Kansas panel discusses infant mortality rates

One out of every nine black babies born in Kansas will die as an infant.

Linda Kenney, director of the Kansas Department of Health and Environment’s Bureau of Family Health, shared this statistic with members of the Governor’s Child Health Advisory Committee and the Kansas Blue Ribbon Panel on Infant Mortality during a joint session Sept. 18.

Kenney said the black infant mortality rate in Kansas is 2.2 to 2.8 times higher than the white infant mortality rate.

“Infant mortality disproportionately affects certain populations in Kansas,” Kenney said. “Infant mortality is an indicator of the health and well-being of a population….With an economic downturn you can expect to see some problems with infant mortality.”

The Kansas Blue Ribbon Panel on Infant Mortality formed to explore the issue and brainstorm ways to reduce the state’s infant mortality rate.

Kansas’ 2007 infant mortality rate was 7.94 infant deaths to every 1,000 live births. The national infant mortality rate in 2007 was 6.77; in Missouri the rate was 7.5.

A recent Annie E. Casey report states that Kansas ranks 29th among states in infant mortality rates.

School nurse Mary Ann Shorman, RN, BSN, serves on the Governor’s Child Health Advisory Committee. Shorman works in the Hays School District. She said the state’s infant mortality rate became a concern among Child Health Advisory Committee members.

“It was something that the committee felt was really important to look at, and that’s how (the Blue Ribbon Panel) got started,” she said.

The panel seeks to lower the infant mortality rate, but members acknowledge that is a multi-faceted issue.

Congenital abnormalities caused about 20 percent of infant deaths in Kansas in 2007. About 18 percent of infant deaths that year were due to short gestation and low birth rates; 15 percent were attributed to Sudden Infant Death Syndrome; 10 percent were caused by complications of pregnancy; and 37 percent are attributed to other, unspecified reasons.

“I would hope that we could gather information and maybe more specifically narrow down what it is that we would want to target,” Shorman said.

Committee members agree that education needs to be part of the solution.

“There’s a lot of ways to deliver education,” Kenney said.

Programs that involve nurse home visits are one way Kenney suggests educating new parents. These programs teach parents about pre- and post-natal care and can provide information to help lower risk factors for future pregnancies.

John Evans, MD, an obstetrician and gynecologist in Topeka, said many of his at-risk patients have multiple children.

Committee member Diane Dalrup, March of Dimes director of program services, said she would like to see the Blue Ribbon Panel support a family spacing waiver that would allow low-income new mothers a six-month to two-year Medicaid waiver. She said this would enable women to receive follow-up care after child birth.

According to the National Academy for State Health Policy, 26 states have these waivers for mothers who would not otherwise qualify for Medicaid. The federal government provides a 90 percent match to states that provide this service.

“The key word here is comprehensive,” Dalrup said. “We’ve all done little bits for long enough and we know they don’t have long-term impacts.”

Makeba Williams, MD, an obstetrician and gynecologist at the University of Kansas Medical Center, said she sees women who fall through the cracks after child birth.

“They are lost,” Williams said.

Williams told the story of one patient who came to her a year ago, 35 weeks pregnant. The patient had not had any prenatal care.

This patient did not come to follow-up visits after her pregnancy and is now pregnant again with her fifth child. This time the woman waited until 25 weeks to seek prenatal care.

“This is just a recurring thing without continuity of care,” Williams said.

Evans said care during the early stages of pregnancy can help curb infant mortality. He recommends that women make an appointment with their physicians early in their pregnancy to get an accurate date for how far along the pregnancy is.

“Dating in pregnancy is really critical,” Evans said. “Most physician offices, at least in our area, don’t want to see the patient until they are 12 or 13 weeks along. ... We are really trying to rattle the tree and see if we can improve that.”

Wichita neonatologist Barry Bloom, MD, suggests the panel focus its efforts on premature births.

“Our premature rate continues to go up just like around the country and that doesn’t seem to be our target,” Bloom said. “We know there will be a benefit if we reduce prematurity.”

Bloom said the amount of premature infants born in Kansas has increased by 50 percent in the last 20 years.

In 2006, 16.5 percent of black infants born in Kansas were premature births. That same year, 11.6 percent of all white infants, 11.6 of all Hispanic infants and 10.6 of all Asian infants were premature.

“This is an epidemic,” Bloom said.

The Kansas Blue Ribbon Panel on Infant Mortality plans to meet again in October to discuss what items they want to focus on and what recommendations they plan to make.

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