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Infant Toddler Development Training
Module 6, Lesson 1

Infant Morbidity and Mortality

Major indicators of overall health in a population are the rates of infant mortality and morbidity. The rates of mortality and morbidity are measures that are gathered and published as vital statistics. The American Academy of Pediatrics has published these statistics in children since the 1950's. Health goals are often set based on statistics related to these two indicators of children's well being or the lack thereof. Healthy People 2010 is the most recent health initiative that lists objectives for health planning and goals. A major goal of this initiative is to reduce mortality and morbidity in infants.

US Infant mortality rates published by the American Academy of Pediatrics (2003) show a decreasing trend in mortality:

Year IMR Comments
1900 150/1000 Infections, poor hygiene
1914 100/1000 (10 %) Pre-antibiotics
1936 57.1/1000 Some antibiotics
1950 29.2/1000 New technology, more premature infants living, increased morbidity
1957 26.1/1000 Widespread use of penicillin, sulfa, streptomycin
1980 12.6/1000 Prematurity the leading cause of death at 50 - 60% Congenital anomalies at 20 - 25% Stillbirths at 10%
1990 9.2/1000 Teen birth rate dropping for the 15 - 19 age group
1995 - present 6.9/1000 Disparity of different populations Teen birth rate dropping for the 15 - 19 age group

*Infant Mortality Rate (IMR) is the number of deaths in comparison to live births.

The most recent vital statistics are reported in the Morbidity and Mortality Weekly Report (MMWR) that is published by the Centers for Disease Control Figures are based on the 2000 census data. There is a trend over the past decade that documents a decline in the birth rate in the United States that is now 13.9 births in 1000 women of childbearing age. This rate results in a positive population balance. There has been some decline in the number of births to teen-age mothers.

Infant mortality in the United States is stable at 6.9/1000 infants. There continues to be disparity between cultural groups with higher mortality figures for the African American and Hispanic populations. Figures can be found at Centers for Disease Control Florida's vital statistics and information on health issues may be found at Florida Department of Health or the expanded link to the vital statistics information for Florida at Florida Department of Health Vital Statistics.

Common Causes of Infant Morbidity and Mortality

baby frowningExamples of morbidity include respiratory conditions, impairments of speech or intelligence, nervous or mental health conditions, nonparalytic orthopedic conditions, diseases of the eyes or ears, and congenital anomalies. These conditions put an infant or toddler at higher risk for chronic disabilities or even death. The following are common causes of morbidity and mortality.

Congenital Anomalies are conditions that are present at birth that manifest in a structural defect. These include those that are visible such as a cleft lip or imperforate anus and those that are not visible to the naked eye such as the absence of the corpus callosum of the brain.

Neonatal Infections include bacterial sepsis, and viral infections in newborns. These infections affect infant morbidity and mortality. They have continued to be one of the leading causes of infant mortality for the last twenty years. Antibiotics may sometimes treat bacterial infections, but the immature immune status of the neonate makes it very susceptible to overwhelming infection.

  • Bacterial sepsis is a significant cause of morbidity. The early onset of a group B strep infection causes pneumonia, sepsis, meningitis, persistent pulmonary hypertension of the newborn, and hypoperfusion and can result in organ damage and death. The same issues can occur with other bacterial infections and cause similar sequelae in older children.
  • baby sleepingViral infections can infect the mother in any trimester and cause a variety of sequelae to the newborn. Examples include rubella, measles (rubeola), varicella, herpes simplex, cytomegalovirus, and parvoviruses. Though there are characteristic findings for each virus, all incidences in the first trimester can cause miscarriage; all in the second trimester can cause growth issues and many cause sensory organ damage. Some infants when infected during the birth process to cytomegalovirus (CMV) may not show immediate problems, but may develop problems such as progressive hearing loss. Their hearing loss may be manifested over several years making detection and follow-up crucial.
  • Neonatal exposure to sexually transmitted diseases may cause problems for the newborn. Examples include syphilis, chlamydia, gonorrhea, and human immunodeficiency virus (HIV). All may result in significant morbidity and mortality.
  • Diseases due to parasites, though more common in children from third world countries, contribute slightly to the morbidity and mortality in infants. The major exception of a parasite in the United States that can have a devastating affect on the infant is toxoplasmosis. The pregnant woman may become infected primarily through touching anything that has come into contact with contaminated cat feces. Pregnant women are advised NOT to change litter boxes. However, they may reduce the risk of infection with good hand washing and wearing gloves if they do change litter boxes, dig in garden soil or handle raw meat

Low Birth Weight (LBW), <2500 grams, and especially very low birth weight (VLBW), <1500 grams, contribute to the causes of morbidity and mortality. Although the gestational age of viability and survival has dropped over the years, technology does not ensure complete well-being. Premature births, particularly for infants of very young gestational age, still contribute to significant morbidity.

Sudden Infant Death Syndrome (SIDS) is a cause of death for both neonates (first 30 days of life) and also for infants. The cause is unknown, but there are measures such as putting babies to sleep on their back that have been shown to reduce the incidence.

Substance Exposed Newborns (SEN) are also at higher risk for morbidity and mortality. A mother's use of tobacco, ethanol (alcohol), cocaine, or other illegal drug can have a significant affect on the baby because they harm the integrity of the placenta. The infant may suffer withdrawal, be smaller for gestational age, and have less fat reserves. They may be at risk for hypertension, diabetes, and later learning and behavioral problems. There are also prescription drugs that contribute to the overall numbers of infant mortality or morbidity and can negatively affect the baby.

baby cryingMetabolic Abnormalities contribute to the IMR. For example, hyperbilirubinemia (high bilirubin levels) if untreated may result in a condition known as kernicterus (bilirubin in the brain) and can lead to seizures, intracranial hemorrhage, death, and if the infant survives, can cause mental retardation. While there are treatments for high bilirubin levels there are still casualties. Children who have hyperbilirubinemia are also at risk for hearing loss. Another common metabolic condition seen in the NICU is hypoglycemia (low blood sugar) which can lead to seizures and brain injury if severe or prolonged.

Seizures are a sign of brain dysfunction and have a variety of causes including hypoglycemia (low blood sugar), hyponatremia (low sodium concentration), hypocalcemia (low calcium), hyperbilirubinemia, hypoxic-ischemic encephalopathy (HIE), infections (meningitis and encephalitis are examples of inflammation of the membrane coverings surrounding the brain), trauma, malformations, and intracranial hemorrhage. Seizures in the newborn period are often not full-blown and their symptoms may be subtle. However, the seizures can be generalized as well as partially complex, or focal in distribution.

Injuries from falls, vehicle crashes and pedestrian accidents account for approximately 3.3% of deaths in young children, including toddlers. Drowning is also a significant safety factor for infants and toddlers. The ITDS should be alert to preventive measures such as never leaving a child unattended at bath time or around open water buckets, open toilet bowls or bodies of water.

 

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