Abstract

Preventing sleep-related infant deaths using fetal infant mortality reviews

Emily Beck, BS¹, Brittany Sullivan, B.S.¹, Elizabeth Corpuz, BA¹, Emily Carroll, BA¹, Joi Presberry, MPH¹, Debra Lenz, MS², Terra Bautista, BA², Brenda O'Rourke, RN, BSN² and Catherine Kothari, PhD¹
(1)Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, (2)Kalamazoo County Health and Community Services, Kalamazoo, MI

APHA 2021 Annual Meeting and Expo

Background: Fetal/Infant Mortality Review (FIMR) is an evidence-based community-level quality improvement process that reviews infant deaths and produces preventative recommendations. The CDC reports 3500 sleep-related infant deaths annually in the US. Kalamazoo County, MI historically has high infant mortality among minority groups, including safe-sleep deaths.

Methods: Of 98 feto-infant deaths reviewed by Kalamazoo FIMR, 18 were unsafe-sleep and generated 105 recommendations. A multistep process was developed coding recommendations. GEE (alpha=.05) estimated unsafe-sleep-death among birth cohorts (Kalamazoo County, 2006-2019, N=43,485 births from 2006-2019).

Results: Fifty-two of 278 infant deaths (18.7%) in Kalamazoo County, MI (2006-2019) were associated with unsafe sleep. Low-income (OR 6.68,p<.001), Black (OR 3.15,p=.011), and young mothers (OR 0.91,p<.001) experienced greatest risk. Strongest predictors of unsafe sleep deaths were: prenatal smoking (aOR 3.23,p<.001), being single (aOR 3.39,p=.006), inadequate healthcare (aOR 1.86,p=.033), and lower birthweight (aOR 1.00,p=.05).

Eighteen of the 19 unsafe-sleep deaths occurring 2015-2020 were reviewed by Kalamazoo FIMR. Recommendation categories, similar across socioeconomics and race were:

Improve systems of care (26.7%), specifically “develop coordinated, multi-system, community-informed response to safe-sleep barriers”,
Family/community communication on emerging risk trends and available resources (21.9%),
Provider communication/relationship-building skills (16.2%),
Addressing family social risk (3.3%), specifically “refer all eligible individuals/families to home visitation,
Care coordination for mom/family (11.4%).

Conclusion: The safe sleep inequities found in this study necessitate targeted interventions aligning with FIMR recommendations to ensure improvement in infant-fetal care outcomes. These recommendations would improve current prevention guidelines and strengthen compliance with guidelines both in the medical system and within the home.

Assessment of individual and community needs for health education Epidemiology Planning of health education strategies, interventions, and programs Public health or related organizational policy, standards, or other guidelines Public health or related public policy Public health or related research