Tiny babies big hopes

One out of every 100 infants born each year in Mississippi dies before his or her first birthday.

Could the solution be as simple as providing primary care and social support to mothers?

Sponsors of a new program launching this month plan to find out.

The Interpregnancy Care Project of Mississippi is a combined effort between University of Mississippi Health Care, the Mississippi State Department of Health and the World Health Organization’s Collaborative Center for Reproductive Health. ICPM addresses one of the leading causes of infant mortality in the state: very low birth weight – less than 3.3 pounds.

In 2007, only a small percentage of women – between 2 to 4 percent – delivered very low birth weight babies in Mississippi. However, these births accounted for 51.2 percent of the infant deaths in the state.

Recent research findings suggest that problems such as low birth weight deliveries are more common among mothers in poor health with little or no access to primary health care. The program targets this group of high-risk mothers.

“By working with these women, we have the ability to make a profound impact on the infant mortality rates in Mississippi,” said Juanita Graham, health services chief nurse for the Mississippi State Department of Health. “Generally speaking, healthier mothers have healthier babies.”

ICPM is modeled after a 2006 pilot program at Grady Memorial Hospital in Atlanta, Ga. Both programs are rooted in the premise that providing high-risk mothers with continuous primary care and social support will decrease the occurrences of very low birth weight among participants.

The Georgia program, under the guidance of Dr. Alfred Brann, professor of pediatrics at Emory University, was successful in lowering negative outcomes, such as very low birth weight, in subsequent births.

The benefits of ICPM, if successful, are two-fold. Aside from easing the emotional cost of very low birth weight deliveries that may cause suffering and possible death of a child, the highly specialized care for these tiny babies is very costly and may not prevent even costlier long-term health problems.

The cost of maintaining the health of these infants is “an expensive rescue mission,” according to Dr. Glen Graves, professor of pediatrics at the University of Mississippi Medical Center and principal investigator for the ICPM. “If we can prevent just one very low birth weight delivery, we can literally save hundreds of thousands of dollars.”

Brann and his colleagues in Georgia determined that the cost for one woman enrolled in the two-year program was just over $4,000. ICPM has the same potential to be highly cost-effective.

Because the best predictor of a very low birth weight delivery is a prior one, the ICPM identifies high-risk mothers after they have delivered a very low birth weight baby. In addition, the program targets African-American women because across the nation, very low birth weight deliveries occur twice as often among African-Americans as they do among Caucasians.

ICPM will work with two groups of mothers: one group from metropolitan Jackson and another group from an 18-county area of the Delta. The Delta Health Alliance is funding the Delta component of the program, while MSDH is funding the metropolitan component with some help from the Jackson-area March of Dimes.

UMHC and MSDH have applied jointly for a Health Resources and Service Administration grant for continued funding.

Several UMHC departments will collaborate on the project, including the Departments of Pediatrics, Maternal Fetal Medicine, Family Medicine and Dentistry. Brann, the first neonatalogist at UMMC and director of the World Health Organization Collaborating Center for Reproductive Health, will serve as a consultant.

The program enrolls high-risk mothers in a comprehensive 24-month primary-care program that addresses seven areas linked to very low birth weight deliveries, including poorly controlled chronic diseases, substance abuse, reproductive-tract infections, nutritional disorders and obesity, depression and domestic abuse, periodontal disease and short interpregnancy intervals.

To that end, participants are assisted in outlining a reproductive plan allowing for an optimal 18-24 months between pregnancies. They are given a dental screening and offered community outreach support through group meetings and home visits.

The program’s success will be determined by comparing the subsequent birth outcomes of the two groups of high-risk mothers enrolled in the program to the outcomes of two similar groups of non-participating high-risk mothers.

Dr. Kaye Bender, dean of the School of Nursing, has spent most of her career studying infant mortality. She believes the new program holds great promise for the state.

“As a nurse, I always tell my students that Florence Nightingale once said the measure of the quality of life of any society is best demonstrated by that society’s infant mortality rate,” Bender said. “Anything that positively affects the lives of our newborns is good for all of us.”

-Jen Hospodor

2009-03-17 00:00:00 18876