State of South Dakota's Child: 2023.

In 2022, there was a decrease in births in the state with 111 fewer resident newborns than in the previous year. This represented a decrease of 1% of its white and 3.5% of its AIBO (American Indian, Black and Other) births. The 2022 birth rate per 1,000 population for the state (12.3) is higher than observed nationally (10.9) but matches its 2020 rate that was an historic low. Approximately 22% of all births in 2022 were AIBO and this percent of the state's entire birth cohort has decreased in the past several years. The American Indian contribution to the AIBO cohort has also decreased as its racial diversity has increased. The percent of births that are low birth weight has consistently been lower in South Dakota than nationally. An increase of 16 infant deaths in 2022 from 2021 and the decreased number of births led to an increase in the infant mortality rate (IMR = deaths in first year of life per 1,000 live births) from 6.3 to 7.8, but this 2022 IMR is not statistically significantly higher than its previous five-year mean. Further, the 2022 increase in the IMR was almost entirely among white infants with the post neonatal mortality rate (PNMR = deaths between 28 and 365 days of life) decreasing between these two years for AIBO infants. Nonetheless, the state's five year mean rates of death (2018-2022) are significantly higher for the AIBO than white infants for the neonatal (0-27 days) and post neonatal periods of the first year of life. Recently, however, the ratio of AIBO to white post neonatal mortality rate (PNMR) has decreased, but increased for the neonatal mortality rate (NMR). Infants in South Dakota are significantly more likely between 2018 and 2022 to die of congenital anomalies, sudden unexpected infant death (SUID), and accidents/homicides than in the United States in 2021. SUID remains the leading cause of post neonatal death and its risk may be decreased when babies are placed to sleep supine and alone in environments that are devoid of soft hazards.

State of South Dakota's Child: 2022.

In 2021, South Dakota observed an increase in the number of births from 2020 when the state experienced its lowest historic birth rate. Nonetheless, this increase represented a 3.7 percent decrease from the state's previous five year (2016-2020) mean of live births. This growth in the 2021 cohort of newborns was seen almost entirely among its white population. Further, South Dakota's current rate of birth remains slightly higher than that observed nationally. Over recent years, the racial diversity of South Dakota's newborns became similar to that observed nation-wide with nearly one quarter being American Indian, Black or Other races (AIBO). This trended down in 2021 with 22 percent of the state's newborns AIBO. Further, in South Dakota, the percent of all AIBO newborns who are American Indian is decreasing. Currently, 60 percent of the AIBO population is American Indian compared to more than 90 percent in 1980. During the pandemic years of 2020 and 2021, racial disparities in perinatal outcome occurring during previous years continued to be observed but the onset of prenatal care in the first trimester for both white or AIBO pregnant women did not change. There were 71 infant deaths in 2021 yielding a decrease in South Dakota's infant mortality rate (IMR) from 7.4 to 6.3 (higher than the 5.4 IMR for 2020 for the U.S.). Though there was a decrease in the state's 2021 IMR to 6.3, the reduced rate from its previous five year mean of 6.5 is not statistically significant. The state's 2021 neonatal mortality rate (NMR = 0 to 27 days per 1,000 live births) and post neonatal mortality rate (PNMR=28 to 364 days per 1,000 live births) dropped for the white population and increased for the AIBO population, though the actual number of AIBO deaths associated with these rate increases were low. Between 2017- 2021, the South Dakota rates of death for AIBO compared to white newborns was significantly higher for perinatal causes, sudden unexpected death (SUID), and other causes. Compared to the U.S.' 2020 rates of infant mortality, South Dakota's comparable 2017-21 rates were significantly higher for congenital anomalies. In 2021 there were 15 deaths in the state due to SUID; a decrease from the previous year, yet little overall improvement in decreasing the rate of this cause of death has not been achieved. Between 2017 and 2021, SUIDs comprised 22 percent of infant deaths for both white and AIBO infants. A discussion of strategies to prevent these persisting tragedies is presented.

