Child Fatality Review and Prematurity

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Child Fatality Review and Prematurity

• A Look at Cuyahoga County
• Lorrie Considine RN
• Cuyahoga County
• Board of Health
• October 2009

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The Numbers

• 240 Children Died in Cuyahoga County in 2008
• 10 more than last year
• 171 Infants (Birth to 1 year)
• 9 more than 2007
• 30 Children Age 1 to 9
• 3 less than previous year
• 39 Children Age 10 to 17
• 4 more than 2007

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Causes of Infant Deaths

• Prematurity 102
• Birth Defects 31
• Sleep Related 22
• Infection 6
• Other Perinatal
• Complications 5
• Homicide 3
• Other Medical 2

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Racial Disparity in Cuyahoga County 2008

• Minority infants are 3 times more likely to die
  than white infants

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Prematurity in Cuyahoga County

• Prematurity is the largest contributor to child
  and infant deaths

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Prematurity in Cuyahoga County2008

• Infant born before 37 weeks
• 102 infants
• Racial disparity

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Prematurity in Cuyahoga County

• 102 infant deaths in 2008
• 76 lived less than 1 day
• 2 lived less than 1 week
• 54 were males
• 85 were all other races

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Closer Look at Prematurity in Cuyahoga County

• Gestational Age
• Less than 24 weeks (71)
• 24 to 31 weeks (25)

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Preterm Birth by Maternal AgeCuyahoga County

• March of Dimes Data 2004-2006

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Cuyahoga CountyVery Preterm Births by Maternal
Age

• March of Dimes Data 2004-2006

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Folic Acid Study

• Taking folic acid 1 year or more prior to
  conception
• 70 decrease in spontaneous preterm births 20-28
  weeks
• 50 decrease in spontaneous preterm births 28-32
• Bukowski, Malone,Porter, Nyberg, Comstock 2009
• 80 of preterm infants that died in Cuyahoga
  County in 2008 were 20-28 weeks

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Possible Causes of Preterm Births

• 40 unknown
• Infections/inflammation
• UTI, STI, Chorioamnionitis
• Maternal or fetal stress
• Physical or social
• Stress hormone released
• Uterine bleeding
• Overstretched uterus
• March of Dimes

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Maternal Risk Factors Associated with
Prematurity Deaths

• Poverty 75 72
• STI 36 35
• Chorioamnionitis 35 34
• Smoking 32 31
• Chronic health issue 24 23
• Previous preterm
• delivery 21 20
• Late prenatal care 20 19
• Previous fetal loss 19 18

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Maternal Risk Factors Associated with
Prematurity Deaths

• Drug use in pregnancy 15 14
• History of mental health
• issues 15 14
• History of domestic
• violence 14 14
• At risk maternal age 14 14
• Multiple gestation 14 14
• Intrauterine drug
• exposure 13 13

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Teens Prematurity 2004-2008

• 41 Infant Deaths due to Prematurity
• Risk Factors
• 76 live in poverty
• 63 no prenatal care / late entry
• 42 STI
• 32 chorioamnionitis
• 24 tobacco 17 illicit drugs 12 alcohol
• 10 chronic health problems
• 20 family history of neglect 29 family history
  of domestic violence

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Life Course Perspective

• Comprehensive public health approach
• Reproductive health spectrum
• Entire life course of women

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Life Course Perspective

• What is it?
• Proactive lifelong approach
• Looks at conditions that can affect mom baby
• Medical
• Behavioral/Social
• Environmental
• Start in early childhood

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Web Address for Full Report

• www.cuyahogacounty.us/protectingourfuture