Improvements in Infant Mortality Thru Prenatal Programs

Infant Mortality Rate (IMR) is one of most important indicators of the general level of health or well being in a community. The most recent data (2003) showed IMR for the United States at 6.9 deaths per 1,000 live births. For Texas, it is 6.6, and Tarrant County is 7.5 deaths per 1,000 which are higher than State & National rates. The primary cause of infant mortality in Tarrant County is cited as prematurity & low birth weight. Approximately 80% of all neonatal deaths occur within the first week of life. Key findings: An increase in infant mortality rates among African Americans from 12.6 to 16.1 between 2001 to 2003; African American's have a greater proportion of infant death (17.4%) due to Sudden Infant Death Syndrome than do Caucasians (11.7%) or Hispanics (11.6%); women who reported no prenatal care had an infant mortatity rate of 25.3.

The data indicated the need for community programs targeted towards the reduction of premature and low birth weight births, as well as improving women's health before conception & during pregnancy, particualrly among African American's. JPS, a 459 bed teaching facility, with >6,000 deliveries a year & 28 health clinics, chose 3 targeted zipcode areas that had the highest IMR rates for the county (16.3; 15.0; 14.4) as our target for a new initative to get women into prenatal care to affect neonatal mortality. Baseline data showed that only 67.5% of women received prenatal care from these targeted areas in 2005.

Organizational initiatives were to increase community awareness, identify & address barriers to care, and to provide coaching & mentoring thru a case managment approach during the prenatal process. JPS was successful with a total of 3,516 personal contacts for community awareness educational programs. From the 3 zipcodes, 547 women were case managed during their pregnancy and resulted in a 93.3% prenatal care rate. Infant care follow-up also showed that 94% discharged from JPSH had their newborn well child checks & 91% were up to date with immunizations when discharged from the case management program after 2 months post delivery. More importantly, of the infants born at JPS in 2006 from the targeted areas, there was only 1 newborn death. Because of this initial project & results, JPS has expanded to an additional 3 zipcodes and following infants for the first 15 months of life for immunization rates for 2007.