State of South Dakota's Child: 2021.

The total number of 2020 resident births in South Dakota continues to decline with a 4 percent decrease from the previous year yielding the state's lowest crude birth rate (12.3 per 1,000 population) since its first recording in 1910. Currently, similar to the U.S., approximately one-quarter of all births are minority. The percentage of American Indian births is decreasing in its contribution to this population of the state with a growing percent of African American and multi-race newborns comprising the minority population in the state. South Dakota had one more infant death in 2020 (n=81) compared to 2019. The decrease in births led to a non-significant increase in the state's infant mortality rate (IMR) from 7.0 to 7.4 that is significantly higher than the U.S. rate (5.6) in 2019. An increase in nine sudden unexpected infant deaths (SUID) from 2019 to 2020 contributed to the rising IMR. Compared to the U.S., South Dakota has a lower percent of its infant deaths among those who are low birth weight (55 vs. 66 percent). Approximately one-third of white infant deaths occurred after the first 27 days of life; this was true for approximately half of all minority infants. Overall, South Dakota's minority infants have significantly higher rates of neonatal and post neonatal death than its whites, specifically due to perinatal causes, SUID, and accidents/homicide. How SUID contributes to the state's IMR is an area for needed attention as these deaths are increasingly known to accompany risks that, if alleviated, could prevent loss of early life. An examination of data from the year 2020 is the first opportunity to see possible relationships between perinatal outcomes and the pandemic that spanned approximately three-quarters of this year. Drawing causal relationships is not possible, but several observations about the impact of the pandemic are made as natality and infant mortality data for this year are explored in this annual report.

Trends in Rates of Sudden Unexpected Infant Death (SUID): Hopes for Prevention.

Infant deaths that occur unexpectedly during sleep have been attributed over generations to various explanations for this shocking and tragic loss of life. Historically, these deaths have been coded as caused by sudden infant death syndrome (SIDS), which defied prevention. This paper explores the evolution of understanding SIDS to the current use of the term sudden unexpected infant death (SUID) defined by the Centers for Disease Control as including three causes: SIDS, accidental strangulation and suffocation in bed (ASSB) and unknown. Data presented in this paper demonstrate that with enhanced death scene investigations there has been a shift over the past three decades in how SUIDs are coded. In 1990-4, nationally, 84 percent of post neonatal deaths were attributed to SIDS, 12 percent to unknown, and 3 percent to ASSB. Most current data (2014-18) show that 42 percent are now attributed to SIDS, 34 percent to unknown, and 25 percent to ASSB. While there has been stalled progress in the decrease of SUIDs, the diagnostic shift observed yields promise for the prevention of these deaths with public health measures that educate the public on the hazards of safe sleep for babies.

State of South Dakota's Child: 2020.

Between 2015 and 2019, the total number of births in South Dakota declined by 7 percent. As infant mortality rates are calculated per 1,000 live births, slight increases or decreases in total deaths and deaths due to specific causes manifest in notable shifts in yearly infant mortality rates (IMR). In 2019, 10 more infants died than in 2018 (80 vs. 70). With the decline in the state's births, the IMR increased from 5.9 to 6.7, which is significantly higher than the U.S. rate of 5.7 for 2018. South Dakota's 2019 increase in births of very low birth weight infants and deaths due to congenital anomalies contributed to this increase in mortality. In South Dakota, between 2015-19, 62 percent of all infant deaths occurred during the first 27 days of life. Though the rate of death for the state's minority infants remains significantly higher than that of its white infants, a decline in the ratio of the minority to white IMR is noted. Further, the rate of death due to sudden unexpected infant death (SUID) remained stable between 2018-19 but there is evidence that increasingly these deaths are caused by accidental suffocation or strangulation in bed which is typically preventable with safe sleeping environments for infants. The interactions between birth weight, incidence, cause, and timing of death are explored in this annual review of infant mortality.

State of South Dakota's Child: 2019.

