state infant mortality toolkit · birth weight: the first weight of the newborn obtained after...

A Standardized Approach for Examining Infant Mortality

State Infant Mortality Toolkit

Resources

A. GlossaryAge-Specific Birth Rate: live births per 1,000 women in a

specified age group.

Antenatal: Occurring before birth; prenatal.

Birth Defect: an abnormality of structure, function or body metabolism present at birth that often results in a physical and/or mental disability or is fatal.

Birth weight: the first weight of the newborn obtained after birth.

Not low birth weight: 2,500 grams (5 ½ pounds) or greater.

Low birth weight: less than 2,500 grams or 5 ½ pounds.

Very low birth weight: less than 1,500 grams or 3 ½ pounds

Cesarean Section: an operation to deliver a baby through an incision in the abdomen, often performed when the risk of a vaginal birth is deemed too high for either the mother or the fetus.

Ectopic Pregnancy: a pregnancy that occurs outside the uterus; also called tubal pregnancy.

Fertility Rates: live births per 1,000 women aged 15-44 years. A more direct measure of fertility than the birth rate, and refers to births per woman of reproductive age rather than per total population.

Fetal Death: Death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy; and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.

Incidence: the number of new events that occur in a specified population over a specified period of time.

Infant Mortality: all deaths from birth to 1 year of age.

Infant Mortality Rate: deaths from birth to 1 year per 1,000 live births.

Neonatal Mortality Rate: deaths from birth through 27 days per 1,000 live births.

Postneonatal Mortality Rate: deaths from 28 days to 1 year per 1,000 live births.

Intrapartum: occurring during childbirth or during delivery.

Linked Birth/Infant Death File: Period linked file: A period linked file starts with all infant

deaths that occurred in a specified time period and then links to births during the year prior to that death. For example, infant deaths that occurred in 2012 may link to births that occurred in 2012 or 2011. The birth-infant death linked file produced by the National Center for Health Statistics for studying infant mortality is a period linked file, and is commonly used for PPOR analysis.

Birth cohort linked file: A cohort linked file starts with all births that occurred in a specified time period and then links to deaths during the year after birth. For example, births that occurred in 2012 may link to deaths that occurred in 2012 or 2013. It is important to note that the use of one linked file type or the other is neither right nor wrong, and each has their strengths and weaknesses.

Medicaid: a federal-state entitlement program that provides health care coverage for low income pregnant women and children, persons with disabilities, and poor, elderly individuals.

Nativity: the documented origin of birth relating to citizenship.

Obstetrics: the medical specialty dealing with the care of all women’s reproductive tracts and their children during pregnancy (prenatal period), childbirth and the postnatal period.

Parity (birth order): the number of children born to one mother

Perinatal Period: generally means around (peri) the time of birth (natal), and it can be used to refer to the entire or parts of the period beginning before conception through part of the first year of life. There are two definitions that are most commonly used in the United States:

I. 28 weeks gestation through age 6 days. This definition provides greater comparability with other jurisdictions.

II. 20 weeks gestation through age 27 days. This definition provides greater opportunity to examine the distribution of these deaths, and changes over time.

Perinatal Regionalization: the classification of hospitals based on their capacities and resources to handle a full range of services to mothers and infants during pregnancy, delivery and post-delivery.

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Plurality: The number of babies resulting from a single pregnancy

Prenatal Care: Early Prenatal Care: pregnancy-related care started

in the first trimester (1-3 months).

Late Prenatal Care: pregnancy-related care started in the third trimester (7-9 months)

Preterm Birth: live birth prior to the 37th completed week of pregnancy.

Very Preterm Birth: live birth prior to the 32nd completed week of pregnancy.

Postnatal: occurring after birth

Respiratory Distress Syndrome (RDS): an acute disorder of the lungs that usually occurs in premature newborn infants and is caused by immaturity of the lungs. RDS can sometimes lead to death or to a chronic abnormality of the lungs.

Risk Factor: an aspect of lifestyle, environmental exposure, or an inborn inherited characteristic, which on the basis of epidemiological evidence is known to be associated with poor health outcomes.

Sudden Infant Death Syndrome (SIDS): is the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene and review of the clinical history.

Sudden Unexpected Infant Death: SUID includes SIDS, along with other unexpected causes of infant death, including accidental suffocation and undetermined causes.

Surfactant: a detergent-like substance that stabilizes the small air sacs of the lungs and prevents the air sacs from collapsing upon exhalation. Deficiency of surfactant in the lungs of preterm babies is the cause of respiratory distress syndrome (RDS). In recent years, it has become possible to treat preterm babies with RDS by spraying the surfactant that they need into their windpipes.

Teratogen: substance that can cause birth defects in a developing fetus when a woman is exposed during pregnancy.

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B. Helpful FormulasNote: “not-stated values” refer to those that are missing.

