September 22, 2006

Conference explores infant mortality morass

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Conference explores infant mortality morass

America's infant mortality is among the worst in the Western world, and it's not getting any better, speakers at a Nashville conference said this week.

The leading cause is prematurity. Yet compared to research spending on heart disease and cancer, little is committed to finding out why so many babies are born too early.

“This is the area of research that has the most impact on human health, and it's the least funded area of medical research,” asserted Kenneth Ward, M.D., chairman of Obstetrics and Gynecology at the University of Hawaii in Honolulu.

Vanderbilt's pioneering neonatologist and professor of Pediatrics, Mildred Stahlman, M.D., put it more strongly in the keynote speech that opened the conference Monday.

“A country that spends more per capita on personal health care than any other country, and perhaps leads the world in medical technology, has no acceptable excuse for an infant mortality that ranked 26th in the world in 2000.”

The conference, which ended Wednesday at the Nashville Marriott at Vanderbilt, was entitled “Why Our Babies Die.” Presented by the Meharry-Vanderbilt Alliance, it featured leading experts from around the country.

Stahlman was recovering from a minor injury and was unable to attend. Her address was delivered by William Walsh, M.D., chief of nurseries at the Monroe Carell Jr. Children's Hospital at Vanderbilt. On Tuesday, Walsh discussed the use of hypothermia to reduce long-term consequences of hypoxia during delivery.

Much has been written about the racial and ethnic disparities in birth outcomes. But while poverty and lack of access to health care are major contributors, there is increasing evidence that genetics also plays a role.

Earlier this month, researchers at Virginia Commonwealth University reported that African-Americans were more likely than Caucasians to carry a genetic variation which limits production of the structural protein collagen.

This could increase the risk for premature rupture of the membranes and too-early delivery.

Ward cautioned that findings like these are preliminary and must be replicated.

But he also predicted that understanding the genetic contributors to premature labor eventually may make racial distinctions obsolete.

“In several decades,” he said, “we'll stop talking about a black group and a white group … and we will talk more about the underlying alleles (alternative forms of genes) that are important.”

That won't make socioeconomic factors irrelevant, however.

“It's time to change the way we deliver care if we really want to do something about why our babies die,” said Karla Damus, Ph.D., R.N., associate professor of Obstetrics & Gynecology and Women's Health at the Albert Einstein College of Medicine in New York, and senior research associate at the National March of Dimes Birth Defects Foundation.

Improving prenatal care may not be enough, Stahlman wrote.

“Does it also require a lifetime of good maternal mental as well as physical health, good nutrition, and a social milieu which is supportive? The experiences in countries such as Sweden suggest that much more societal intervention is necessary than that which we have been willing or able to provide.”