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Infant Injury Deaths in       New York City              Martine Hackett Ph.D., MPH  Bureau of Maternal, Infant and Reprod...
Infant Mortality Rate NYC        1898-2009                                           2009 Historic                        ...
Infant Mortality Rate NYCby Gestational Age, 1995-2009            Source: BVS
Infant Mortality Rate NYC 2009       by Race/Ethnicity         Source: Bureau of Vital Statistics
Geographic Disparities in Infant  Mortality NYC 2005-2009                          Highest IMR:                          B...
Leading Causes of Neonatal and                                           Postneonatal Death, NYC 2009                     ...
Diagnostic Shift in Classification of                                      Infant Deaths, Injury vs. SIDS                 ...
  
Infant Deaths NYC 2004-2007                                  Infant injury                                     N=256SIDSN=...
What are the characteristics of infantswho die of sleep related injury deaths in                 NYC?• Infant Mortality Re...
Demographic Characteristics• Infants who die of Undetermined Injury  deaths are predominantly:  – Between 28 days-4 months...
Circumstances at time of         death
Excess Bedding** at Time of Death by  Cause of Death, NYC 2004-2007*                                                      ...
Prone Position at Time of Death by   Cause of Death, NYC 2004-2007                                                        ...
Bed Sharing at Time of Death by Cause      of Death, NYC 2004-2007                                                        ...
Location of Infant When Found Dead by   Cause of Death, NYC 2004-07*100%                                                  ...
Unsafe Sleep Surface by Cause of Death,           NYC 2004-2007*                                                          ...
Risk FactorsSIDS:           Suffocation:    Undetermined:• Excessive     • Excessive     • Excessive (soft)  (soft)       ...
Type of Sleep Surface When Infant        Found Dead, NYC 2004-07                            n=203Unknown or NA     6%     ...
Summary• Accidental injuries (which are preventable) have  replaced SIDS as the second leading cause of  post-neonatal dea...
Summary• Shift the conversation to Injury Prevention   – Parent and provider education on the importance of a safe     sle...
Safe Sleep Dept. Homeless Services training
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Safe Sleep Dept. Homeless Services training

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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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