Racial Disparities in Infant Mortality

Introduction

Infant mortality is a national issue that varies in location and is on the rise. According to the Nebraska Department of Health and Human Services, in 2013, 139 infants died in the state of Nebraska. These deaths are primarily from birth defects, prematurity, and Sudden Infant Death Syndrome/Sudden Unexpected Infant Death.  The rise is especially being seen in Omaha. For instance,  North Omaha has a higher rate of infant death of 10.9  compared to Western Omaha, where they have an infant mortality rate of 4.7,  as seen

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in the chart below provided by Douglas County Health Department. Because the infant mortality rate in North Omaha (10.9) is doubled compared to the infant mortality rate in West Omaha (4.7), information that is sent home with new mothers was gathered and compared from both West and North Omaha hospitals as secondary data. In the following pages, a comparison of the analyzed information will conclude an understanding of the difference in infant mortality rate between North and West Omaha.

 

Methodology

Each person in the group went to a local Omaha hospital and got a folder that contains information the hospital sends home with mothers who just gave birth. Hospitals that were included in this research were Nebraska Medical Center, Creighton University Medical Center, Bergan Mercy Medical Center, and Methodist Women’s Hospital. The information included in the folders was analyzed by first being put into similar categories. These categories are what created the topics in this essay; Infant and Mother Care Books, Pamphlets regarding SIDS, Shaken Baby Syndrome, New Born Health Screenings, and Immunizations. All of these categories play a significant role in infant health as well as the mother’s which in turn plays a significant role in the decrease or increase of rates in infant mortality.

 

Findings

When looking at the information given in the mother’s folders, five common themes were found. First, Infant and Mother care books were given in all five folders. This was important because it contained a lot of information and covered various care topics. Pamphlets regarding mother care and support groups were also seen throughout folders. This is an important topic because a mother’s mental health affects the quality of care given to the infant. Immunizations and Health Screen pamphlets were also seen throughout all folders and this information is critical to the infant’s health. Pamphlets on Sudden Infant Death Syndrome (SIDS) were also found and this topic needed to be covered in the research because, SIDS is a leading cause of infant mortality. Shaken Baby Syndrome pamphlets were also found and needed to be included in the research because it can also lead to infant mortality.

  Analysis

 

In the cited Nebraska Child Death Review Report, it is stated that “After each of the DHHS investigations (also called Initial Assessments), no case was opened to offer ongoing services to the families. In all of the cases, the injuries were caused by abuse or neglect. Through its investigation of the two deaths and nine serious injuries it was found: Children age 3 and under were the victims in every case. Specific challenges were found which limited the effectiveness of Initial Assessments with very young children, especially low community visibility. Physical abuse by the child’s father or mother’s male partner was the cause of injury in the majority of cases. Assessment of the perpetrators was often limited before the death or serious injury” (11).This corresponds with the group’s findings involving shaken baby syndrome and how it is addressed in the pamphlets/books.

“Between May 2013 and December 2015, the [Office of Inspector General (OIG)] received 11 reports of infants dying suddenly and unexpectedly – seven who had prior or current child welfare involvement and four who died in licensed child care centers. These types of cases are often referred to as sudden unexpected infant death (SUID), and usually occur in an unsafe sleep environment. The OIG found that:  Unsafe sleep practices were present in every child death investigated for this report.  Licensed child care centers have three years to take safe sleep training after opening. Some providers lacked important knowledge about infant safe sleep.  The Division of Children and Family Services and its contractor, Nebraska Families Collaborative, lacked training, resources, and policy on promoting infant safe sleep and prevention of SUID. “

 

As demonstrated in the below chart, provided in the 2015 Nebraska Child Death Review report, In 2015, at least 148 infants died before their first birthday, a mortality rate (IMR) of 5.6 deaths per 1,000 live births. Nebraska’s IMR (infant mortality rate) remains below the Healthy People 2020 goal of 6 per 1,000, and ranked 35th highest in the nation for 2014. However, the 10-year trend does not show significant improvement, and the increase between 2014 and 2015 erased all gains made between 2011 and 2012 (12).

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Books

Each folder of information that was received from the hospitals in the area, included a small book going over important information for parents and infant. After reading through each book it was decided to be the most beneficial to pull out the most relevant information relating to prevention of infant mortality given in each. It is important to look at the information being given in these books because it is the majority of information in the folder.

