Posted: August 4, 2017 at 4:29 am

According to America’s health rankings, West Virginia ranks 44th among all U.S. States for infant mortality, the number of infants who die before the age of one. The state’s rate was 7.3 per 1,000 live births, while the national rate was around 5.9 for the year 2016. A Child Fatality Review filed with the state legislature at the end of 2016 found that of the 143 infant deaths in 2014, 40 were preventable and 67.5 percent of those were children born to families living in poverty.

Teams of health care professionals, emergency responders and law enforcement professionals produce the Child Fatality Review Report.  They review the deaths of every child in the state, from birth to 17, looking for patterns in order to prevent future fatalities.

Because of the way infant deaths are classified, 25 of the 40 preventable deaths are listed as undetermined. Of the remaining preventable infant deaths, 10 were deemed accidents, three homicides and two were pending (cause of death has not been determined to date).

The undetermined deaths are also often referred to as Sudden Unexplained Infant Deaths (SUID), a term given to most infant deaths occurring outside of the hospital, which include undetermined/unknown causes, asphyxia and suffocation. Among the preventable infant deaths deemed “undetermined,” the most recurrent risk factor was co-sleeping (in which parents share a room or bed with their infants as opposed to having them sleep in cribs in separate rooms). The unsafe sleep-related deaths totaled 28 because some were reported in the accident or homicide category.

“Sudden Infant Death Syndrome (SIDS) is the cause assigned to any death in infancy that cannot be explained after thorough investigation of the case, thorough investigation of the scene and autopsy,” said Janani Narumanchi, MD, section chief of general pediatrics and medical director of pediatric outpatient and outreach services at WVU School of Medicine. “Sudden Unexplained Infant Death (SUID), also referred to as Sudden Unexpected Infant Death, is-as the name suggests-an unexpected death that can be explained or unexplained. It includes SIDS or other ill-defined deaths that occur in infancy.”

Of the 28 unsafe sleep-related deaths, the review team found 13, or 46 percent were exposed to second-hand smoke. Smoking has long been regarded as an important risk factor for adverse pregnancy outcomes. It is linked to an increased risk of miscarriage, pre-term delivery, low birthweight and stillbirth. It also increases the risk of sudden infant death syndrome after birth.

Narumanchi explained that exposure to tobacco smoke puts the child at risk for SIDS as it decreases the arousal response in infants. That means that the children go into a deeper sleep and don’t wake up when they are in danger. She said that even if a parent doesn’t smoke in the room where the child is sleeping, any smoke exposure, anywhere in the house, increases the chances of SIDS.

To educate new parents on safe sleep, the “Say YES to Safe Sleep for Babies” educational program was launched in response to the fact that the leading cause of injury-related death for West Virginia infants under age 1 is suffocation and strangulation in an adult bed or other unsafe sleep surface.

The checklist below highlights safe sleep best practices. It also includes a video produced by Our Babies: Safe and Sound, a project of TEAM for West Virginia Children.


The infant mortality rate is a widely-utilized indicator of the health of a nation because it is associated with public health, maternal health, health care access, and socioeconomic status. It has been widely reported that the United States has a relatively high infant mortality rate compared with other developed countries. According to the Centers for Disease Control, more than 23,000 American infants died in 2014, or about 5.8 for every 1,000 live births, putting the U.S. on par with countries like Serbia and Malaysia. Most other developed countries—as geographically diverse as Japan, Australia and Sweden—have lower rates, closer to 2 or 3 deaths out of every 1,000 in the year 2015.


America Health Rankings


However, it is important to note that infant mortality is defined differently in the United States than in some other countries.  Research published in 2016 by Texas A&M University explained that a baby born weighing less than a pound and born after only 21 weeks gestation is not counted as actually “born” in some countries. In the United States, despite these premature babies’ relatively low odds of survival, they would be considered live births. The researchers concluded that these premature births, where babies are born prior to 37 weeks of pregnancy, are the biggest factor in explaining the United States’ high infant mortality rate.

