CLEVELAND, Ohio — In the first three months of this year, Cuyahoga County’s infant mortality rate showed a troubling and dramatic rise, driven largely by a jump in the number of extremely preterm infants born who are unlikely to survive, according to statistics released at a quarterly meeting of city-county infant mortality initiative First Year Cleveland.
The overall infant mortality rate, defined as the number of live-born infants who die before reaching a first birthday per 1,000 live births, was 8.43 last year and rose to 10.1 the first quarter of this year. Despite a slight increase in the county’s infant mortality rate from 2017 to 2018, the rate has decreased significantly since 2015.
The biggest driver of infant death in the region continues to be prematurity and preterm births, followed by birth defects and sleep-related deaths. In the first quarter of 2019, 21 babies born before 22 weeks gestation were born in the county. Eighteen of those babies were black. In all of 2018, only 49 babies were born this premature.
“That’s a huge jump from what we’ve seen previously,” said Richard Stacklin, data analyst with the Cuyahoga County Board of Health, which has been gathering and analyzing the county’s infant death data each month in an effort to better track trends and target improvement efforts.
Gestation is typically 39 to 41 weeks, and 22 weeks is considered the lower threshold of viability. In Ohio, any baby born alive who dies, regardless of his or her chance of survival, is counted in infant mortality statistics.
There have been more births in the county at this extremely preterm stage over the past year, said Stacklin, particularly among black women. Because babies born this early have a low chance of survival, it’s likely that the vast majority of these births will end up being part of the county’s total infant deaths for the year.
Bernadette Kerrigan, First Year Cleveland’s executive director, noted that if the current trend holds for the year, there will be more deaths due to extreme prematurity than in any recent year. In 2018, when there were 117 infant deaths in the county, there were 44 among babies born before 22 weeks gestation. “It is very alarming that we’re only through March and are at 21 extreme premature deaths,” Kerrigan said. “We have to do business differently.”
Kerrigan and Stacklin did not speculate as to the causes of the increase in very preterm births, and asked the meeting’s attendees to talk with doctors, women and community health workers to try and figure out a reason.
Bright spots in the infant mortality figures included no Hispanic infant deaths in the first quarter of 2019 (deaths were rising in this group last year), and 12 fewer infant deaths among black babies in 2018.
Other FYC updates:
The First Year Cleveland website, firstyearcleveland.org, is getting a revamp and is scheduled to relaunch in late spring of this year. The site will include updated infant mortality statistics for the county as they’re compiled each month by the Cuyahoga County Board of Health.
Prize winners for last year’s “Battle For our Babies” infant mortality technology challenge include a team from Ohio State University that used the Alexa-based voice activation system to provide stress management support to mothers; a team of STEM students from Rochester University who came up with a football-themed app to help fathers take a more active role in the lives of their children; and an app created by a team at Northeastern University that simulates the role of a community health worker in screening women for and resolving health risks before conception.
The FYC action team in charge of spreading the safe sleep message is planning to host a “safe sleep cooking and conversation challenge” this summer. Community members will be asked to bring their best savory or sweet dish for judging to one of four participating restaurant locations. While eating, they will learn about safe sleep and be encouraged to spread the message of the “ABCs”-- babies should sleep alone, on their backs, in a crib. Winning cooks at each restaurant will be invited to present their dishes for a final event at Zanzibar Soul Fusion sometime in August.
A research team involving Kent State University psychology professor Angela Neal-Barnett and East Side doula group Birthing Beautiful Communities has gathered hair samples from more than 50 black women enrolled in a study to test their levels of the stress hormone cortisol during pregnancy. The team’s research, funded by the Ohio Commission on Minority Health, Sisters of Charity Foundation of Cleveland and Mt. Sinai Health Care Foundation, also examines the impact of group-based emotional and psychological support during pregnancy for black women.
FYC Policy and Engagement Committee members are keeping their eye on four infant mortality-related elements of Gov. Mike DeWine’s new Children’s Initiatives office, said committee co-chair Marcia Egbert, the Gund Foundation’s senior program officer for human services. These are:
An additional $47 million in the state budget to pay for expansion and enhancement of home visiting services, which involve either community health workers, nurses or social workers paying visits to mothers during pregnancy and up to two years after the birth of a child;
Continued investment of $2.9 million for nine counties hardest hit by infant mortality through the Ohio Department of Health’s Ohio Equity Institute;
Plans by the Ohio Department of Medicaid to apply this year to the Centers for Medicare & Medicaid Services (CMS) for a waiver that would, in part, allow the state to expand and improve its substance abuse disorder treatment for women with infant children. The waiver would include programs that allow for the care of women with opioid use disorder and their babies with neonatal abstinence syndrome in the same place. The waiver would also request approval to expand eligibility for continuous Medicaid coverage for pregnant women from two months post-delivery to a full year;
Improvements to the pregnancy risk assessment form (PRAF) used to screen mothers on Medicaid for their risk of poor birth outcomes such as low-birthweight babies, preterm birth and infant mortality. The forms are currently sent by hospital systems to Medicaid and the state’s Medicaid managed care organizations. The revamp proposes requiring all obstetricians to complete and submit the form electronically within seven days, as well as looking at ways to better use the information gathered to get high-risk pregnant women into available programs to improve the health of mothers and babies in the state.
This story has been updated to clarify incorrect information provided by First Year Cleveland. During the first quarter of the year, 21 infants were born extremely premature, at less than 22 weeks gestation, according to birth records. While it is not yet clear how many of these infants survived, it is likely that the vast majority did not. Incorrect information provided by the Ohio Governor’s office has also been corrected: Ohio Equity Institute counties receive $2.9 million per year.