Safe Sleep Dept. Homeless Services training

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  • When looking at infant causes of death we look at deaths occurring in 2 time periods, the neonatal period (1-27 days) and the postneonatal period (28 days -1 year). Leading causes of death in the neonatal period (1-27 days) are not as easily preventable as those occurring postneonatally since the main causes of neonatal death are birth defects and death due to prematurity and LBW. In NYC, during 2000-2003, the years in which the case review were conducted, the leading causes of death in the postneonatal period was birth defects, all other diseases (a grouping of all other diseases separate from injury), injury and SIDS (red and black bars). As you can see, injury and SIDS are the 3 rd and 4 th leading causes of postneonatal death in NYC. I will be talking about injury deaths in NYC during this presentation.
  • This slide shows the breakdown of the 256 infant deaths in NYC 2004-2007
  • Slides 20-27 look a little sloppy, so since I had access to the original charts in Excel I did the following: - Made categories along X axis consistent with previous slides (SIDS, Suffocation, Undetermined) - Tweaked with the sizing (kept aspect ratio) - Deleted some of the errant “0%” and random asterisks - Made sure Chi Squares were consistent noted where relevant
  • I thought we were swapping out soft bedding for excessive bedding?!!
  • Safe Sleep Dept. Homeless Services training

    1. 1. Infant Injury Deaths in New York City Martine Hackett Ph.D., MPH Bureau of Maternal, Infant and Reproductive HealthNew York City Department of Health and Mental Hygiene
    2. 2. Infant Mortality Rate NYC 1898-2009 2009 Historic Low IMR: 5.3 deaths/1000 live births Source: Bureau of Vital Statistics
    3. 3. Infant Mortality Rate NYCby Gestational Age, 1995-2009 Source: BVS
    4. 4. Infant Mortality Rate NYC 2009 by Race/Ethnicity Source: Bureau of Vital Statistics
    5. 5. Geographic Disparities in Infant Mortality NYC 2005-2009 Highest IMR: Brownsville 11.3 Followed by: East NY, Bed Stuy, Jamaica, St. Albans, Central Harlem, East Harlem
    6. 6. Leading Causes of Neonatal and Postneonatal Death, NYC 2009 9 9.0 Neonatal 9 Postneonatal 8 7.1 8 Rate per 10,000 live births 7 Rate per 10,000 live births 7 5.9 6 6 5 5 4.3 4 4 3.5 3 2.7 3 2 2 0.8 1 1 0.1 0 0 Short gestation and LBW Injury Birth defects Birth Defects Cardiovascular disorders SIDS Respiratory distress of the newborn Other Respiratory Causes 6Source: Bureau of Vital Statistics; compiled by BMIRH
    7. 7. Diagnostic Shift in Classification of Infant Deaths, Injury vs. SIDS NYC 1993-2009 80 70IMR per 100,000 Live Births 60 50 40 30 20 10 0 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 19 19 20 20 20 20 19 19 19 19 19 20 20 20 20 20 20 SIDS InjurySource: Bureau of Vital Statistics; compiled by BMIRH
    8. 8.   
    9. 9. Infant Deaths NYC 2004-2007 Infant injury N=256SIDSN=35 Unintentional Undetermined EXCLUDED: Intentional & Injury Deaths Injury Deaths therapeutic N=53 N=165 complication deaths Excluded: Suffocation Deaths Fire, Drowning, N=38 Falls, Poisoning Source: Bureau of Vital Statistics
    10. 10. What are the characteristics of infantswho die of sleep related injury deaths in NYC?• Infant Mortality Review Committee reviewed data from two sources – Office of Vital Statistics • Birth and Death Certificates – Office of Chief Medical Examiner • Autopsy • Death Scene Investigation • Family Interview • Provider Interview• Data from 2004-2007 analyzed for Accidental Suffocation and Undetermined causes of death 10
    11. 11. Demographic Characteristics• Infants who die of Undetermined Injury deaths are predominantly: – Between 28 days-4 months old – Born full term – Mothers are Black, non Hispanic – Mothers are U.S. born – Mothers age is <20 – Mother’s education is </=12 years
    12. 12. Circumstances at time of death
    13. 13. Excess Bedding** at Time of Death by Cause of Death, NYC 2004-2007* Excess Bedding100% No Excess 43% Bedding 80% 63% 61% Unknown or 60% Not Applicable 40% 40% 11% 17% 20% 26% 22% 17% 0% SIDS (N=35) Suffocation (N=38) Undetermined ** Defined as bedding in excess of bed sheets (any (N=165) number) and 1 blanket *Chi-Sq p<.05
    14. 14. Prone Position at Time of Death by Cause of Death, NYC 2004-2007 Prone100% 35% Not Prone 40% 45%80% Unknown or Not Applicable60% 51%40% 54% 47%20% 8% 14% 6% 0% SIDS (N=35) Suffocation (N=38) Undetermined (N=165)
    15. 15. Bed Sharing at Time of Death by Cause of Death, NYC 2004-2007 Yes 6%100% No 80% 55% 65% Unknown or 60% 91% Not Applicable 40% 45% 29% 20% 3% 5% 0% SIDS (N=35) Suffocation (N=38) Undetermined (N=165)
    16. 16. Location of Infant When Found Dead by Cause of Death, NYC 2004-07*100% Crib/Bassinette/ 21% 22% Playpen80% Adult Bed 80% Couch/Sofa60% 53% 62% Other40% 13% Unknown or Not20% 14% 6% 6% 13% 4% Applicable 5% 0% SIDS (N=35) Suffocation (N=38) Undetermined (N=165) *Chi-Sq p<.05
    17. 17. Unsafe Sleep Surface by Cause of Death, NYC 2004-2007* Unsafe Sleep Surface 100% 20% Safe Sleep 80% Surface 79% 72% 60% Unknown or Not 80% Applicable 40% 22% 20% 21% 6% 0% SIDS (N=35) Suffocation (N=38) Undetermined (N=165) *Chi-Sq p<.05
    18. 18. Risk FactorsSIDS: Suffocation: Undetermined:• Excessive • Excessive • Excessive (soft) (soft) (soft) bedding bedding bedding • Prone position• Prone • Prone • Unsafe sleep position position surface• Second hand • Unsafe • Bed sharing smoke sleep surface • Bed sharing
    19. 19. Type of Sleep Surface When Infant Found Dead, NYC 2004-07 n=203Unknown or NA 6% Had Unsafe crib/bassinet sleep 45% Crib or surface bassinet or (adult bed, playpen couch, car seat) No 34% crib/bassinet 62% or unknown 55% Source: BMIRH
    20. 20. Summary• Accidental injuries (which are preventable) have replaced SIDS as the second leading cause of post-neonatal death• Characteristics of undetermined infant deaths similar to suffocation and SIDS deaths – Prone position still being used 15 years after Back to Sleep• Many undetermined injury deaths are “sleep- related”• Safe Sleep messages are new to many families; not just SIDS
    21. 21. Summary• Shift the conversation to Injury Prevention – Parent and provider education on the importance of a safe sleep environment – Support families in need by providing the tools for safe sleep – Consumer advocacy for modeling safe sleep – Interagency collaborations for consistent messaging and practices

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