Local health officials are ramping up efforts to address an alarming number of Bartholomew County infant deaths, which have increased to the highest level since 2011 and might go up further after state officials release updated statistics early next year.
Despite focusing on prevention efforts in 2019, Columbus Regional Health officials are still grappling with many of the complex issues surrounding infant mortality, which refers to the death of a baby less than 1 year of age.
Last year’s efforts included continuing to build partnerships with a number of community organizations and county and state offices, including the Bartholomew County Coroner’s Office and Coroner Clayton Nolting.
Last year, eight infants died before their first birthday within Bartholomew County, compared to four infant deaths in 2018, according to the Bartholomew County Health Department. The department only tracks deaths that occurred within the county and statistics may not reflect the infants’ county of residence.
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A total of 52 infants deaths were recorded within Bartholomew County from 2009 to 2019, including nine in 2011, according to county records.
Data from the Indiana State Department of Health shows that 165 infants who resided in Bartholomew County died before turning 1 year old between 1999 and 2017 — or roughly equivalent to half the current student body at Rockcreek Elementary School.
By comparison, state health department figures show that Monroe County saw 15 fewer infant deaths than Bartholomew County over the same time period, despite Monroe County having nearly 4,500 more births.
The Indiana State Department of Health records infant deaths by the county in which the infant resided at the time of death, which is not necessarily the county in which the infant died, state health officials said.
For example, the state would classify an infant who lived in Bartholomew County but died at a hospital in Marion County as a Bartholomew County death. ISDH spokeswoman Greta Sanderson said she expects 2018 county-level infant death statistics to be released next month.
The causes of infant deaths in Bartholomew County last year included issues related to premature birth or preterm labor, one case of methadone intoxication and rulings of a sudden unexpected infant death (SUID), among others, according to county records. A baby is considered premature if born prior to the 37th week of gestation.
Additionally, the number of deaths attributed to unsafe sleep environments last year increased to three, compared to one in 2018, Healthy Communities officials said.
Nolting said many infant deaths in Bartholomew County are preventable — including all five of the coroner cases he had last year that involved an infant death.
“All of the (infant) deaths I was involved in last year were completely preventable, and that is what really gets me,” he said.
Nolting, who sits on the Bartholomew County Fetal Infant Mortality Review Team and is a Columbus police officer, said infant mortality is “a huge issue for Bartholomew County.” Nolting said more educational outreach, including combating the “taboo” and “unnecessary stigma” surrounding the subject, is needed.
“The committees I sit on, they are constantly racking their brain for how we can improve education, how we can improve outreach, how they can go out in the community and give out free cribs, give out safe sleep pamphlets,” he said. “It’s a conversation nobody likes to have, but we need to have it and discuss it,” he said.
‘Disappointing’ numbers
For officials at Healthy Communities and Columbus Regional Hospital, the number of infant deaths in the county last year was described as “disappointing,” especially given what they said were “amplified” efforts to address infant mortality.
Those efforts included educational outreach programs, training first responders on safe sleep environments, a Nurse-Family Partnership Program that brings nurses into a one-on-one coaching relationship with new mothers in their first pregnancy, as well as other initiatives.
“We’ve been doing a lot of work on (infant mortality), so it’s very disappointing that we’ve amplified our efforts and our number went up,” said Chris Newkirk, CRH clinical quality adviser.
Last year, Healthy Communities formed its Infant Mortality Prevention Action Team that includes more than 50 members from community organizations, including police and fire departments, local physicians, nurses, social workers, higher education, social service agencies, among others.
In 2018, CRH started a Fetal Infant Mortality Review Team, which reviews every case of infant death in Bartholomew County. The local review team was one of the first such teams in Indiana.
Last year, officials at Healthy Communities set out priority areas to address infant mortality, including promoting safe sleep environments, preconception care and decreasing premature births, said Patty Pigman, co-coordinator of the Infant Mortality Prevention Action Team at Healthy Communities.