The year 2018 continued a three-year trend of decreasing live resident births in South Dakota with increased racial diversity among the minority cohort of newborns. In 2018 there was a decrease in very low birth weight newborns and this was reflected in a decline from the previous year's infant mortality rate (IMR) of 7.8 to 5.9 per 1,000 births. The state's 2018 IMR also is lower than its previous five year (2013-17) mean rate of 6.5 and is not significantly different than the most current 2017 rate (5.8) for the U.S. Decreases from 2017 were also seen in the state's neonatal mortality rate for its white and minority populations, although not for its post neonatal mortality rate. The distribution of causes of infant death in 2014-18 in South Dakota show that compared to the U.S. (2017), a lower percent of infant deaths were caused by perinatal causes and a higher percent were caused by sudden unexpected infant death (SUID). In South Dakota, there is a significantly higher rate of death due to SUID among its minority than white infants and the state's rate of death due to this cause is significanly higher than what is observed nationally in 2017. The complexity of addressing this cause of death in the state is discussed.

State of South Dakota's Child: 2018.

In 2017, similar to 2016, there was a decrease in total live resident births in South Dakota. Racial minorities comprised 25 percent of these newborns, demonstrating a similar pattern of diversity among births observed nationwide. Unlike 2016, when the state recorded its lowest ever rate of infant mortality (4.8 per 1,000 live births), in 2017 it spiked to 7.8. This increase was primarily observed in the neonatal deaths in both the white and minority population. An increase in births of very low birth weight newborns and deaths due to congenital anomalies partially contributed to this increase. Compared to the nation, a higher percent of the state's infant deaths occur among those with birthweights above 2499 grams. A positive finding apparent in the 2017 mortality data was the decrease in the rate of sudden unexpected infant deaths from what has been observed in recent years. The small number of births in the state requires caution in interpreting findings that show year to year variability. Nonetheless, while the trend in infant mortality in the state is declining, it remains higher than the 2016 rate 5.9 for the nation.

Racial differences within subsets of Sudden Unexpected Infant Death (SUID) with an emphasis on asphyxia.

OBJECTIVE: Sudden Unexpected Infant Deaths (SUID) is defined as a combination of Sudden Infant Death Syndrome (SIDS), Unknown Cause of Death (UCD) and Accidental Suffocation and Strangulation in Bed (ASSB). Overall rates from 2000 to 2015 have been trending down. Racial differences in occurrence are seen. STUDY DESIGN AND SETTING: Using the CDC Wonder Database, the total rates of SUID and its subsets were examined. RESULTS: Non-Caucasian infant death rates for the total SUID group, and the SIDS component, are trending downward significantly faster than for Caucasians. UCD trends in rates show an apparent small, non-significant, decline for non-Caucasians, and are unchanged for Caucasians. ASSB rates are trending upward slightly more rapidly (not significantly) for non-Caucasians than Caucasians. CONCLUSION: The trend showing ASSB trending upward more in non-Caucasians than Caucasians may suggest: 1) A racial difference that certifiers are more willing to certify SIDS than ASSB in Caucasians, and/or 2) Certifiers are biased towards certifying more ASSB than SIDS in non-Caucasians, and/or 3) Asphyxia risks may be increasing more in non-Caucasian SUIDs. Option #1 would require educational efforts to recognize the asphyxia risks in Caucasians. Option #2 would require documentation of racial bias in infant death certification followed by efforts to reduce the bias. Option #3 would require focused targeting of non-Caucasian populations to reduce asphyxia risks. Potentially all three scenarios could co-exist.

State of South Dakota's Child: 2017.