Age-specific birth rate: (live births divided by population in specified age group) x 1,000.Example: Birth rate for females ages 15-19 years = (505,488/8,580,271) x 1,000 = 58.9 per 1,000 women 15-19 years

Fertility rate: (births to women 15-44 years divided by population of women 15-44 years) x 1,000.Example: Fertility rate = (3,952,767/59,283,566) x 1,000 = 66.7 per 1,000 women 15-44 years

Fetal death ratio: [fetal deaths divided by (live births + fetal deaths)] x 1,000820 fetal deaths in 2008 among state residentsExample: 820 fetal deaths and 130,000 live births in 2008 to state residents[820/(130,000 + 820)] x 1,000 = 6.3 fetal deaths per 1,000 live births plus fetal deaths in 2008 among state residents

Infant mortality rate: (deaths of infants [under age 1 year] divided by live births) x 1,000. Example: Infant mortality rate for all races = (31,710/3,952,767) x 1,000 = 8.0 infant deaths per 1,000 live births

Infant mortality rate, cause specific: (deaths of infants due to a specific cause [such as birth defects] divided by live births) x 100,000.Example: Birth defects-specific infant mortality rate for all races =(6,854/3,952,767) x 100,000 = 173.4 birth defects-related infant deaths per 100,000 live births

Low birth weight rate (percentage): [low birth weight infants divided by (live births minus those without a birth weight value)] x 100.Example: Low birth weight rate for all races = [287,607/ (3,952,767 - 4,554)] x 100 = 7.3 percent or 7.3 per 100 live births

Prenatal care rate (percentage): [births to mothers receiving either early or late/no prenatal care divided by (live births minus those without a birth weight value)] x 100.Women who received early prenatal care in YEAR= 3,098,806Example: Early prenatal care rate for all races = [3,098,806/(3,952,767 – 90,068)] x 100 = 80.2 percent

Rate of births to teens: (birth to teen mothers ages 15-19 years divided by teen female population) x 1,000.Total number of live births in YEAR= 3,952,767Example: Birth rate for teens of all races = (505,488/8,580,271) x 1,000 = 58.9 per 1,000 females ages 15-19 years

C. Standard Abbreviations ListCDC Centers for Disease Control and PreventionIMR Infant mortality rateICD-10 International Classification of Disease, 10th revisionLBW Low birth weightRDS Respiratory distress syndromeSGA Small for gestational ageSIDS Sudden infant death syndromeSUID Sudden unexpected infant deathU.S. United StatesVLBW Very low birth weight

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D. 1989 Revision of U.S. Standard Birth and Death Certificate Variables

Infant Variablesl Namel Date/time of birthl Place of birthl Sexl Weight at birthl Birth order (for multiple order births)l Pluralityl Congenital defectsl Apgar scorel Gestational agel Method of feeding at discharge

Maternal Variablesl Name (maiden and marital surname)l Date of birthl Place of birthl Last menstrual period (LMP)l Height/weight (pre-pregnancy/at delivery)l Month prenatal care began/endedl Number of prenatal care visitsl Past medical historyl Past obstetric historyl Smoking/alcohol usel Race/ethnicity of motherl Marital statusl Parity (total number of live births)l Gravidity (total number of pregnancies)l Maternal education l Birth attendantl Sources of payment for deliveryl Mode of deliveryl WIC food provisions during pregnancyl Social Security Number (used for linking records)l Birth interval (calculated)l Pregnancy interval (calculated)l Weight gain (calculated)

Paternal Variablesl Race/ethnicityl Date of birthl Place of birthl Educationl Presence/absence of namel Social Security Number

l Date of deathl Place of deathl Causes of death or underlying causesl Parent’s informationl Age at time of deathl Autopsy conductedl Method of disposition

For copies of the original birth and death certificates, follow this link: NCHS Report on “The 1989 Revision of the U.S. Standard Certificates and Reports”: www.cdc.gov/nchs/data/series/sr_04/sr04_028.pdf

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E. 2003 Revised U.S. Standard Birth and Death Certificates

U.S. STANDARD CERTIFICATE OF LIVE BIRTH LOCAL FILE NO. BIRTH NUMBER:

C H I L D 1. CHILD’S NAME (First, Middle, Last, Suffix) 2. TIME OF BIRTH (24 hr)

3. SEX

4. DATE OF BIRTH (Mo/Day/Yr)

5. FACILITY NAME (If not institution, give street and number)

6. CITY, TOWN, OR LOCATION OF BIRTH

7. COUNTY OF BIRTH

M O T H E R 8a. MOTHER’S CURRENT LEGAL NAME (First, Middle, Last, Suffix)

8b. DATE OF BIRTH (Mo/Day/Yr)

8c. MOTHER’S NAME PRIOR TO FIRST MARRIAGE (First, Middle, Last, Suffix) 8d. BIRTHPLACE (State, Territory, or Foreign Country)

9a. RESIDENCE OF MOTHER-STATE

9b. COUNTY 9c. CITY, TOWN, OR LOCATION

9d. STREET AND NUMBER 9e. APT. NO. 9f. ZIP CODE 9g. INSIDE CITY LIMITS? □ Yes □ No

F A T H E R 10a. FATHER’S CURRENT LEGAL NAME (First, Middle, Last, Suffix)