“Education is important, but the thing that we’re really trying to get to is behavior change and what’s hard is helping moms quit smoking, helping people understand that early prenatal care is important and then behavior changes around safe sleep,” she said. “…It’s just kind of helping people be set up to make the healthiest choices for themselves and their babies.”
The priority areas were determined after officials at Healthy Communities reviewed all safe sleep deaths in Bartholomew County from 2015 to 2017 and looked for common elements that could have prevented many of those deaths, Pigman said.
“Not that those would have prevented all of those deaths, but it probably would have taken a chunk out,” she said.
Not all causes of infant death are preventable — Indiana as a whole tends to fare poorly in many measures of public health and social determinants considered risk factors for infant mortality, including smoking during pregnancy, obesity, diabetes, child poverty, lack of prenatal care, among others.
In 2017, the infant mortality rate in Indiana was 7.3 per 1,000 live births — seventh highest in the country. Last month, state health officials announced that Indiana’s infant mortality rate decreased to 6.8 deaths per 1,000 live births in 2018 — the largest one-year drop in six years.
In 2019, 17.4% of women who gave birth at CRH reported smoking during their pregnancy, said Kylee Jones, tobacco awareness coordinator at Healthy Communities.
Additionally, nearly 29% of pregnant women in Bartholomew County did not receive prenatal care during the first trimester in 2017, the latest year data is available, compared to the national average of around 23%, according to figures provided by CRH.
This year, officials at Healthy Communities plan to continue focusing on the same priority areas and expand tobacco cessation efforts, educational outreach and other programs, including a postpartum mood disorder support group, increasing postpartum mood disorder testing for mothers when they take their baby to a pediatrician and a free prenatal class for expectant fathers called Daddy 101. That program covers the role of being a father, car seat safety, safe sleep, and helping identify if the baby’s mother might be suffering from postpartum mood disorder, among other issues, Pigman said.
Officials at Healthy Communities said while they have not detected an association between postpartum mood disorder and infant mortality in Bartholomew County, the disorder, as well as other mental health issues, are often linked to physical health issues and are important areas of maternal and child health to focus on.
When asked about the biggest challenge the action team has faced over the past year, Pigman said, “The number is up.”
But that number could go up further once state health officials release data that includes the number of Bartholomew County infants who reportedly died in other counties, she said.
“Unfortunately, we anticipate 2019 will be high again,” Pigman said.
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There are about 3,500 sleep-related deaths among babies in the United States each year, according to the federal Centers for Disease Control.
To reduce the risk of sleep-related infant deaths, the CDC recommend placing the baby on his or her back for all sleep times, using a firm sleep surface such as a safety-approved crib and having the baby share a room with his or her caregivers, but not a bed.
Other organizations refer to these or similar recommendations as the "ABC’s of safe sleep" — alone, back and crib.
Additionally, the CDC recommends parents refrain from placing soft bedding such as blankets, pillows, bumper pads or soft toys in the baby’s sleeping area.
Visit cdc.gov/vitalsigns/safesleep or pathways.org/abcs-of-safe-sleep for more information.
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Smoking during pregnancy exposes the mother and baby to a wide range of harmful chemicals that limit the supply of oxygen and delivery of nutrients to the baby, according to the Mayo Clinic. One chemical in particular, nicotine, has been shown to permanently damage a baby’s brain and lungs.
Smoking during pregnancy is associated with a wide range of health problems for the baby — including premature birth, low birth weight, certain birth defects, miscarriage, preterm premature rupture of the amniotic sac and several other issues.
After birth, babies born to mothers who smoked during pregnancy are at an increased risk of sudden infant death syndrome (SIDS), asthma, childhood obesity, among other problems.
Additionally, pregnant women who are exposed to secondhand smoke are at an increased risk of pregnancy loss, SIDS, low birth weight, certain birth defects, asthma attacks, ear infections and more.
Visit quitnowindiana.com/quit or call 1-800-QUIT NOW to contact the Indiana Tobacco Quitline.
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For more information about infant mortality in Bartholomew County and those working to lower the numbers, visit:
crh.org/community-foundation/healthy-communities/infant-mortality-prevention-team
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