Though the Fatality Review team classified 40 infant deaths as preventable in 2014, 143 infants died that year. One of the leading causes behind infant deaths is preterm birth (before 37 weeks of pregnancy have been completed). According to the CDC, in 2013, about one-third (36 percent) of infant deaths was due to preterm-related causes. Babies who survive can have breathing issues, intestinal (digestive) problems, and bleeding in their brains. Long-term problems may include developmental delay (not meeting the developmental milestones for the child’s age) and lower performance in school.

Infant deaths occurring from preterm births are not considered preventable deaths by the Child Fatality Review team, so they were not included in the report submitted to the legislature.

As reported by CDC, infant mortality is divided into two age periods: neonatal (birth to 27 days) and postneonatal (28 to 364 days). Approximately two thirds of all infant deaths (not restricted to preventable deaths) occur in the neonatal period, and one third occur in the postneonatal period.

“Almost most causes of infant deaths occur at hospitals (birth defects, prematurity, maternal complications and respiratory distress syndrome), whereas only one category occurs post hospital discharge and that is sudden infant death syndrome (SIDS),” said Thomas Hulsey, chair of the department of Epidemiology and interim chair of the department of Biostatistics at the WVU School of Public Health.  “The distinction is important as the former causes can be prevented by improving hospital care and spreading awareness among youth (about risks of adolescent pregnancy) who are at higher risk of preterm birth and maternal complications.”

As noted by March of Dimes, on an average week in the Mountain state:

  • 400 babies are born
  • 42 babies are born to teen mothers (ages 15-19)
  • 50 babies are born preterm (less than 37 weeks)
  • 38 babies are born low birth weight (less than 2500 grams)
  • 3 babies die before their first birthday

The latest preterm birth rates reported by CDC and March of Dimes for the year 2016, show that West Virginia stood at a rate of 11.3 Preterm births per 1,000. The national rate was 9.6. The state ranked 42nd and received an average grade D in the 2016 premature birth report card (some counties scored higher than 11.5 percent, which translates to a grade F). According to March of Dimes, the map below shows states’ grades in term of preterm birth.


“There is probably not just one thing a fetus needs to thrive in the womb, it’s a complicated system with many things that need to go right to have a healthy fetus,” said Cody Smith, MD, assistant professor and associate program director of the Neonatal Fellowship Program at the WVU School of Medicine. “Things that moms can do include: trying to plan their pregnancy to the best they can, focusing on good nutrition, exercising, making sure their weight is healthy, taking their prenatal vitamins, and avoiding taking substances, alcohol, excessive caffeine and tobacco use.”



There is a lot of evidence to show that home visitation programs have a positive impact on moms and babies. The state’s Office of Maternal, Child and Family Health offers a number of West Virginia Home Visitation Programs (WVHVP) which involve partnerships at the federal, state and community levels to help families in need. The program connects families with services and resources that provide education and support, referrals and information on resources right to their doorsteps.

Nicole Deprospero, manager of the Maternal Infant Health and Outreach program (MIHOW), one of West Virginia home visitation programs, said there is a lot of information women need about infants and caring for them they can’t get on the Internet. Her MIHOW program in Monongalia County employs mothers from the local community as outreach workers and role models, who educate families about nutrition, child health, and development, and positive parenting practices. The community-based home visiting program started in 1978, services provided are free, voluntary, confidential, and not income based.


While progress has been made to reduce infant and child mortality in West Virginia, the state rate remains consistently higher than other states. West Virginia scored worse than the national average in several indicators of child well-being, according to the latest Kids Count report, published in June 2017. The state ranked 43rd, with 25 percent of children living in poverty, another problem plaguing Appalachia, compared to the 21 percent national average. West Virginia had the same percentage last year and has been around that same ratio several years in a row.


Story, videos and graphics by Dalia Elsaid