Bergan Mercy Medical Center and Creighton University Medical Center gave out the same books. This could be concluded because they are both ran by Catholic Health Initiatives (CHI). Five main beneficial topics were found in this book; crib safety/safe sleep, shaken baby syndrome, excessive crying, car seat safety, and postpartum depression.

Safe sleep and crib safety tie together because they both can lead to Sudden Infant Death Syndrome (SIDS). Information on not sharing the bed with the infant and hazards such as pillows, loose blankets, and infant positioning. Enough information was given to understand hazards to infants during sleep and in cribs, but not enough to stress how common SIDS is.

Information on Shaken Baby Syndrome was also included in CHI’s book. Shaken Baby Syndrome (SBS) was briefly explained and tips on preventing it were also given. A proper amount of information was given to stress the seriousness of Shaken Baby Syndrome, what to do if it occurs, and how to prevent it.

A factor that goes into SBS is excessive crying. When an infant is excessively crying, parents are more likely to get stressed out and unintentionally shake the baby out of frustration. Information is given on what to do if a parent is reaching a point of frustration from the infant’s crying. Giving these tips to diffuse frustration help prevent SBS.

Car seat safety is always important for children. CHI’s book gave a rundown of how to pick a safe car seat, how to install, and how to make sure one’s infant secure in the seat. Giving this information helps ensure that the parents may do so correctly and that their infant will be safe in the vehicle. This book gave an overview on the topic so that the most important parts were included.

Postpartum depression affects many mothers. Not only will a mother be struggling, but the baby will be in danger too because the mental state of the mother will affect the quality of care the infant receives. This topic was touched in CHI’s book by covering signs of postpartum depression and suggestions of when to call a doctor. A significant amount of information was covered but there could have been more options on resources to help a mother with postpartum depression.

Creighton Medical Center and Bergan Mercy Medical Center tie in last for the quality of information given. They both touched on important topics, but there could have been more topics covered. Along with that, they also provided very few resources and parents are more likely to struggle to get the help they need because they were not given the proper amount of information or resources to choose from or receive the proper help.

Nebraska Medical Center (NMC) had the highest amount of quality information given in their book relating to prevention of infant mortality in comparison to the other hospitals. Topics include: choking, excessive crying, Shaken Baby Syndrome, Safe sleep, car seat safety, Postpartum depression, father’s emotional state, and sibling safety.

Just like  CHI’s book, NMC mentioned excessive crying and shaken baby syndrome together because they go hand in hand. There was also more information on options to soothe a crying baby. This is extremely helpful because having more options given to one helps to be more aware of to soothe a crying infant can decrease the time in which a mother would go straight to letting her frustration get to her and start shaking the infant. Information on what to do if  a mother feels like she is frustrated to the point where she may shake her infant are included as well as signs of abusive head trauma which relates to shaken baby syndrome and what to do if it has occurred.

SIDS and safe sleep was also mentioned in NMC’s  book. A large page was dedicated to information on safe sleep practices that reduce SIDS of occurring. There were also more reminders such as making sure to tell and show a babysitter or other caregivers about factors leading to SIDS so that they are aware of them and informed about SIDS. More information was given in this book that would help the parents and caregivers and also highly stresses the importance of avoiding SIDS and dangerous sleeping practices.

Car seat safety information was also given in NMC’s book. Proper and helpful tips were given about car seat installation and choosing a safe seat. What makes this information better than CHI’s is that they give additional resources such as credible websites and a number to text for video demonstration. Having information and resources included in the book helps ensure that everything is covered and gives parents options, so they can find one they like and are more likely to look at the information.

CHI included information about postpartum depression, yet Nebraska Medical Center did as well, along with information regarding father’s emotions. Postpartum depression was explained and included symptoms, warning signs, and information on who to call and when. This book also touched on the emotions fathers could be feeling and when they should get help. It was extremely important that the father’s emotions were taken into consideration because they can have significant worrisome feelings, even though they were not the ones who gave birth. The emotions and thoughts that fathers can have can affect their emotional state which can lead to infant mortality by poor care and things such as Shaken Baby Syndrome. Once again, additional resources such as access to videos, numbers, websites, and even a quiz to see if you are experiencing depression. All of these, again, give enough help that someone can choose a resource they like to get the help that they need, which is vital to reducing infant mortality.

