For the last 20 years I have worked as a pediatrician caring for children, ensuring they receive appropriate treatments and providing families with tools they need to give their children a safe and healthy life. And I am heartbroken when I review our state and national infant mortality statistics. In the United States, now, nearly six out of every 1,000 babies will die before age 1 — and Maine’s rate is even slightly higher than the national average. This is unacceptable, and both state and national efforts have been underway to reduce infant mortality rates.

Recently, there have been accusations that Maine had somehow been unaware of the recent increase in Maine’s infant death rate — this is false.

Preliminary data shows that Maine’s infant mortality rate has improved over the last two years. Our research has indicated that four primary issues seem to be driving the rate of infant death in Maine:

• Issues related to prematurity

• Congenital conditions

• Sudden Infant Death Syndrome (SIDS)

• Sudden Unintended Death Syndrome (SUIDS)

Maine is extremely proactive with its newborn screening and birth defects programs. However, prevention strategies for many congenital conditions often remain unclear. That is why Maine has chosen to focus its energy on prevention strategies that target premature birth, low birth weight and SIDS/SUIDS.

In the last two years, more than 15 infant deaths have been associated with an unsafe sleep environment. This is unacceptable and could be avoided.

The Maine Department of Health and Human Services convened a safe sleep workgroup to address issues such as the dangers of bed-sharing, especially when drugs and/or alcohol are involved. Training has been given to Maine families home visitors, public health nurses and child protective workers to help ensure that newborns will all have access to safe sleep environments.

The Maine CDC, through its perinatal outreach program, continues to educate parents, caregivers and birthing facilities about safe sleep practices, breastfeeding, and child abuse prevention endorsed by the American Academy of Pediatrics.

We know that smoking during pregnancy correlates strongly with low birth weight and prematurity. According to a National Vital Statistics Report, more than 18 percent of pregnant women in Maine smoke in the three months prior to their pregnancy.

To help address the issue, Maine has trained home visitors to assess and refer pregnant women to smoking cessation programs, and our Partnership for a Tobacco Free Maine program has doubled down on practices proven effective in reducing smoking rates among pregnant women.

We are also studying low-risk C-section practices, working with hospitals that have high rates and offering guidance to reduce their rates, as a means of reducing premature births.

The department has strengthened substance abuse screening protocols and encouraged universal screening for all pregnant women to identify any substance abuse during pregnancy. We realize that Maine’s substance abuse crisis severely impacts our children and we are working closely with providers about these initiatives and the importance of talking to all women about treatment options.

DHHS established a hotline for pregnant women who are ready to enter treatment through a partnership with 211. More recently, we’ve implemented a “bridging program” that assigns nurses to coordinate with child and family services and home visitors to meet the needs of pregnant women with risk factors as well as those of infants with complex health issues. And we continue to support comprehensive home visiting to ensure that infants have the best possible start to life, using the national, evidence-based parent coaching model known as Parents as Teachers.

In an effort to reduce abusive head trauma implicated in SUIDs, more than 900 providers and all birthing hospitals in the state have completed trainings and adopted the Period of Purple Crying program to educate new parents about ways to cope with a crying infant in an effort to reduce the families’ risk for child abuse and abusive head trauma. And home visiting, nursing, child welfare and licensing staff all evaluate the safety of homes and daycares throughout the state.

Those who care for Maine’s children are working tirelessly together to improve Maine’s infant mortality rate. While it may take time for the data to reflect the impact of our work, I am confident that our commitment will save infants’ lives.

Dr. Christopher Pezzullo is the state health officer at Maine Department of Health and Human Services.

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