10b. DATE OF BIRTH (Mo/Day/Yr) 10c. BIRTHPLACE (State, Territory, or Foreign Country)

CERTIF IER 11. CERTIFIER’S NAME: _______________________________________________

TITLE: □ MD □ DO □ HOSPITAL ADMIN. □ CNM/CM □ OTHER MIDWIFE

□ OTHER (Specify)_____________________________

12. DATE CERTIFIED

______/ ______ / __________

MM DD YYYY

13. DATE FILED BY REGISTRAR

______/ ______ / __________

MM DD YYYY

INFORMATION FOR ADMINISTRATIVE USE

M O T H E R 14. MOTHER’S MAILING ADDRESS: 9 Same as residence, or: State: City, Town, or Location: Street & Number: Apartment No.: Zip Code:

15. MOTHER MARRIED? (At birth, conception, or any time between) □ Yes □ No IF NO, HAS PATERNITY ACKNOWLEDGEMENT BEEN SIGNED IN THE HOSPITAL? □ Yes □ No

16. SOCIAL SECURITY NUMBER REQUESTED FOR CHILD? □ Yes □ No

17. FACILITY ID. (NPI)

18. MOTHER’S SOCIAL SECURITY NUMBER:

19. FATHER’S SOCIAL SECURITY NUMBER:

INFORMATION FOR MEDICAL AND HEALTH PURPOSES ONLY

M O T H E R 20. MOTHER’S EDUCATION (Check the box that best describes the highest degree or level of school completed at the time of delivery) □ 8th grade or less □ 9th - 12th grade, no diploma □ High school graduate or GED completed □ Some college credit but no degree □ Associate degree (e.g., AA, AS) □ Bachelor’s degree (e.g., BA, AB, BS)

□ Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)

□ Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)

21. MOTHER OF HISPANIC ORIGIN? (Check the box that best describes whether the mother is Spanish/Hispanic/Latina. Check the “No” box if mother is not Spanish/Hispanic/Latina) □ No, not Spanish/Hispanic/Latina □ Yes, Mexican, Mexican American, Chicana □ Yes, Puerto Rican □ Yes, Cuban □ Yes, other Spanish/Hispanic/Latina (Specify)_____________________________

22. MOTHER’S RACE (Check one or more races to indicate what the mother considers herself to be) □ White □ Black or African American □ American Indian or Alaska Native (Name of the enrolled or principal tribe)________________ □ Asian Indian □ Chinese □ Filipino □ Japanese □ Korean □ Vietnamese □ Other Asian (Specify)______________________________ □ Native Hawaiian □ Guamanian or Chamorro □ Samoan □ Other Pacific Islander (Specify)______________________ □ Other (Specify)___________________________________

F A T H E R

Mot

her’s

Nam

e __

____

____

____

__

Mot

her’s

Med

ical

Rec

ord

No.

__

____

____

____

____

____

___

23. FATHER’S EDUCATION (Check the box that best describes the highest degree or level of school completed at the time of delivery) □ 8th grade or less □ 9th - 12th grade, no diploma □ High school graduate or GED completed □ Some college credit but no degree □ Associate degree (e.g., AA, AS) □ Bachelor’s degree (e.g., BA, AB, BS)

□ Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)

□ Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)

24. FATHER OF HISPANIC ORIGIN? (Check the box that best describes whether the father is Spanish/Hispanic/Latino. Check the “No” box if father is not Spanish/Hispanic/Latino) □ No, not Spanish/Hispanic/Latino □ Yes, Mexican, Mexican American, Chicano □ Yes, Puerto Rican □ Yes, Cuban □ Yes, other Spanish/Hispanic/Latino (Specify)_____________________________

25. FATHER’S RACE (Check one or more races to indicate what the father considers himself to be) □ White □ Black or African American □ American Indian or Alaska Native (Name of the enrolled or principal tribe)________________ □ Asian Indian □ Chinese □ Filipino □ Japanese □ Korean □ Vietnamese □ Other Asian (Specify)______________________________ □ Native Hawaiian □ Guamanian or Chamorro □ Samoan □ Other Pacific Islander (Specify)______________________ □ Other (Specify)___________________________________

26. PLACE WHERE BIRTH OCCURRED (Check one) □ Hospital □ Freestanding birthing center □ Home Birth: Planned to deliver at home? 9 Yes 9 No □ Clinic/Doctor’s office □ Other (Specify)_______________________

27. ATTENDANT’S NAME, TITLE, AND NPI NAME: _______________________ NPI:_______ TITLE: □ MD □ DO □ CNM/CM □ OTHER MIDWIFE □ OTHER (Specify)___________________

28. MOTHER TRANSFERRED FOR MATERNAL MEDICAL OR FETAL INDICATIONS FOR DELIVERY? □ Yes □ No IF YES, ENTER NAME OF FACILITY MOTHER TRANSFERRED FROM: _______________________________________

REV. 11/2003

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state infant mortality toolkit · birth weight: the first weight of the newborn obtained after...

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