Choking and infant CPR was mentioned in this book that was not included in CHI’s book or Methodist Women’s Hospital’s book. What to do when an infant is choking is included along with resources to find somewhere near you to be taught infant CPR in depth and a video resource  that will teach a parent infant CPR. Sibling safety was also not mentioned in the other books but was mentioned in NMC’s. Sibling safety is significant to reduction in infant mortality because one could leave their infant with an older child to watch or even just spend time with and they could let the baby sleep improperly which could lead to SIDS or they could shake the baby thinking it would make the infant laugh which would lead to Shaken Baby Syndrome.

Methodist Women’s Hospital (MWH) had some of the same topics as CHI and NMC including excessive crying, car seat safety, postpartum depression, SIDS, and Shaken Baby Syndrome. This book also touched a little bit on father’s emotions, as did the Nebraska Med Center. One thing that this book includes that others did not, is a section on caring for a premature infant.

Car seat safety in MWH’s book gave little bits of general information for parents regarding car seat safety, such as never leaving child alone and when they should be rear facing. This book could have had  more information on car seat safety but what made this better than CHI’s books is that it included a source that parents can go to, to help get the proper car seat that makes sure it will be safe for the infant. This section also includes a reminder on Shaken Baby Syndrome and to avoid jerky movements in the car to prevent SBS. This information helps prevent infant mortality more than CHI did.

Half of a page was focused on soothing a fussy baby; excessive crying. The only information that was given to help soothe an infant’s crying was to swaddle and explains how to swaddle. This is not the best information for the topic compared to others because if swaddling is not something the infant likes, they were not given other options or ways to help the infant calm down, which could higher the parent or caregiver’s frustration, which could then lead to something as significant as Shaken Baby Syndrome.

A whole page was dedicated to Shaken Baby Syndrome in MWH’s book, more information was given than the other two. SBS was explained and multiple options were given on what the caregiver can do if they are becoming frustrated with the infant. Signs and symptoms of SBS were given and information on what to do if one thought the baby has been shaken. There were also eight other resources given to help prevent Shaken Baby Syndrome or to get help. All the resources given are extremely helpful in order to prevent infant mortality.

Sudden Infant Death Syndrome was also given a whole page in the book. SIDS was explained and a list was provided with a significant amount of tips and information to avoid SIDS. There were also multiple credible sources given at the end and a reminded to tell other caregivers or people interacting with the infant the potential hazards that could cause SIDS. Because of the depth of information and how helpful it is to parents and caregivers, this makes it better than the other two books.

Postpartum depression was talked about in MWH’s book and once again, had a whole page dedicated to it. The emotional changes were mentioned and what postpartum depression was described along with a significant amount of signs and symptoms. Resources and ways to get help were mentioned at the end. There was also advertisement on the first page of the book about a mommy support group that the hospital offers. Again, because of the depth of information and resources, this book is better than the other two.

Emotions regarding the father were also mentioned in the book. This is helpful to include so that the fathers know that what they might be feeling is normal or that maybe they should seek help.

Based off the books, one could rank Methodist Women’s Hospital first due to the in depth information and resources given to help mother and infant. More quality information  was provided that would help reduce the risk of infant mortality. The Nebraska Medical Center would come in second, although they may have had more information, they could have given more resources and more in depth on topics such as SIDS and SBS, considering those are a significant factor to the rates of infant mortality.  Then, I would say there is a tie between Bergan Mercy Medical Center and Creighton Medical Center, since they were the same book. This book provided little bits of information and not very many resources. There was not enough information or help to impact a decrease of infant mortality. This also helps conclude that the West Omaha hospital has better resources and information regarding care than the North Omaha hospital.

SIDS Pamphlets

Information was collected from four different hospitals all over Omaha, Nebraska in order to compare and contrast discharge information for new mothers about safe sleep. Making sure new mothers know that their baby is sleeping safely is extremely important. New mothers who are unequipped with the vital knowledge about safe sleep could end up with tragic results. Sudden Infant Death Syndrome (SIDS) is a leading cause of death for infants that generally occurs while the baby is asleep. The cause for SIDS isn’t exactly defined, as there are several different variables that can cause this, but there are also steps mothers can take to prevent it.