There was a slight decrease in 2016 from 2015 in the total number of live births in South Dakota, but it was the fifth consecutive year that there were more than 12,000 newborns in the state. Nearly one-quarter of South Dakota's births represent minority populations mirroring what is observed nationally. Infant mortality in South Dakota dropped to its lowest ever rate per 1,000 live births (4.8) in 2016. Fewer births of less than 500 g newborns, increased survival of very low birth weight newborns, and a decrease in deaths due to congenital anomalies contributed to this low mortality rate. Though there is little progress observed in decreasing the trend in rate of sudden unexpected infant death (SUID), 2016 brought a decrease in the rate of these deaths from a previous spike in 2015. While positive indicators are observed in the 2016 data, South Dakota's mean mortality rate of 6.6 for 2012-16 is statistically higher than the U.S. rate of 5.8 for 2014. Further, consistent with previous trends, the South Dakota mean 2012-16 mortality rate for minority infants (11.8) was significantly higher than that for white infants (5.1). These observations are discussed with strategies to prevent infant deaths.

Regional Infant and Child Mortality Review Committee 2017 Final Report.

The Regional Infant and Child Mortality Review Committee serves 10 counties in southeastern South Dakota and aims for its reviews to prevent future loss of life during childhood. The Committee reviewed 29 deaths in 2017 (compared to 32 cases in 2013, 25 in 2014, 24 in 2015, and 25 in 2016). In 2017, four deaths in the region were attributable to homicide, including, for the first time in the 21 years of the Committee's reviews, two cases involving adolescents. Similar to 2013, there was a spike of five deaths attributed to suicide, yielding a rate for the region that is higher than that observed nationally. Four infants in 2017 died of sudden unexpected infant death (SUID). Though this marked a decrease in the number of SUID observed in previous years in the region, each occurred in an unsafe sleep environment and reflects the need for continued community education regarding safe sleep. In addition, a car crash involving an unbelted teen driver led to a death revealing the ongoing need to promote seat belt use for all who operate vehicles. The report provides the Committee's recommendations for community action that could prevent future deaths of infants and children.

Regional Infant and Child Mortality Review Committee - 2016 Final Report.

The Regional Infant and Child Mortality Review Committee serves 10 counties in southeastern South Dakota and aims to use its reviews to prevent future loss of life during childhood. In 2016, the Committee reviewed 25 deaths (compared to 32 cases in 2013, 25 in 2014, and 24 in 2015). In 2016, three deaths in the region were attributable to maltreatment. This is an outlier from previous years when typically one such tragedy occurs and reveals the fragility of young life in stressed and unstable home environments. In 2016, there was also an increase from recent years in accidental deaths that included three children who were not properly restrained as passengers or while driving. In 2016, five infants died during sleep compared to seven the previous year and four of these deaths occurred with risks present in the sleep environment. The Committee has not seen progress towards decreasing infant deaths during sleep in our region. In fact, their number may even be increasing. The report provides the Committee's recommendations for community action that could prevent future deaths of infants and children.

State of South Dakota's Child: 2016.

In 2015, there was an increase in the number of births in South Dakota compared to the previous year. Further, the state's 2014 birth rate (14.4) exceeded the 12.5 rate observed nationally for this year. Similar to national trends, one-quarter of South Dakota newborns represent minority populations. The infant mortality rate of 7.3 for the state in 2015 was 24 percent higher than the 2014 rate. Analyses of factors that contributed to this increase show that twice as many infants died of sudden unexpected infant death (SUID) in 2015 as has been observed in previous years. SUID was the cause of 30 percent of the state's infant deaths in 2015 versus 19 percent in 2014. Between 2011 and 2015, the SUID rate has been four times higher for minority than white infants. A discussion of strategies for the prevention of these deaths is presented.

The Institution of a Standardized Investigation Protocol for Sudden Infant Death in the Eastern Metropole, Cape Town, South Africa,.

