An analysis of deaths among infants and children born into Oklahoma's Children First nurse home visitation program, 1997-2004

Objective: Children First is a nurse home visitation program for low-income first-time mothers in Oklahoma. The objectives were to describe infant/child deaths to participants; to identify participants at greater risk of experiencing an infant/child death; to examine IMR among participants compared to other first-time births in Oklahoma; to examine child maltreatment deaths; and to use study results for program improvement. Methods: Data on participating children (N=15,102) and mothers (N=22,206) were matched to birth and death certificates to identify participant child deaths. Death certificate variables were merged with program data to fully describe participant and death characteristics. Results: 78 children born to participants have since died; 66% were natural infant deaths. Leading causes of death were congenital anomalies (14.1%), SIDS (14.1%) and short gestation (11.5%). Accidental death was the leading manner of death for children >24 months, with the leading cause being exposure to uncontrolled fire. Participants who experienced an infant or child death had a more crowded household (3.6 vs. 3.2 residents) and were more likely to have an annual household income <$15,000 when compared to other participants. The program's IMR was approximately one-half that of other first-time births in Oklahoma, OR=0.54, 95% CI (0.41, 0.70). Conclusion: Participating mothers have a lower IMR than other first-time mothers in the state. Participants with crowded households and lower income may be at greater risk of infant/child death. Results highlight areas of potential program improvement, including a stronger focus on preventing sleeping-related death and unintentional injuries.