Researchers say that one cause of death by SIDS is a predisposed likelihood caused by the male chromosomes for respiratory failure, according to (Mage, David T., and E. Maria Donner. “Is Excess Male Infant Mortality from Sudden Infant Death Syndrome and Other Respiratory Diseases X-linked?” Acta Paediatrica 103.2 (2013): 188-93. Academic Search Complete. Web. 10 Oct. 2016. ) Knowing that males are more likely to suffer from SIDS, it can be concluded that mothers should be extremely cautious with baby boys. One of the main reasons that people let these things happen to their infant is because the medical care they receive is not thorough enough with the discharge information. The Nebraska Medical Center’s information for new mothers gives new parents some steps to follow in order to keep their newborns safe, healthy and happy.

Nebraska Medical Center’s discharge information pamphlet about safe sleep for newborns states that the optimal position for safe sleep regarding newborns is laying face up on their backs. NMC also states that the baby should be sleeping in a firm mattress with a sheet that is fitted on all sides of the mattress, and that the crib is safety approved and up to regulation.  A link to a website where mothers can access information to understand the safety status of their crib is then provided. NMC’s pamphlet also lists some tips on checking if your crib is up to regulation, “There shouldn’t be more than a soda can’s width between bars.” is one tip that is provided for the mother to check out on her own. NMC also provides information about what items the mother should be putting in the crib with her baby, and what she should not. Sleeping with your newborn is discouraged, the baby is to have its own area to sleep with plenty of open space to prevent a blockage of it’s breathing passages. However it is stated, “Remove pillows, blankets, stuffed toys, bumper pads, and other soft objects from the crib. Don’t use devices to prop baby on side.” This pamphlet actually advises using things like a “blanket sleeper” instead of a real blanket, to avoid strangulation. But, the Methodist Women’s Hospital advises against using devices specifically advertised to prevent SIDS, which would include the “blanket sleeper”. The Methodist Women’s Hospital is in a stereotypically wealthier part of town than the Nebraska Medical Center and women being given information from Methodist may be better equipped to prevent SIDS then the mothers giving birth at the Med Center.  The Med Center does advise that the baby’s head should be kept cool while they sleep to avoid overheating, it tells mothers that the baby should not be sweaty and to check if they feel too warm after they have been laying down in their designated sleeping area. The med center includes that the baby should be nowhere near people smoking cigarettes while it sleeps.

According to discharge information from the Methodist Women’s Hospital on the West side of Omaha, SIDS is something that is heavily influenced by the environment the baby is sleeping in. The pamphlet states that the baby needs to be on a sturdy surface in order to prevent the crib collapsing in on the baby, instructing mothers to make sure to check the recall status on the crib. Aside from keeping the crib up to regulation, it is also stated that the baby should not be laid to sleep in an informal setting such as a couch, waterbed, adult bed, chairs, etc. This poses a risk for the newborn to fall and cause lethal damage to their fragile frames. The discharge information from “Safe Sleep and Your Baby”, the Methodist Women’s Hospital pamphlet, also states that putting objects in bed with the child is a hazardous move. New parents may not expect that their child’s cuddly teddy bear could kill them, but as the pamphlet states “ Pillows, quilts, comforters, sheepskins, bumper pads, and stuffed toys can lead your baby to suffocate. Note: Research has not shown us when it’s 100% safe to have these objects in the crib.” This information is vital and could prevent the loss of a child from SIDS.

Seeing how Bergan Mercy Medical Center and Creighton University Medical Center did not give any pamphlets or extra information regarding SIDS, West Omaha has more quantity and a higher quality of information regarding SIDS than North Omaha.

Pamphlets Beneficial to Mother Care

One of the biggest problems that mothers face after having a baby can be the stress that comes with it. As a result, hospitals have taken the time to provide literature to make the process as stress free as possible, some more than others. This make the process much easier for the mothers, mentally and intellectually.  CHI, for example, provides a pamphlet on the sacred hour and the nine stages of newborn behaviors as well as a sheet to be postpartum discharge medication program. The pamphlet explains that holding the baby, skin to skin, for an hour is very beneficial to the mother, the baby, and even the father.  Short term and long term benefits that the sacred hour provides for the baby include the ability to breathe easier, as well as maintain a normal heart rate and temperature rate. It also makes the baby more calm and cry less.  The sacred hour (skin to skin)  also helps the baby to obtain the ability to latch to the breast all by themselves.

