Monthly Public Health Topic
Public Education and Information An infant death is just the tip of the iceberg Of 11,424 infants born in Alaska in 2008, 65 did not live to their first birthday (an infant mortality rate of 5.7 per 1000 live births)i. These tragic deaths represent the tip of the iceberg as an indicator of overall population health. State and community-level infant mortality rates are often used to measure overall population health status due the relationship of this outcome not only with infant and maternal health, but with social, environmental and economic conditions.
Alaska does better than much of the rest of the country in preventing deaths that occur during the first 28 days of life (the neonatal period). In 2008 our neonatal mortality rate was 2.1 per 1000 live births, compared to 4.5 for the nation in 2006 (the most recent year with data available). The Maternal and Infant Mortality Review (MIMR) program of the Alaska Section of Women’s, Children’s and Family Health (WCFH) organizes a committee of physicians and other medical experts who attempt to review the circumstances of every infant death that occurs in Alaska and make determinations of the causes and preventability of the deaths. During 1992-2004, the MIMR committee found that half of all neonatal deaths were related to preterm delivery (less than 37 weeks gestation), while congenital anomalies, perinatal events or conditions, and infections contributed to 35%, 21% and 14%, respectively.ii
The 2008 postneonatal mortality rate for Alaska (deaths during 28 days to one year of age) was 3.6/1000 live births, higher than the nation’s rate of 2.2 in 2006. Over 50% of postneonatal deaths are due to Sudden Infant Death Syndrome (SIDS) or other unexpected and unexplained asphyxia, according to MIMR committee findings. Twenty percent are related to infections and 20% to congenital anomalies, while around 10% are caused by intentional injuries.ii
Due to the current high and stable rate of postneonatal mortality in Alaska, as well as the fact that the majority of these deaths are believed to be preventable, the Maternal and Child Health Epidemiology Unit in the Section of WCFH has been focusing recent research on this outcome. Alaska Native infants have a higher rate of postneonatal mortality compared to non-Native infants, yet one study found that this increased risk was almost all explained by higher proportions among Alaska Native mothers of women with less than 12 years of education, women who were unmarried and did not indicate a father on the infant birth certificate, and women who reported prenatal alcohol or tobacco useiii. Mothers with these three characteristics experience postneonatal mortality rates that are up to 20 times higher than women with none of the characteristics. These characteristics are not genetic, and point to causes of infant death other than biologic factors.
In another recent study, the MCH Epidemiology Unit found that among Alaskan infant deaths during 1992-2004 due to SIDS or unexplained asphyxia and unexpected deaths that occurred during sleep, 43% occurred while the infant was sharing a sleep surface with someone elseiv. Almost all (99%) of these deaths had other known risk factors for infant mortality, such as maternal tobacco use or sleeping with an impaired caregiver, indicating that bed sharing was not an independent risk factor for infant mortality.
The MIMR committee believed that a safer sleep environment or position might have prevented 58 postneonatal deaths which occurred during 2000-2004, one-third of all possibly preventable postneonatal deaths during that five-year period. In response to MIMR and MCH Epidemiology Unit findings, the Section of WCFH has started the Alaska Infant Safe Sleep (ISS) Initiative to address unintentional preventable postneonatal mortality. In the spring of 2009, the ISS initiative conducted a statewide health facility assessment on infant safe sleep and identified some model practices and as well as a need for policies and education materials. With the exception of the back sleeping position, there is a lack of consistency in the message that Alaskan families are receiving, and many of the materials in use are outdated and do not reflect current knowledge about safe sleep risks and protective factors. In particular, information about risk reduction while bed sharing, which 43% of Alaskan mothers of newborns practice always or almost alwaysv, is conspicuously absent from almost all educational materials. The Alaska Infant Safe Sleep Initiative will:
- Develop a relevant Alaskan infant safe sleep policy statement and social marketing message, building on work done by the National Institutes of Health-approved Healthy Native Babies program
- Design educational products for providers and the public
- Help plan and execute an Alaska Infant Safe Sleep Summit in September 2010
- Promote integration of infant safe sleep messages and activities, focusing on key groups such as families, childcare providers, health care professionals, and the general public
The first Alaska Infant Safe Sleep Task Force meeting will be Tuesday, September 29th in Anchorage. Anyone interested in infant safe sleep is welcome to join us! For questions about the initiative, please contact Debbie Golden, perinatal nurse consultant at "> or 907-334-4494.
- Provisional data from the Alaska Bureau of Vital Statistics. Subject to change.
- MIMR Committee consensus decisions on factors that caused or contributed to the death, allowing for multiple causes of death.
- Blabey MH, Gessner BD. Three maternal risk factors associated with elevated risk of postneonatal mortality among Alaska Native population. Matern Child Health J. Vol 13 (2009).
- Blabey MH, Gessner BD. Infant bed-sharing practices and associated risk factors among births and infant deaths in Alaska. Pub Health Reports. Vol 124. (2009).
- Schoellhorn KJ, Perham-Hester KA, Goldsmith YW. Alaska Maternal and Child Health Data Book 2008: Health Status Edition. MCH Epidemiology Unit, Section of Women’s, Children’s and Family Health, Division of Public Health, Alaska Department of Health and Social Services. December 2008.
Articles for publication should be sent to either Tim Struna, Sandra Woods, Shannon Deike-Sims, or Gretchen Clarke.