Natural death is the leading cause of death in children because half of all deaths happen in infancy and 95% of infant deaths are natural. Older children die of natural causes most often from complications of congenital anomalies, cancer, heart and respiration problems and infection.

The 2003 Michigan Health Statistics reports that for every 1,000 infants born in Michigan, approximately nine will die before the age of one.  Neonatal deaths refer to babies who die within their first 28 days of life.  They represent about two-thirds of infant deaths and the largest single group of deaths in the state.

The remaining third occur as post-neonates from day 28 and up to age one.  Of the deaths occurring during the neonatal period, about half happen in the first week of life, often from congenital anomalies or conditions associated with prematurity, low birth weight and respiratory distress.

Prematurity and low birth weight continue to be the greatest predictors of infant mortality.  Preterm refers to births occurring before the 37^th week of pregnancy, and low birth weight infants are those weighing less than 2500 grams or 5 ½ pounds at birth.  While vast improvements have been made in treating these infants, preventing babies from being born too early and too small is still a great challenge.

In 2002, there were 15,510 preterm births in Michigan, representing 11.9% of all live births. Between 1992 and 2002, the rate of infants born preterm in Michigan increased more than 10%The rate of preterm birth in Michigan is highest for black infants (18.4%), followed by Native Americans (12.5%), Hispanics (11.0%), whites (10.3%) and Asians (9.2%).  Compared with singleton births (one baby), multiple births (twins, triplets and higher) in Michigan were about six times as likely to be preterm in 2002.

There are still many gaps in our understanding of why some women go into labor well ahead of schedule.  Risk factors for preterm birth and low birth weight include:  previous preterm birth and/or low birth weight infant, multiple birth, smoking, unplanned pregnancy and poor nutrition.  Certain pregnancy complications such as high blood pressure and diabetes increase the risk of prematurity.  Other significant risks are genital tract infections (including sexually transmitted diseases), stress, anxiety, depression and other psychological factors.  Recent studies are looking at the long-term effects of stress over time and even inter-generational factors contributing to preterm delivery and low birth weight.

Preconception care helps to ensure that a woman is in optimal health before getting pregnant. Attention to nutrition, healthy weight and use of tobacco, alcohol and drugs improves the chance for a healthy birth outcome.  Early access to quality prenatal care, including health promotion, risk assessment and appropriate interventions can also have an impact on preventing preterm births and increase the odds for an infant having normal birth weight.

According to the 2000 Pregnancy Risk Assessment Monitoring (PRAMS) data, the overall prevalence of unintended pregnancies in Michigan was 41%.  For births to mothers on Medicaid, this rises to 66%.  Unintended pregnancy rates are highest for black women, teens between the ages of 13 – 17 years, women with less than a high school diploma, unmarried women and women with an annual household income of $10,000 or less.

If a pregnancy is unintended and unwanted, the mother is more likely to seek prenatal care late in pregnancy, or not at all.  She is more likely to expose the fetus to harmful substances such as tobacco, alcohol or illegal drugs.  Women who are not committed to the pregnancy are less likely to alter behavior or follow their provider’s advice, thus increasing the risk of a premature or low birth weight infant. 

Stresses brought on by or made worse by the pregnancy, including chronic anxiety, substance abuse and domestic violence also play a great role in increasing the risk of poor birth outcomes.  A study by Michigan State University researchers in Saginaw, Michigan, found that half of all infant deaths they reviewed were to mothers who were current or prior victims of domestic violence.

When families experience the loss of an infant, access to and utilization of bereavement support services can be very effective in helping them deal with the loss and prepare for successful subsequent pregnancies.  MDCH, in a partnership with Tomorrow's Child of Michigan, has expanded the number of bereavement visits to six for families whose child dies suddenly and unexpectedly.

During almost any given year in Michigan, a number of highly publicized abandoned baby cases bring attention to the number of babies born to mothers, usually teens, who deny and/or hide their pregnancies and births. In a matter of three years, child death review teams reviewed seven deaths of infants whose mothers hid their pregnancies and births.  They found that in most cases the mothers were young and afraid to tell an adult of the pregnancy.  The teens typically managed to hide the pregnancy, did not obtain prenatal care and gave birth in secrecy without seeking help.  In a number of the cases, the mothers believed their babies were stillborn.  Michigan passed four new laws in June 2000 to address these cases.  Under the new laws, parents who do not want their newborn baby can surrender it to a person on duty at a hospital, police or fire station.  When parents follow this procedure, they can use it as an affirmative defense against prosecution for child abandonment or exposure (not against child abuse or neglect).  A hotline was established to provide information that could prevent infant abandonment and help parents find the help that they need.  This package of laws puts in place a system that attempts to protect infants from injury or death.