Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.

April 10, 2009

1. MCH LIBRARY RELEASES NEW EDITION OF KNOWLEDGE PATH ABOUT AUTISM SPECTRUM DISORDERS

Autism Spectrum Disorders: Knowledge Path is an electronic guide to resources about screening for autism spectrum disorders, diagnosis, treatment and intervention, communication, education, vocational challenges, and impact on family life. The new edition of the knowledge path, produced by the MCH Library, contains information on Web sites, publications, distance learning resources, databases, and social media. Separate sections present resources that address early identification, early intervention and education, concerns about vaccines, and environmental health research. The knowledge path is intended for use by health professionals, educators, researchers, policymakers, and families and will be updated periodically. The knowledge path is available at http://mchlibrary.info/KnowledgePaths kp_autism.html.

MCH Library knowledge paths on other topics are available at http://www.mchlibrary.info/KnowledgePaths/index.html. The MCH Library welcomes feedback on the usefulness and value of these knowledge paths. A feedback form is available at http://www.mchlibrary.info/KnowledgePaths/feedback.html.

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2. MCH LIBRARY RELEASES ONLINE RESOURCE BRIEF ABOUT ADOLESCENT HEALTH

Adolescent Health: Resource Brief is an electronic guide to recent resources on Web sites and other related resources for health professionals and families. The brief, produced by the MCH Library, contains links to related bibliographies, knowledge paths, organizations lists, and other resource briefs developed by the library. Selected topics include adolescent pregnancy and parents, adolescent pregnancy prevention, health insurance and access to care for children and adolescents, school health, sexuality education, and social and emotional development in children and adolescents. The brief is available at http://www.mchlibrary.info/guides/adolescent.html. MCH Library resources on this and other maternal and child health topics are available at http://www.mchlibrary.info/guides.html.
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3. REPORT PROVIDES POLICY RECOMMENDATIONS TO HELP YOUNG FAMILIES

A Policy Platform to Promote Health and Success Among Young Families identifies challenges that young families face today and the federal programs that are currently, or could be, responsive to those challenges. The report, produced by the Healthy Teen Network, constitutes a set of federal policy recommendations aimed at establishing or reforming programs and systems that influence whether young families may achieve health and success after an adolescent birth. The report discusses young families' needs and gaps in resources and services according to the following seven "life domains": (1) health and human services, (2) housing, (3) education, (4) work force and life skills development, (5) child welfare and development, (6) income security, and (7) knowledge development and transfer.

The report is available here.

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4. ARTICLE DISCUSSES PROGRAM TO DECREASE ELECTIVE DELIVERIES BEFORE 39 WEEKS

"We were able to demonstrate that with institutional commitment, it is possible to implement a quality improvement process in an integrated healthcare system that resulted in a substantial and sustained decrease in elective deliveries before 39 weeks of gestation," write the authors of an article published in the April 2009 issue of Obstetrics & Gynecology. Induction of labor in the United States as a proportion of all births rose from 9 percent in 1989 to 21 percent in 2002, with a sharper increase in elective than in medically indicated inductions. It is known that perinatal morbidity is higher in infants delivered before 39 weeks of gestation, with cesarean delivery being an independent risk factor for increased respiratory morbidity at term. Although the American College of Obstetricians and Gynecologists has stated that elective delivery should not be performed before 39 weeks of gestation to minimize prematurity-related neonatal complications, the authors found that in their health care system, a significant number of deliveries were being performed before 39 weeks. In this article, the authors report on a program that has produced a sustained decrease in early term elective deliveries in this health care system.

The authors queried the electronic medical records of Intermountain Healthcare, an integrated health care system involving nine labor and delivery units in Utah. Once the baseline rate of elective deliveries before 39 weeks was determined, a program was developed to curtail this practice. The medical and nursing staff at each facility received education on the possible negative consequences of elective deliveries before 39 weeks, a patient-education brochure was developed, and program leaders promoted the program at each facility.

The authors found that

* Within 6 months of implementation of the program, the percentage of elective deliveries occurring before 39 weeks of gestation decreased from a baseline of more than 28 percent to less than 10 percent.

* Six years after implementation of the program, the rate of elective deliveries occurring before 39 weeks remained below 3 percent.

* In 39-41 week deliveries that occurred after the program was implemented, there was a significant decline in postpartum anemia, meconium aspiration, Apgar scores less than 5 at 1 minute, and cesarean deliveries due to fetal distress, compared with 39-41 week deliveries that occurred before program implementation.

The authors conclude that "early elective delivery seems to be a problem nationwide. Indeed, . . . the National Quality Forum and the Institute for Healthcare Improvement have recently taken up prevention of elective deliveries before 39 weeks of gestation as a measure of quality. We hope this article will stimulate initiatives in other hospitals and institutions as well."

Oshiro BT, Henry E, Wilson J, et al. 2009. Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system. Obstetrics and Gynecology 113(4):804-811. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19305323.

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5. ARTICLE REVIEWS RELATIONSHIP BETWEEN HOSPITAL PRACTICES AND LIKELIHOOD THAT WOMEN WILL EXCLUSIVELY BREASTFEED

"We identified several hospital practices, as reported by mothers, that were strongly related to rates of exclusive breastfeeding," write the authors of an article published ahead of print in the May 2009 issue of the American Journal of Public Health. Exclusive breastfeeding through at least the first 6 months of life is the physiologically appropriate approach to infant feeding. Mixed or formula feeding caries with it increased risks of infection, developmental problems, mortality, and long-term ailments such as diabetes and cancers for mother and child. Nonetheless, less then 12 percent of U.S. mother-infant pairs achieve the goals of exclusive breastfeeding up to age 6 months. The goal of the study described in this article was to provide clinical and hospital administrative decision-makers with the information they need to institute policies and practices that enhance a woman's ability to achieve her intended duration of breastfeeding. The authors examined the results of a national survey that asked mothers about their feeding intentions as the end of their pregnancies approached and their actual feeding patterns 1 week after the birth. The authors also asked mothers to report on their experiences with hospital practices known to influence breastfeeding success.

The authors present results from a 2006 national survey of 1,573 women ages 18-45 who had given birth in 2005 in a hospital to a singleton, still-living infant. The sample was generally representative of the national population of birthing mothers.

The authors found that

* Mothers' reports of fulfilling their feeding intentions differed by parity, with 65 percent of primiparas and 79 percent of multiparas feeding their infant at 1 week in the way they had intended at the end of the pregnancy. The largest group were those mothers who intended to, and at 1 week were, exclusively breastfeeding their infants.

* Experiencing hospital practices that inhibit exclusive breastfeeding (i.e., staff supplementing breastfeeding with formula or water, being given free formula samples, infants being given pacifiers) was significantly associated with mothers' failure to fulfill their intentions to exclusively breastfeed.

* Mothers whose infants did not experience supplementation were 4.4 times (primiparas) more likely and 8.8 times (multiparas) more likely to achieve their intention to exclusively breastfeed.

The authors concluded that "practices [that inhibit breastfeeding] must be changed at the hospital and professional levels to ensure that the hospital experience more consistently contributes to the health and welfare of mothers and babies."

Declercq E, Labbok MH, Sakala C, et al. In press. Hospital practices and women's likelihood of fulfilling their intention to exclusively breastfeed. American Journal of Public Health [published online ahead of print on March 19, 2009]. Abstract available at http://www.ajph.org/cgi/content/abstract/AJPH.2008.135236v1.

Readers: More information is available from the following MCH Library resource: - Breastfeeding Resource Brief at http://www.mchlibrary.info/guides/breastfeeding.html.


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MCH Alert © 1998-2009 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02MC00001) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
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