The rate for the sudden infant death syndrome (SIDS) in Cape Town, South Africa, is estimated to be among the highest in the world (3.41/1000 live births). In several of these areas, including those of extreme poverty, only sporadic, nonstandardized infant autopsy, and death scene investigation (DSI) occurred. In this report, we detail a feasibility project comprising 18 autopsied infants with sudden and unexpected death whose causes of death were adjudicated according to the 1991 NICHD definitions (SIDS, n = 7; known cause of death, n = 7; and unclassified, n = 4). We instituted a standardized autopsy and infant DSI through a collaborative effort of local forensic pathology officers and clinical providers. The high standard of forensic investigation met international standards, identified preventable disease, and allowed for incorporation of research. We conclude that an effective infant autopsy and DSI protocol can be established in areas with both high sudden unexpected infant death, and elsewhere. (SUID)/SIDS risk and infrastructure challenges.

State of South Dakota's Child: 2015.

In 2014 there was an increase in the number of births in the state with 24 percent representing minority populations. This year also brought a decrease from 2013 in deaths for infants, yielding an infant mortality rate of deaths per 1,000 live births (5.9) slightly below that of the most current national rate of 6.0 in 2013. Consistent with previous years, disparities persist in rates of death for white and minority infants with 45 percent of 2014 infant deaths (versus 24 percent of the births) represented by minorities. Between 2010 and 2014, 57 percent of white and 60 percent of minority post neonatal deaths in South Dakota were attributable to sudden unexpected infant death, accidents and homicide for both whites and minorities. The rates of infant deaths due to these causes, however, were significantly higher (p < .01) for minorities than for whites.

Regional Infant and Child Mortality Review Committee - 2015 Final Report.

The Regional Infant and Child Mortality Review Committee serves 10 counties in southeastern South Dakota and aims to use its reviews to prevent future loss of life during childhood. In 2015, the committee reviewed 24 deaths (compared to 32 cases in 2013 and 25 cases in 2014). Consistent with observations made in previous years, in 2015 all infants (n=7) who died during sleep did so with risks present in the sleep environment. Progress in decreasing these infant deaths in the region is not being observed, and in fact, may even be deteriorating. Two children died subsequent to a motor vehicle crash and neither were wearing a seat belt. The committee was pleased, however, to note that there were no childhood fatalities associated with teenaged drivers. One teen suicide in 2015 marked a decrease in the number observed in 2013 and 2014, but represents an ongoing concern about the safety of emotionally volatile adolescents. Further, one child homicide occurred in the region in 2015 reflecting the fragility of young in the presence of stressed and unstable home environments. The report provides the committee's recommendation for community action that could prevent future deaths of infants and children.

Death certification: a primer, Part IV--problems in death certification.

Beyond errors in diagnosis, procedural errors in completing the cause of death statement for the death certificate can usually be placed into a few distinct categories. Physicians often forget, after struggling to deal with a litany of medical problems, that an external event, usually trauma, brought a patient into their care in the first place. In these instances, the death needs to be reported to the coroner and the coroner must certify the death (since it was the external event that actually started the chain of events leading to the death). Likewise, physicians also must recognize a death that was precipitated by seemingly simple and common trauma, such as a fall in an elderly individual (which may seem like a natural event), must be certified by the coroner. Another common error in death certification is listing the elements of the cause of death statement in the wrong order, i.e., an order where one listing is not directly caused by the process listed directly under it. While listing nonspecific processes, such as congestive heart failure, in the cause of death statement is perfectly acceptable, what caused these nonspecific processes must also be listed beneath them. If that cause is unknown, then that needs to be stated. Abbreviations, of any kind, should not be part of the cause of death statement. Physicians should certify deaths for those patients they are providing care for, and in whom death is the result of known medical conditions, regardless of whether they or other medical personnel were actually present (in attendance) to witness the death.

Death certification: a primer part III--certainty and the unknown cause of death.

