Nebraska Child Death Review Team

1.      Pregnancy-Related – 87 deaths

Pregnancy-related factors such as prematurity, maternal complications, and events of labor and delivery were the underlying cause of 29% of all infant and child deaths during 2004.   Of these, prematurity accounted for 51% and maternal complications for 42%.  Among infant deaths attributed to prematurity, 55% were to multiple gestation infants who are known to have both higher prematurity and mortality rates.  One infant died from a perinatally-transmitted HIV infection.  Preconception care - interventions begun before the start of pregnancy, may represent the best opportunity to reduce perinatal risk factors and improve pregnancy outcomes.

Preconception care should be considered a vital and routine aspect of care for all reproductive age women.

All personnel who are involved in the care of pregnant women, fetuses   and newborns should use the current AAP Guidelines for Perinatal Care. 

The Centers for Disease Control and Prevention recommends that all pregnant women have access to HIV counseling and testing and, when indicated, antiretroviral (ARV) medications during labor to prevent HIV transmission to their babies.

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2.      Birth Defects – 74 deaths

Heart defects (19.2%) and chromosomal anomalies (17.8%) were the largest categories of lethal birth defects.  Six infants and two older children died from neural tube defects. The causes of most birth defects, including chromosomal anomalies, are unknown.  However, women who do not take multi-vitamins, who use alcohol, tobacco or other drugs, who are overweight or who have diabetes are at higher risk of having a child with birth defects.

Women of childbearing age, whether or not they plan on becoming pregnant, should consume a daily multi-vitamin containing 400 micrograms of folic acid, the best way to prevent neural tube defects.

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3.      Motor Vehicle-Related Incidents – 40 deaths 

Eighty-two percent (81.5%) of motor vehicle-related deaths occurred to children killed while riding in a motor vehicle, and an additional five children (12.8%) were killed in all terrain-type vehicles (ATV) and motorcycle crashes.  While the total number of children killed in motor vehicle-related incidents has declined over time, under-use of age-appropriate restraints (safety belt or child safety seat) continues to be a leading factor.  Statewide, alcohol was involved in one out of four crashes where a child died.

Nebraska’s graduated licensing law should be strengthened to include provisions on passenger restrictions (number of passengers) and night time driving restrictions for teen drivers.

Parents should limit the number of teenage passengers a teen driver may carry.

Children under 16 should not ride or drive adult size all terrain-type vehicles (ATV) under any circumstances.

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4.      Unintentional Injuries – 22 deaths 

The majority of unintentional injury deaths were from drowning (27.3%), residential fire (18.2%), and accidental suffocation or hanging (13.6%).  One teen was killed while playing with a firearm.

Young children should never be unsupervised in or near water, even shallow wading pools.

Children who are in the vicinity of moving motor vehicles or machinery should be under focused adult supervision at all times.

Parents who keep firearms in the home must understand the importance of storing unloaded firearms and ammunition in separate, locked and inaccessible locations.

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5.      Cancer / Malignant Neoplasms  - 19 deaths 

After years of slight declines, the overall childhood cancer mortality rate in Nebraska rose significantly in 2004, largely due to an increase in brain tumor-related deaths.  Although a relatively small number, 2004’s 13 brain cancer cases represented a rate of 2.99 deaths per 100,000 children, a significant increase from the 1994-2003 average rate of 0.96 deaths per 100,000 children.  There were no significant differences in mortality rates by child’s race, ethnicity or sex.  It is difficult to predict whether the increases seen in 2004, which are spread out around the state, represent the beginning of a sustained increase or a one-time phenomenon.  The Nebraska Cancer Registry, the Comprehensive Cancer Control Program and the CDRT will continue to monitor childhood cancer occurrence and risk factors.

Providers should stay up to date on findings regarding risk factors for, causes of and treatments for childhood cancers. Children diagnosed with cancer should be enrolled in clinical trials in order to receive access to the newest experimental treatments. 

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For more information, contact:
Debora Barnes-Josiah, Ph.D.
Nebraska Child Death Review Team Coordinator
Phone: (402) 471-9048
Fax: (402) 471-7049

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