The pamphlet also offers many benefits to the mother as well. It helps the mother and the baby get to know each other sooner, which helps support infant brain development as well. It also helps the mother to produce more relaxation hormones and helps with breastfeeding. It also helps to produce the mother’s breast milk supply. There are also benefits for the father too. Being able to hold the baby skin to skin, be part of the experience, and marvel at the abilities of their baby to name a few. Fathers being a part of the process are also very helpful to the mother sociologically.

The second part of the pamphlet that CHI provides explains the 8 instinctive behaviors of Newborns. Stage one is the birth cry which is helpful in the infant’s lung expanding. Stage two is relaxation which when there is no mouth movement and the infant’s hands are relaxed. Stage three is awakening which is when the infant shows small movements in the head and shoulders. Stage four is activity which is when the newborn begins to make increased mouthing and suckling movements and the baby opens their eyes and look at their mother. Stage five is resting which can happen at any time and is when the infant is skin to skin with the mother and the infant is covered with a blanket or towel. Next is stage six which is familiarization, this is when the infant becomes acquainted with their mother. The following stage is stage seven which is when the baby begins to breast feed. Stage eight follows and consists of the baby falling back to sleep on the mother.  This book is very informational. Knowing this information can be very helpful to the mother. It can be comforting to know what to expect and lower anxiety levels if you know the process and are sure of what stages the baby will go through.

The next piece of information that CHI offers is a medication discharge sheet. This gives the mother the opportunity to have all of her required medications with her when she leaves. These medications are in list of mild to moderate pain and provide what the appropriate dosage. It also provides other lists of medications that would be helpful to the mother.  These include medications for constipation, gas, Nausea, sleep, and hemorrhoid pain. Having a list such as this has been proven helpful because it is one less thing that the newly mother has to worry about. It also helps the mothers to understand the types of problems they may have as well as what to take to treat them.

Methodist Women’s Hospital provides a short and simple discharge plan. It helps with the mother’s well-being and infants care when leaving. This is called the S.M.A.R.T. discharge plan. The letter “S” stands for symptoms and validates that you know the signs and symptoms to report and call if there is a problem. The letter “M” stands for medications. This validates that you know what medications to take, their side effects, and the cost and location of where the prescriptions could be filled. The letter “A” is for appointments. It ensures that the mother’s have a doctor appointment set up and are able to attend in a timely manner and have transportation. The letter “R” stands for recommendations.  It ensures that the mother understands her discharge plan and that she know things such as diet, activity, incisional care and bathing. The last letter “T” stands for talking, as in having any questions or concerns the mother may have regarding the discharge.  The entire discharge plan is ensuring that the mother is confident in taking care of her newborn as well as taking care of herself.

The Nebraska Medical Center was by far the most informational when it comes to helpful information to the new mom. The first paper is a small pamphlet that is entitled “Mommy and Me” this is a breastfeeding and postpartum support group that meets to discuss many topics. These topics include the adjustment period, nursing in public, returning to work/pumping, baby washing and slings, and infant massage. Support groups are very helpful to a new mom because they can talk to other mothers who are feeling the same things, which can make them less anxious.  Reading information is helpful, but talking about it and figuring it out with other moms much more helpful. It helps the mother to feel like they are not alone in the process and gives them experience to talk about any problems they have regarding postpartum and breastfeeding and possible ways to fix the problem to make them more prepared for problems they may face. This can have very positive effects for the mother mentally.

The next piece of information given by the Medical Center is the nine instinctive stages. This is very similar to the eight instinctive stages found in the CHI book but is slightly more detailed. It also explains that the first hour of birth are developmentally distinct time for a baby and mother and there are well documented short and long term physical and psychological advantages when the baby is held skin to skin. This again helps the mother to be both mentally and intellectually prepared for the sacred hour.

The next piece given by the Medical center is a discharge prescription delivery service. This states that “upon your discharge, we will deliver new prescriptions medications to your room prior to leaving the hospital.” This is the most convenient piece thus far. This also explains hours, payment options, refill information, and whom to call if there are any questions. Having prescriptions at the ready for new mothers is not only convenient but time saving. It allows the mother to go straight home and spend more time with their newborn.

