I NFANT M ORTALITY IN O HIO What Can We Do Locally? Rebecca (Becky) Dershem Director of Nursing, Allen County Public Health

W HAT IS I NFANT M ORTALITY ? 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!

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I N O HIO : 61% OF I NFANT D EATHS ARE A TTRIBUTED TO 5 C AUSES : 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 in United 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, Year Moving Averages By Area of Ohio Source: Ohio Department Of Health, Community Profiles

T HE R OLE OF P UBLIC H EALTH PREVENT, PROMOTE, PROTECT o Community Needs Assessment – Survey completed in 2014 o o Go to Vital Statistics, then Community Health Statistics. Select CNA o County Health Rankings – National state-wide rankings o o Select your county & their ranking of the 88 counties. Find the data source for your scores. o Child Fatality Review Board in each County o 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 & 2014 (Hospital Self -Reported Data) 2013 Bluffton 2013 LMH2013 SRMC2014 Bluffton 2014 LMH2014 SRMC Live Births Total Births: 2404 # of Deliveries (Moms) Total Births: 2410 to 2383 Moms # < 37 /0 weeks1.20%10.80%8.90%1.30%10.80%9.60% # <35/0 weeks04.10%2.40%02.80%3.00% # <32/0 weeks00.60%0.20%00.40%0.70% # 37-38/6 weeks45.60%57.70%ND18.30%34.70%29.70% LBW < 2500 Gms0.80%7.40%5.70%0.40%7.30%7.50% Ages: < 15 yrs0%0.20%0.10% yrs1.60%2.20% 0.40%1.10%2.30% yrs2.00%8.00%6.00%3.30%6.50%5.10% yrs 94%84.10%86.50% > 35 yrs10.20%5.30%6.90%17.20%8.30%5.90% Total C/Births34.40%32.20%29.60%24.50%34.80%27.70% Primary C/B20%15.90%14.50%9.50%14%11.70% Repeat C/B18%19.40%17.80%15%20.70%16% No Prenatal Care0.07%1.20%0.60%0 1-3 Prenatal Vs01%0,8%0.00%0.50%2.00% Tobacco Use12.60%23.10%17.30%19.80%23.10%17% ETOH use2.50%00.40%00.20%1.90% Drug Hx0.00%1.60%0.80% 2.90%1% # Chose Breastfeeding84%70.00%56.90%86.60%69.40%64.70% #BF Exclusively Del-D/CND70%17.60%37.50%69.40%ND ND = No Data

A LLEN C OUNTY D ATA INFANT MORTALITY REVIEW Child Fatality Review of 10 Year Data: 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: 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: OCPIM Dr. Arthur James - Spokesperson Members 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: OPQC Dr. Jay Iams – Spokesperson for Progesterone Members include: Multiple providers from Academia & Private Providers, Hospitals, Insurers, State Health Officials, Public Health 1. Progesterone Project – Protocol for giving between the th week of pregnancy for mothers with an identified short cervix. 2. Neonatal Abstinence Syndrome – NAS Reducing 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

P UBLIC H EALTH AS THE C ATALYST 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 & 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.