Each year more than four million families in the United States bring home from the hospital a healthy baby who has all of the potential for a full and productive life. The birth of a baby is a joyous event, and the baby's survival is taken for granted. But one family in 100 will suffer the loss of their child soon after birth (www.kidshealth.org). A baby is delicate and has not developed immunities to widespread diseases. When a country has a high rate of infant death, it usually signals high mortality risk from infectious, parasitic, communicable, and other diseases associated with poor sanitary conditions and malnourishment (www.prb.org). As a result, the infant mortality rate, which is the number of deaths of children under age 1 per 1,000 live births, is considered one of the most sensitive measures of a nation's health (McKenzie, 2005). Infant death is an important measure of a nation's health because it is associated with a variety of factors, such as maternal health, quality of access to medical care, socioeconomic conditions and public health practices (McKenzie, 2005).
Infant mortality has two components, neonatal mortality and post-neonatal mortality. Neonatal mortality is deaths that occur during the first 28 days after birth. The most common causes of neonatal deaths are premature deaths and low birth weight. Post-neonatal mortality is deaths that occur between 28 days and 365 days after birth. The most common causes of post-neonatal deaths are sudden infant death syndrome and congenital birth effects. LOW BIRTH WEIGHT
Very little is known about the causes of low birth weight and preterm birth despite an extensive amount of research (www.futureofchildren.org). Low birth weight that results from suboptimal intrauterine growth is associated with three major risk factors: cigarette smoking during pregnancy, low maternal weight gain, and low pre-pregnancy weight. These three risk factors account for nearly two-thirds of all growth-retarded infants (Kramer, 1997). Other risk factors for low birth weight include race, first births, female sex, short maternal stature, maternal low birth weight, prior low birth weight birth, maternal illnesses, fetal infections, and a variety of metabolic and genetic disorders. While these risk factors may provide important clues about the causes of low birth weight, many of them are only weakly related to low birth weight and are generally not modifiable by intervention programs or changes in public policy (www.futureofchildren.org). SUDDEN INFANT DEATH SYNDROME (SIDS)
SIDS, or Sudden Infant Death Syndrome, is defined as the sudden, unexpected, and unexplained death of any infant or young child (McKenzie, 2005). SIDS is the most widespread cause of infant death in developed countries. SIDS accounts for about half of the deaths that occur between one month and one year of age (McKenzie, 2005). The peak period for SIDS is between two and four months old. It is very rare before one month of age, and at least 95 percent of all the cases have occurred before children reach six months old (www.kidshealth.org). SIDS is rare in babies who sleep face up in a crib or who sleep face up with a mother not using alcohol, drugs, or cigarettes (and not on a waterbed or soft sofa). SIDS is more common in babies who sleep in humid environments, who are over-bundled, who nap in rooms with space heaters, who are exposed to cigarette smoke, who sleep on soft surfaces, who do not use pacifiers, and those who sleep face down or in a prone position (www.prb.org). The rate of SIDS is also elevated in those babies who do not receive timely well-child care and immunizations.
Situations that occur even before the baby is born may affect the risk of SIDS. Anything that causes a smaller amount of oxygen to get to the baby in the uterus will increase his or her risk. Usually, smoking during pregnancy doubles the likelihood, and the odds increase with each cigarette. Other drugs of abuse such...