The next pamphlet given is about how to safely take care of your child. It explains many things such as, how to prevent abduction, how to keep the baby safer in a hospital, and even a safety checklist. Knowing the facts as well as some tips on prevention of unsafe events can help to ease a mother’s mind and help her to be more prepared.

Of the four hospitals, the Nebraska Medical Center is the most informational about information helping mothers mentally and intellectually. The second best would have to be CHI, third would be Methodist and fourth would be Creighton. Creighton received last because it does not offer any information on this topic. The information collected from different hospitals was conducted as figuring out what was most important to least. Conducting this information was useful in finding different themes for this paper. Shaken Baby Syndrome (SBS) is one of the key factors in infant mortality rate all around the world.

Brochures on Shaken Baby Syndrome

The information collected from different hospitals was conducted as figuring out what was most important to least. Conducting this information was useful in finding different themes for this paper. Shaken Baby Syndrome (SBS) is one of the key factors in infant mortality rate all around the world.

With the findings from each hospital, it was found that some hospitals didn’t give out a packet or brochure about Shaken Baby Syndrome. The following hospitals gave out packets of the same information: Methodists Women’s Hospital, CHI, and Nebraska Medical Center. The following hospitals didn’t give one out: Bergan Mercy and Creighton Medical Center.

Shaken Baby Syndrome is one leading cause of infant mortality all around the United States. From the brochures provided by Department of Health and Human Services of Nebraska (DHHS), Shaken Baby Syndrome is a result of vigorously shaking an infant or young child by the shoulders, arms, or legs. A single shaking episode usually results in bleeding in and around the brain leading to death or permanent brain damage. This is known as a type of child abuse. Infants and young children are more susceptible to Shaken Baby Syndrome because their heads are bigger in proportion to their bodies and their shoulders and neck muscles are weak and underdeveloped. Some side-effects from Shaken Baby Syndrome, if survived, are blindness, mental retardation, seizures, cerebral palsy, hearing loss, paralysis, broken bones, speech impediments, learning disabilities, and severe developmental delays. (DDHS Nebraska Brochure)

From the article “Abusive Head Trauma: Judicial Admissions Highlight Violent and Repetitive Shaking” says that Abusive head trauma is also known as Shaken Baby Syndrome. AHT is a significant cause of severe brain injury in infants, and a leading area of controversy is whether shaking alone is sufficient to cause the characteristic injuries associated with abusive head trauma. Violent shaking is thought to subject the infant’s head to acceleration-deceleration and rotational forces that create differential movement of the brain within the cranial compartment, which results in subdural, subarachnoid, and retinal hemorrhages often associated with hypoxic ischemic injury. Brain computed tomography, also known as a CT, is often the first examination to be used for patients with acute injury for demonstrating the subdural hematoma (SDH) also known as blood outside the brain that provides one of the diagnostic clues. (Abusive Head Trauma Article)

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Above is a CT image of a 6-month-old infant who was shaken several times per week for more than 2 months. Right lateral and interhemispheric hyperdense SDHs can be seen, as associated with a mild mass effect on the right. (Abusive Head Trauma Article)

 

Here above is another image of a CT of a 5-month-old infant who suffered multiple shakings over more than 1 month. Multifocal SDHs of different densities can be seen in separate locations. A, Lateral hypodensity (white arrows) associated with interhemispheric hyperdensity (black arrow); B, tentorium cerebelli hyperdensity (black arrow). (Abusive Head Trauma Article)

If there is a possibility that a baby has been shaken, 911/emergency services should be contacted. Here are some signs and symptoms of Shaken Baby Syndrome: irregular, difficult or stopped breathing, extreme crankiness, convulsions or seizures, tremors or shakiness, vomiting more than usual, lump arms and legs, no reaction to sounds or acts lifeless, and difficulty staying awake. (DHHS Nebraska Brochure)

