Kyra Reed, PGY3 Emergency Medicine/Pediatrics
“Preventing infant death is EVERYONE’s responsibility”.
This recurrent message from the 2014 Infant Mortality Summit resonated deeply with the audience as we gazed upon the 654 pairs of infant socks arranged on the stage. These socks represent the number of infants that do not survive to see their first birthday in Indiana each year. The issue surrounding infant mortality is multifaceted and complex, spanning a variety of socioeconomic, cultural, and geographic lines. The goal of the summit was to educate on facts, inspire, share innovative ideas/solutions, and to bring together resources to combat this public health concern in Indiana.
Reflecting on the conference, this message definitely included Emergency Medicine in my mind. We can all strive to find a teachable moment or provide a small intervention with families in the ED, such as information on safe sleep, injury prevention, and coping with parental stress. This just might save a life.
A few highlights from the summit:
— Charlie’s Kids Foundation is an organization created in memory of Charlie, son of Maura and Sam Hanke, who died from SIDsS in 2010. The book above, “Sleep Baby, Safe and Snug”, was written to educate families about safe sleep through vivid illustrations. Each page displays the AAP’s guidelines for safe sleep and early literacy in a creative and beautiful way. Perhaps a future project could be to pass out books to parents/guardians/foster parents of infants from the ED? Find out more: http://charlieskids.org/
— Non-accidental trauma is an unfortunate reality, and this is part of what we see in the ED. Dr. David Olds with the Nurse-Family Partnership found that with the institution of home visiting nurse programs, the incidence of NAT and pediatric injuries substantially decreased.
— CVS announced that all tobacco products have been removed from their shelves. A win in the effort to decrease smoking rates.
— The afternoon breakout sessions also proved equally enlightening. A variety of important topics were covered, including approaches to addressing infant safe sleep, pregnancy and prescription drug abuse, delayed cord clamping in premature infants, smoking cessation in pregnancy, infant mortality in Burmese Chin population, strategies to address disparities in rural areas, postpartum contraception in urban adolescents, breastfeeding improvement strategies, simulation for obstetric/neonatal emergencies to improve outcomes in rural areas, and innovative technological mobile applications to improve education and access to resources. Some specifics from the sessions I attended:
Reducing Infant Mortality in a Vulnerable Burmese Chin Population, with Panel Discussion
– Burmese refugees represent the largest proportion of immigrants to Indianapolis, and numbers are increasing drastically every year
– Culture: Pregnancy is expected shortly after marriage. A larger family represents the strength of the family and provides increased support in times of need.
– Mothers often feel that prenatal vitamins lead to maternal weight gain, which results in large infants and therefore a high risk delivery
– Thus, providers need to encourage vitamin use and nutrition while explaining benefits
– Little to no prenatal care available in home country, all health costs paid out of pocket. No insurance, no blood banks. Most deliveries occur in the home with the assistance of female elder of the community.
– Initial screening for refugees upon arrival to U.S.: CMP, CBC, Hep A/B, UA, UPT, TB, syphilis, HIV
– Ways the community is attempting to improve education include: Educational programs on nutrition, health, and navigating healthcare in U.S., going to apartment communities where large number of Burmese live to provide resources
– Currently, group is working on providing genetic counseling and mental health resources
– Suicide risk in this population 4 times higher than general population
Wabash Valley Healthy Moms and Babies Initiative
– Rural Health Innovation Collaborative (RHIC) in Terre Haute, IN: Learn more http://therhic.org/index.php
– “It’s about connecting people out of their silos,” explains Stephanie Laws, Executive Director of RHIC.
– Goal is to learn from communities and identify priorities of the community
– Striving to promote development of community-based prevention and intervention strategies
– It is a broad spectrum of community participation that leads to sustainability
– Rural culture often does not support asking for help, which impacts health
– Enacting Community Health Advocacy Leaders (evalueLEAD) for Pregnancy Peer Support Program, which creates social networks to provide emotional and instructional support for mothers
– The importance of community leaders in identifying issues and promoting change is undeniable
– The project has observed the immense power that social determinants have in overall health
Training Rural Providers to Save Infants Using Simulation
– Large number of OB units throughout rural Indiana are closing
– Many residents of rural Indiana travel >30miles to access care
– Now have increasing number of deliveries occurring in rural EDs
– This is a low volume yet high risk situation for providers, mothers, and infants in this setting
– RHIC created simulation center to train rural providers for these OB/neonatal emergencies in order to reduce infant mortality
– Simulation scenarios are also brought to rural EDs unannounced to assess preparedness and what resources are needed for these situations
– Most rural providers have never seen an OB/neonatal emergency or it has been >9mo since being involved
– Critical Access Hospitals are eager to learn, and this training has been implemented successfully
– More about http://therhic.org/index.php/simcenter
Overall, a moving and educational conference. Thank you to the Indiana State Department of Health, Summit Speakers, and Breakout Session Speakers/Panelists for all of your hard work and inspirational comments!