1. Nashville Community Health Needs for Children and Youth, 0-24 GOAL 1 All Children Begin Life Healthy

2. 2 “I knew Luke was going to die. I think I had known it the second I saw him.” Luke was born at 23 weeks gestation weighing 1 pound.

3. 3 All Children Begin Life Healthy means… Infants are born full term* at a healthy birth weight** to loving, capable parents ready to breastfeed. Not faced with risks from premature birth:  Temperature control, feeding difficulties, infections, jaundice  Hearing and vision deficiencies  Learning and behavior difficulties  Cerebral palsy and motor coordination problems  Death A better chance of reaching preschool and kindergarten ready to learn. A better chance of being in good health for life. * Full term means 37 to 41 weeks gestation ** Healthy birth weight means over 5lbs 2 oz or 2500 grams

4. 4 There are many current issues that prevent children from beginning life healthy. Poor maternal health that leads to premature or low birth weight, especially:  Hypertension, diabetes, overweight and underweight; infections and poor dental care.  Depression, cigarettes, alcohol and drugs; family and domestic violence; unwanted pregnancy, stress. Lack of or underutilization of prenatal care. Born to a very young or older mother. Born too soon after the last baby.

5. 5 Numbers help tell the story… Tennessee’s National Ranking Infant Mortality*48 Preterm Births47 LBW < 2500 gm45 Definitions (WHO) Preterm< 37 weeks gestation Very Preterm< 32 weeks gestation VLBW500 – 1500 grams *Death in the first year of life

6. 6 Numbers tell the Story of Disparity in Tennessee Infant Mortality

7. 7 Numbers help tell the story… High Costs for Parents, Employers and Community for Premature Babies Term Infant $2,830 Premature Infant $41,610 Costs to employer for first year of life (March of Dimes 2002) Escalating hospital costs with decreasing gestational age

8. 8 Numbers help tell the story… Over 1,000 Premature Births per year in Davidson County Births in Average Week Number of babies 171 Preterm 20 To Teen Mothers 19 Late or no PNC 6 Babies die 2 African Americans have over twice the number of very pre-term births as Caucasians. Davidson County March of Dimes data

9. 9 Currently, a number of programs in the community address these issues. Prenatal Care at MetroGeneral, VUMC, Nurse Midwifery Center; Neighborhood Health Centers. Metro Department of Health. Project Blossom. The March of Dimes. Bridges to Care. Nurse home visiting programs:  HUGS; Nurses for Newborns; Prevent Child Abuse TN. NOTE: This slide provides only a few examples of programs; it is not intended to be a comprehensive list.

10. 10 There are many gaps in today’s programs and services. Many women lack preventive health care prior to pregnancy. Easy, early access to prenatal care. Public awareness of value of being born full term and relationship to mothers health before and during the pregnancy. Lack of breastfeeding support, especially for African Americans. Postpartum and interpregnancy care to help mothers achieve their reproductive life plan.

11. 11 In the next 2-5 years a number of changes are expected. Current TennCare providers seem more proactive and focused on helping mothers have healthier pregnancies. Community Voices (Community Based education program to improve birth outcomes). New research findings.  Impact of better prenatal care.  Use of progesterone and other treatments to prevent preterm births.

12. 12 References Kramer MS et al 2000 Jo American Medical Association. I Adams-Chapman 2006 Clinics in Perinataology. March of Dimes. Phibbs and Schmitt, 2006 Journal of Early Human Development. Wang M et al 2004 Pediatrics. William Walsh and M Lutenbacher et al, 500 premature babies born at VUMC; and interviews with 243 AA mothers.