In response to some parents is when the baby trying to communicate by crying is to shake the baby because the mother or father is upset and can’t figure out why the baby is crying. In this situation it is important to stay calm. No need to get upset because the mother or father may end up regretting what happens next. Some ideas to stop crying are checking for a dirty diaper or rash, try feeding the baby, burp the baby, check for increased temperature for illness, sooth signs or symptoms of teething, and facilitate sleepiness. If they baby doesn’t call down, take the baby into a quiet room, hold baby against the chest by rocking gently or walking, rub the baby’s back, take baby for a ride in a stroller or car, put baby into an infant swing, and check for anything that is discomforting the baby. If nothing seems to work, call for help. If the baby’s cry bothers the mother, the mother should lay the baby down on his or her back in a crib. Go to another room and get a timeout. Breathe in and out, call a friend or relative, exercise, listen to music, read a book, and ask the husband or wife to help you. But don’t forget to check on the baby every five to ten minutes to for the crying to lessen or stop completely. (DHHS Nebraska Brochure)

 

 

Books & Pamphlets Regarding Immunizations and

NewBorn Screenings

There are countless variables at play when talking about the health of a new baby, so the easiest ways to ensure an infant is born healthy and remains that way for years to come are health screenings and immunizations. Health screenings are so important to maintaining the health of a newborn that the same pamphlet, produced by the Nebraska Department of Health and Human Services (DHHS) entitled Parent’s Guide to your Baby’s Newborn Screening was provided by Creighton Medical Center (CHI Health), Methodist Hospital, and Nebraska Medical Center. According to this pamphlet, Newborn screenings are conducted “for every baby born in Nebraska.” The screening process “is as set of tests done to find certain conditions that can cause problems for [the] baby. [. . .] [It cannot be observed] by looking at the baby if they have any of these conditions. The [blood, hearing and heart tests] are needed to find them so that problems can be prevented or reduced” (1).

A breakdown of conditions that health screenings search for in an infant were also found within the DHHS pamphlet. The list of conditions in a standard health screen are as follows: Amino Acid Disorders, which prevent the baby from breaking down nutrients found in protein foods like milk, meats, eggs and cheese; Biotinidase deficiency, which can lead to seizures; Congenital Adrenal Hyperplasia, a hormone imbalance that can lead to sudden death; Congenital Primary Hypothyroidism, a deficiency of thyroid hormone that can lead to intellectual disability and poor growth; Cystic fibrosis, a genetic disorder that may cause coughing or wheezing, shortness of breath, and excessive appetite with poor growth; Fatty acid oxidation defects, which can lead to seizures, cardiac arrest, serious brain injuries and death; Galactosemia, which can lead to harm of the baby’s liver, eyes and brain and can be life-threatening; Hemoglobinopathies, making it more likely for the baby to have anemia, episodes of pain, strokes and life-threatening infections; Organic Acid Disorders, which leads to problems with the heart, muscles and some organs; and Severe Combined Immune Deficiency, which is a lack of a functioning immune system (3-6). All of these can ultimately lead to death if left untreated, so babies born without hospital or public intervention are at a much higher risk of death.

Health screenings are crucial to the health and survival of a baby. According to the Nebraska Child Death Review Report for Child Deaths Occurring kin 2010 and 2011, “Approximately one-third (29.8%) of all child deaths during 2010 and 2011 [in the state of Nebraska] were attributed to perinatal conditions, a category which combines maternal complications during pregnancy, and other conditions specific to pregnancy and the neonatal period” (Nebraska, 13). If not for health screenings, less perinatal conditions would be prevented, meaning that more deaths could potentially occur. The same report also concludes that the top three causes of childhood deaths in the state at large are 1) Pregnancy Related, 2) Birth Defects and 3) Sudden Unexpected Infant Death; further data contained in the report demonstrates that 26.9% (more than one quarter) of the child deaths in Nebraska in 2010 and 2011 appeared to be preventable.

Beyond the pregnancy, keeping the baby healthy after birth is crucial; one of the best ways to do this is through immunization. While health screenings are mandatory under law for all newborn babies, immunization is a choice left to the parents. CHI Health provided a pamphlet titled, What if… you don’t immunize your child? The two most relevant statements in the pamphlet are “Your child will be left at risk of catching the disease,” and “Your child will be an infectious disease threat to others,” referring to the consequences of not immunizing a child. The pamphlet goes over the consequences of Influenza, Pertussis (whooping cough), and Measles; as these are all diseases preventable by vaccination, but also quite dangerous for infants if subjected. Further, this pamphlet discusses the impacts on other children if one child is not immunized, saying “Unvaccinated children can pass diseases on to babies who are too young to be fully immunized.” Further, “[u]nvaccinated children can infect the small percentage of children who do not mount an immune response to vaccination.

