1 GBS, gonorrhea
• 1 diptheroides, prevotella
• 1 GBS, bacteroides
• 1 GBS, herpes, trichomonias

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Did a Social Worker contact the mother during the
hospital stay?

• Yes 25 (56.8)
• Documentation was found in the medical record
  of a Social Worker contacting the mother during
  the hospital stay.

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Were any of the following problems identified
during the mothers hospital stay?

• None
• Depression
• Inadequate support system
• Inadequate housing
• Need for public assistance, Medicaid, food
  stamps, WIC
• Drug/alcohol abuse
• Crime/legal problems
• other

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Discharge Instructions

• Nothing noted in chart 2 (4.5)
• Follow-up in __ weeks 35 (79.5)
• 1-2 weeks 13
• 3-4 weeks 9
• 5-6 weeks 13
• Standard discharge instructions 29 (65.9)
• Other discharge instructions 8 (18.2)
• Mothers could be given more than one discharge
  instructions. Percents do not add up to 100.

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How was the mother instructed to make her post
partum follow-up appointment?

• Call for an appointment 24 (54.5)
• Not mentioned 19 (43.2)
• Appointment made before leaving the hospital
  1 (2.3)

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Did the mother attend her post partum visit?

• Yes 20
• No 8
• Unknown 16 (36.4)