Report of the Task Force to Reduce Infant Mortality and Infant Morbidity in North Carolina phase I: identification of the major factors associated with infant mortality and morbidity in North Carolina.

North Carolinas infant mortality rate has been slowly decreasing over the past years. In 1985 it was 12/1000 live births which is higher than the US average of 10.6 and ranks North Carolina as 45th in the nation exceeded by only 5 states mostly in the Southeastern region. 2/3 of these deaths occur in the 1st month of life. Low birth weight (under 5.5 pounds) plays an essential role in infant mortality. Although low birth weight babies represent 7.9% of all live births they account for 64% of all infant deaths. The risk of dying increases sharply as birth weight decreases. Improvements in perinatal care contributed to the decrease in mortality at every birth weight. However the proportion of low birth weight babies remained fairly constant over the last 30 years. Non-white babies are still more than twice as likely to have a low birth weight and to die in their 1st year of life than white babies. In North Carolina the highest rates of infant mortality and low birth weight are experienced in the Coastal Plains Region which is consistent with the racial distribution in this area. The leading causes of death in North Carolina between 1980-1984 were 1) prematurity-related conditions (37.5% of all infant deaths) 2) congenital anomalies (17.4%) 3) Sudden Infant Death Syndrome (12.8%) and 4) perinatal conditions including infections birth asphyxia and obstetrical complications (11.5%). Factors associated with prematurity include sociodemographic risks (black race low socioeconomic status teenage or single mother) medical risks behavioral and environmental risks physical and psychosocial stress such as adverse working conditions and inadequate prenatal care. 52% of infant deaths are potentially preventable. Infant morbidity is much less documented. 13% of 1-year-olds have some kind of impairment with a severe handicap or delay in 2% of the cases. 1 in 5 children suffers at least 1 major health problem in the 1st year of life with 1 in 10 requiring hospitalization. Low birth weight babies have a greater risk of morbidity also.