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Children's Health

NC Infant Mortality Up, But Fewer Sudden Infant Deaths

The state’s infant mortality rate crept up last year. Infant mortality data is often seen as a indicator of the overall health of a population.

By Rose Hoban

North Carolina’s infant mortality rate crept upward last year, reversing a trend of decreases that had placed the state’s infant mortality rate at an all-time low in 2010.

Last year’s overall rate of 7.2 deaths per 1,000 live births was a tick up from 7.0 deaths per 1,000 in 2010, a 2.9 percent increase. North Carolina’s infant mortality rate continues to leave the state in the bottom of national rankings.

“We still have a lot of work to do, particularly with improving some of the disparities that the numbers bear out,” said state health director Laura Gerald, a pediatrician.

Babies born to African Americans continue to die in infancy at more than twice rate than whites or Latinos (see chart), and babies born in the Eastern part of the state continue to have a higher rate of deaths than those born in other parts of the state.

Last year, a total of 866 infants died in North Carolina out of a total more than 120,403 births in the state, the number of births has been decreasing for the past four years. The rate is calculated by comparing the number of deaths of children younger than one-year-old to the number of live births in the state in a given year, and the rate is calculated per-thousand children born.

2011 NC Infant Mortality Rates (source: State Center for Health Statistics)
Total Rate White African American Hispanic Other* Ethnicity
2009 7.9 5.5 15.8 5.7 4.7
2010 7.0 5.3 12.7 5.0 5.2
2011 7.2 5.5 12.9 5.4 5.2
*includes Native American

SIDS deaths drop

Included in the infant mortality statistics is a decrease in deaths classified as being caused by Sudden Infant Death Syndrome (SIDS).

“This is not the only state that’s seeing a decrease in the numbers (of SIDS cases),” N.C. Chief Medical Examiner Dr. Debi Radish told a meeting of the legislative Child Fatality Task Force Monday morning. “We are paying more attention to the scene, the sleep environment when we examine a death. And when we do that, we don’t classify cases as SIDS now that might have been classified as SIDS ten years ago.”

Radish later explained that in many cases, an investigation by medical examiners finds that babies who died were actually smothered “either in an unsafe bed or sleeping surface or overlying by a parent, or sometimes even a sibling.  so those deaths would look the same at autopsy as SIDS.”

2011 County-level infant mortality rates. Map courtesy NC State Center for Health Statistics

2011 County-level infant mortality rates. Map courtesy NC State Center for Health Statistics

Sleeping with too many pillows, or a heavy comforter, or sleeping on a couch and getting caught in the cushions are some of the situations that are considered “unsafe sleep” for infants, Radish explained. Unsafe sleeping also includes sleeping with another person who rolls over onto the baby.

Radish also attributed some of the drop in SIDS rates to the recent “Back to Sleep” campaign, where parents are encouraged to lay their babies in their backs to sleep, a position that has been found to reduce deaths from SIDS.

“Thirty years ago, when I was training, you never put (babies) on their backs to sleep,” Radish said. “But we’ve learned a lot. When I was training, the teaching was that you couldn’t suffocate in bedclothes. We know better now.”

New birth certificates, more information

For the first time, health officials were able to get more information about mothers giving birth last year because North Carolina rolled out a new birth certificate form, put in place in August 2010.

The new form includes information such as the height and weight of mothers before they got pregnant, their educational level, whether they smoked during their pregnancies and when their prenatal care began.

“We can calculate BMI (Body Mass Index) now from the birth certificates,” said Avery. “What we try to do with these infant deaths is take that death certificate and link it back to the birth certificate, so we can see going forward now, the infants who died, the maternal condition of the mother if they were overweight or obese.”

The 2011 data show about half of women who gave birth were overweight or obese.

“It sounds like you’re getting the kind of data that might eventually be able to see some linkage or not see some a linkage to BMI,” said task force chair Karen McLeod.

Others cautioned against drawing too much from the obesity numbers.

“Rates of overweight and obesity are higher among minorities, but the relationship (with infant mortality) is not necessarily cause and effect,” said Wake County human services medical director Peter Morris, a pediatrician.

Other information from the birth certificates show about 11 percent of women smoked during pregnancy, but many more reported stopping while they were pregnant, and then starting up again after their babies are born.

“Some of our data is that women are getting the message that they should quit during pregnancy, but about half of them go back to smoking when they go home,” said state tobacco prevention branch head Sally Herndon.

“You can’t leave a baby to go smoke and you should be smoking outside,” Herndon said. “It’s not effective to just to step out of the infant’s room to go into the kitchen to smoke because the smoke tends to recirculate through the whole house.”

Herndon said after last year’s budget cuts, little money is left for tobacco prevention targeted at pregnant women.

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