Another pamphlet, simply titled, Immunizations and your New Baby, discusses different diseases children should be immunized against, and expands by speaking to the safety of vaccinations. To the safety question, “Vaccines are among the most effective of all medications. [. . .] It is generally agreed that risks from the vaccines are far less than the risks faced if the child becomes ill.” This pamphlet also speaks to how much more likely disease and death were before vaccines were developed; “Before vaccines were available, parents lived with the constant fear that their children would be among the thousands who were left disabled or dead by common childhood diseases such as polio, measles, or pertussis.”

Referencing back to the Nebraska Child Death Review Report, it demonstrated that infants “accounted for 60% of all child deaths, and approximately 2/3 of infants died within the first month (10). Further, birth defects and sudden unexpected infant deaths were the most common categories of infant mortality, accounting for 28.3% and 9.5% of all child deaths respectively (13). The report demonstrates that early detection of of birth defects and susceptibilities to diseases are key to health maintenance and prevention of death.

In an analysis of the material contained in each “New Mother Packet” obtained, Creighton Medical Center provided the least amount of information overall, but almost all of the pamphlets contained in the Creighton folder were related to health screenings and immunizations. Knowing this, it can be inferred that the educational focus of medical institutions serving lower-income areas is less on the overall well-being of the infant, and focuses primarily on survival and initial health.

Conclusion

In conclusion, it was found that the Methodist Women’s Hospital in West Omaha provided the most information, and provided a wide variety of information which therefore helps in reducing the risk of infant mortality. Further, Nebraska Medical Center provided less information than Methodist Women’s Hospital, but more than CHI/Creighton, University Medical Center, and Bergan Mercy Medical Center. CHI provided the smallest amount of information, and the provided information was focused in on only a couple of areas. Aligning with these findings, our sourcework directed that the highest rates of infant mortality occur in North Omaha. Whether the information provided by hospitals in different areas of the city is the cause or the effect of the disparities in infant mortality in each area is unclear; however, we can definitively conclude that the rates of infant mortality in each segment of the population do differ.

 

 

 

 

Work Cited

 

Adamsbaum, C., S. Grabar, N. Mejean, and C. Rey-Salmon. “Abusive Head Trauma: Judicial Admissions Highlight Violent and Repetitive Shaking.” Pediatrics 126.3 (2010): 546-55. Web.

 

A New Beginning, Your Guide to Postpartum Care, Methodist

Understanding Mother & Baby Care, A Guide to the First Days & Weeks, Nebraska Medical Center

 

Baby News, Caring for Yourself and Your Newborn, Catholic Health Initiatives

 

California Department of Public Health. What if… You don’t immunize your child? Immunization Action Coalition, 2011. Print

 

Discharge Prescription Delivery Service, Nebraska Medical Center

 

Douglas County Health Department. “Infant Mortality.” Infant Mortality (2015): n. pag. Douglas County Health Department. 18 Aug. 2015. Web. 11 Nov. 2016.

 

Helping to Protect Your Baby; A parent’s guide to infant safety, Nebraska Medical Center

Immunizations and Your New Baby. Lincoln, NE: Nebraska Department of Health and Human Services, 2012. Print.

 

Mommy AND Me; Breastfeeding and Postpartum support group, Nebraska Medical Center

 

My S.M.A.R.T. Discharge Plan, Women’s Methodist

 

“Nebraska Child Death Review Report.” (2015): n. pag. Department of Health and Human Services. Nebraska Child Death Review Team, Nov. 2015. Web. Oct. 2016.

 

“Never Shake a Baby”-DHHS Nebraska (CHI, Methodists, UNMC)

 

“Infant Mortality” (2015) Nebraska Department of Health and Human Services. Nebraska Child Death Review Team.

 

Parent’s Guide to your Baby’s Newborn Screening. N.p.: Nebraska Department of Health and Human Services, Oct. 2014. Print

 

Postpartum Medications, CHI Health

 

The First Hour After Birth: A Baby’s 9 Instinctive Stages, Nebraska Medical Center

 

The Sacred Hour, CHI Health