The level of certainty needed to assign a cause of death may be problematic. The certification regulations stipulate that a certifier only needs to believe that a proposed cause of death be more likely than not (i.e. anything more than fifty percent likely). While there is no requirement for absolute certainty in completing a death certificate, the consequences of a specific diagnosis (for example, a diagnosis of acquired immunodeficiency syndrome) may, at the discretion of the certifier, require a higher level of certainty. At times, however, a certifier may not know even a more likely than not cause of death. In some circumstances where death was not anticipated/expected and a thorough postmortem examination fails to establish a cause of death, listing the cause of death as unknown or undetermined is perfectly acceptable. Alternatively, death occurring in an elderly individual, where death would not be entirely unexpected and with no known medical history or stigmata of disease, poses a more difficult certification situation. In these situations the certifier may either choose unknown for a cause of death, or (preferably in my opinion) choose what he or she feels would be the most likely cause of death given the statistical likelihood of causes of death in individuals similar to the decedent.

Death certification: a primer. Part II--The cause of death statement.

The cause of death statement is the core of the death certification process for the physician certifier. The World Health Organization defines the cause of death as the disease or injury that initiates a chain of events leading to death. This cause of death needs to be listed at the bottom of the cause of death statement with the events the cause of death initiated (mechanisms of death) listed above in a direct causal relationship (cause of death 'A,' initiated process 'B,' that in turn caused process 'C,' that in turn produced 'D,' that directly led to the death). In addition to the cause of death and its attendant mechanism(s) of death, the death certificate also includes an area for other significant conditions. This area is to be used for significant medical conditions that are not part of the chain of event leading from the cause of death. An example of an, other significant condition, would be metastatic breast carcinoma in an individual dying of a ruptured aortic aneurysm. The manner of death is restricted to either natural or unnatural (accident, homicide and suicide). Physicians, unless they are also acting as a coroner, are only allowed to certify natural deaths.

Death certification: a primer. Part I--an introduction to the death certificate.

Unlike the medical record, the death certificate is a public legal document that deserves the certifier's best intellectual effort to complete. The death certificate serves a variety of purposes, to include: A. Legal proof of death, usually necessary for a family to receive social security, health insurance, and other death benefits. B. A closure statement to the family from the physician documenting his or her final diagnosis. C. A family heirloom document that preserves a family history of causes of death (which may be invaluable in documenting hereditary diseases within a family). D. The death certificate is the backbone of national death statistics. Incorrect data from death certificates translates into incorrect state and national death rates for all causes. Cause of death assessment is inherently inaccurate (autopsy studies suggest that at least 10 percent of deaths have major unrecognized underlying disease processes that would have altered therapy had they been known). Even correct diagnostic assessments, however, can be lost to the system if they are improperly entered on to the death certificate.

Blood alcohol levels for American Indian mothers and newborns.

Very little is known about the alcohol elimination rates of newborns who have had chronic alcohol exposure in utero. In these case reports, blood alcohol levels were taken immediately before delivery, at delivery, and postdelivery for 2 mothers who drank alcohol during their pregnancies and 3 single-birth newborns. Newborn A1 of Mother A had no physical characteristics of fetal alcohol syndrome (FAS). The initial blood alcohol level for this newborn was 38.4 mg/dL 129 minutes after birth, with a subsequent blood alcohol level of 5.5 mg/dL 304 minutes after delivery, resulting in an alcohol elimination rate of 11.3 mg/dL per hour. The blood alcohol level for Mother A was 87.4 mg/dL 66 minutes before delivery. Newborn A2 of mother A had FAS. Sixty minutes after delivery, the blood alcohol level for this newborn was 39.5 mg/dL, and the alcohol level of the mother was 42.1 mg/dL. Newborn B1 of mother B had FAS. At 67 minutes after birth, newborn B1 had a blood alcohol level of 246.5 mg/dL, which dropped to 178.7 mg/dL 302 minutes after birth, resulting in an alcohol elimination rate of 17.3 mg/dL per hour. This alcohol elimination rate is within the metabolism range (15-49 mg/dL per hour) of adults with alcoholism. The maternal blood alcohol level was 265.9 mg/dL 27 minutes before delivery. Blood alcohol levels drawn on both the mother and newborn at delivery and 2 or 3 hourly follow-up levels can provide evidence that fetal alcohol dehydrogenase activity is induced by chronic maternal alcohol use.