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Early Prenatal Home Visits May Reduce Infant Mortality, According to New Cincinnati Children's Study

Researchers Call for Further Studies to Confirm These Findings

Monday, January 01, 0001

CINCINNATI -- A new Cincinnati Children's Hospital Medical Center study could have national implications for reducing the infant mortality rate in the United States, which ranks 24th among countries that report such statistics to the World Health Organization.

The study shows that an intensive, prenatal home visiting program for high-risk mothers may reduce the risk of infant mortality, particularly for African-Americans. Infants whose families did not receive home visits were 2.5 times more likely to die in infancy compared to families that did receive home visits, according to Edward Donovan, MD, a physician at Cincinnati Children's and the study's lead author.

"While further studies are needed to confirm our findings, home visiting during the earlier portions of the pregnancy may help to reduce the risk of infant death," says Dr. Donovan, a neonatologist. "It's encouraging that African-American families seem to benefit from prenatal home visits because African-Americans have a much higher infant mortality rate in the United States compared to whites."

The study is published in the June issue of the journal Pediatrics.

The Cincinnati Children's researchers examined a community-based program called Every Child Succeeds (ECS). Cincinnati Children's is the managing partner of the program, whose founding partners also include the United Way of Cincinnati and the Cincinnati-Hamilton County Community Action Agency.

ECS was founded in 1999 to ensure an optimal start in life for children of at-risk, first-time mothers, many of whom have several of the risk factors associated with infant mortality, including late-term or no prenatal care, smoking, drug or alcohol consumption during pregnancy, low income, depression and a history of sexual or physical abuse.

ECS provides educational and social services support for first-time mothers and their families. Services feature home visits that often start before a child is born and continue through age 3. Home visitors come from a variety of backgrounds and disciplines, including nursing, education, child development and human services.

Of the 1,665 ECS cases included in the study, 715 were enrolled before birth and 950 after birth. Participants enrolled prior to birth who survived to age 1 had a mean of 6.9 home visits prior to birth and 18.3 visits between birth and age 1. Participants enrolled after birth and surviving to age 1 had a mean of 14.3 home visits before the age of 1.

Among the 715 ECS families in the study who received prenatal home visits, the infant mortality rate was seven deaths per 1000 live births, which compares favorably with the overall infant mortality rate in the United States of 6.8 and the 2004 Hamilton County infant mortality rate of 11.0.

"Our analysis showed that adequacy of prenatal care had a strong association with likelihood of infant death," says Dr. Donovan. "African-American mothers enrolled in ECS prior to the birth of their child were more likely to receive adequate prenatal care, which may have been one of the determinants of the lower infant mortality rate seen in that group."

While this study is encouraging, it was a retrospective study -- one that looked back in time. What is now needed, says Dr. Donovan, are prospective studies to confirm the findings. These studies would be forward-looking and follow mothers and their babies over a period of time from pregnancy through age 1.

Cincinnati Children's, one of the top five children's hospitals in the nation according to Child magazine, is a 475-bed institution devoted to bringing the world the joy of healthier kids. Cincinnati Children's is dedicated to providing care that is timely, efficient, effective, family-centered, equitable and safe. For its efforts to transform the way health care is provided, Cincinnati Children's received the 2006 American Hospital Association-McKesson Quest for Quality Prize". Cincinnati Children's ranks second nationally among all pediatric centers in research grants from the National Institutes of Health and is a teaching affiliate of the University of Cincinnati College of Medicine. The Cincinnati Children's vision is to be the leader in improving child health.