NIH's PRB Progesterone Therapy Adopted by State of Michigan to Combat Infant Mortality

An Infant Mortality Reduction Plan has been unveiled by the Michigan Department of Community Health (MDCH). This is a strategy that includes significant recommendations developed from medical research conducted by the Perinatology Research Branch (PRB) of the Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health (NICHD/NIH), at the Wayne State University School of Medicine.

Announced Aug. 1, the plan promotes the adoption of universal cervical length screening by ultrasound and the use of progesterone in women identified as high risk for premature birth. The use of progesterone in women with a short cervix can reduce the rate of preterm birth — the leading factor in infant mortality — by as much as 45 percent, according to research findings published by the PRB. The study, released last year, was conducted at more than 40 centers worldwide. Roberto Romero, M.D., branch chief of the PRB, was the principal investigator on behalf of NICHD/NIH. Wayne State was the lead center in the trial, led by Sonia Hassan, M.D., associate dean for maternal, perinatal and child health at WSU.

The ultrasound examination is simple to perform, painless and can be performed between the 19th and 24th weeks of pregnancy. Pregnant women with a cervix less than 20 millimeters are at very high risk for preterm delivery. If a woman is found to have a short cervix, she can be treated with vaginal progesterone. Treatment with vaginal progesterone reduced the rate of preterm birth, neonatal morbidity and respiratory distress syndrome. Women can self-administer a once-daily dose.

The recommendation that the state adopt the progesterone protocol was first introduced by Valerie M. Parisi, M.D., M.P.H., M.B.A., dean of the WSU School of Medicine, during the state's Call to Action to Reduce and Prevent Infant Mortality Summit in October 2011. The summit, convened by Gov. Rick Snyder to address the state's high rate of infant mortality, brought together hundreds of health care providers and stakeholders to develop recommendations to combat the problem.

"The strategies introduced by the state today will go a long way in dramatically reducing the state's infant mortality rate, which remains too high," Parisi said. "The key recommendations were developed through medical research conducted at the Perinatology Research Branch at Wayne State University, which demonstrates the branch's significant importance to the people of Michigan and the Detroit region."

The MDCH, headed by Director Olga Dazzo, said the strategies were selected because they reflect evidence-based practices that will reduce and prevent infant deaths.

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While the 2010 state infant mortality rate set a new record low at 7.1 deaths per 1,000 live births, Michigan's rate remains higher than the national average of 6.1 deaths per 1,000 live births, according to the MDCH.

Premature birth is the leading cause of infant mortality in Michigan. The rate of premature birth increased more than 10 percent between 1998 and 2008. One of every eight babies born in Michigan — 295 in an average week — is born prematurely. And Michigan's rate of preterm birth (12.7 percent) exceeds the national average of 12.3 percent.

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The new practices call for the state to partner with Wayne State University and the Detroit Medical Center to share progesterone therapy practices and develop protocol and implementation statewide. The state also will coordinate with the Medical Services Administration to assure benefit coverage for universal ultrasound screening of pregnant women and progesterone administration for Medicaid covered pregnancies.

"The implementation of universal cervical ultrasound screening for all pregnant women to identify women at risk for premature birth, and the use of vaginal progesterone, will be critical in the plan to reduce the rate of preterm birth and infant mortality," said Hassan.

Statewide universal ultrasound screening, Parisi said, would be cost effective if the scan costs no more than $186. With Michigan's 110,000 births annually, the potential cost savings would be $19,603,380 (in 2010 dollars) for every 100,000 women screened.

Premature births are costly. Nationally, preterm birth is a $26 billion annual problem. The CDC reports that preterm births topped the list of the most expensive hospitalizations in Michigan in 2007. Each premature birth in the state costs an average of $102,103 at the time of discharge from the hospital. That is 14 times the cost of a normal birth.

The state's other strategies include promoting the adoption of policies to eliminate medically unnecessary deliveries before the 39th week, promoting safe infant sleep practices to prevent suffocation, expanding home-visiting programs to support vulnerable women and infants, programs to reduce unintended pregnancies, and weaving social determinants of health into all its strategies to reduce racial and ethnic disparities in infant mortality.



Source-Eurekalert