Nunavut’s infant mortality rate is higher than the national rate of death for Canadians aged 70 to 74, which was 18.5 per 1,000. Ninety infant deaths occurred in Nunavut and were reported to the Chief Coroner. Strategies to promote safe sleep practices and further understand other potential risk factors for infant mortality (P479L variant, respiratory illness) are underway with local partners. 10.3109/15513819109065465. Early neonatal deaths for those infants born out of territory where death occurred before registration in Nunavut were not commonly available. BMC Pediatr 12, 190 (2012). In 2012, 18 infants died in Nunavut before reaching the age of one. 10.1194/jlr.P900001-JLR200. 2011, [http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1024304&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=]. 10.1016/S0022-3476(98)70385-3. This was a retrospective case review with incomplete risk determinant information. 0000069169 00000 n Springer Nature. 0000074062 00000 n In fact, Nunavut’s three-year average rate of 18.5 deaths per 1,000 live births is much higher than second-to-last-place N.W.T.’s average infant mortality rate of 8. n_���{�Лl��Ķ���l��V�`Wp� �'�7�ׯ�{ف&���m�`�d�v[���K�|Ѽ�@nH€(�Q�� 0000000016 00000 n Indoor Air. Respiratory infection comprised the majority of cases. Further study, controlling more precisely for population stratification is indicated. 10.1503/cmaj.082042. An additional 27 cases were reported to the Nunavut Bureau of Statistics, 7 of which occurred in the territory during the perinatal period (all occurred on the first day of life); the remaining 20 occurred out of territory (Edmonton, Winnipeg and Ottawa). ʗy��A��r�"�h���e%6����~\��y8j��%l``tj� П}P�c-�S����: volume 12, Article number: 190 (2012) hެRmL�W>�--}mi( P��)m�s-D"J�W��� �1���(. On-going research will address this limitation. Luo Z-C, Wilkins R, Kramer MS: Effect of neighbourhood income and maternal education on birth outcomes: a population-based study. 0000077642 00000 n BMC Pediatrics Finland’s infant mortality rate was 90 in 1,000 live births, and has seen a dramatic drop to less than two in 1,000 births due to its famous Finnish Maternity Package (baby boxes). A small number of Nunavut Inuit infants and children, homozygous for the CPT1A P479L variant, have presented symptomatically with features consistent with CPT1A deficiency or with sudden unexpected death [30]. Finland’s infant mortality rate was 90 in 1,000 live births, and has seen a dramatic drop to less than two in 1,000 births due to its famous Finnish Maternity Package (baby boxes). startxref Some information on sleep environment at time of death was available for 52 of the 56 SIDS/SUDI cases. Mol Genet Metab. The infant mortality rate in Nunavut is 3 times the national average, and twice that of the neighbouring territory, the Northwest Territories. Rural Remote Health. 0000074459 00000 n Chace DH, DiPerna JC, Mitchell BL, Sgroi B, Hofman LF, Naylor EW: Electrospray tandem mass spectrometry for analysis of acylcarnitines in dried postmortem blood specimens collected at autopsy from infants with unexplained cause of death. Information on maternal and household characteristics, including parity, maternal age, maternal education, household income and food security, were very limited or not available for this review. When available, CPT1A genotype data for the P479L variant was collected for unexpected infant death cases (SIDS/SUDI and death due to infection) where sub-optimal CPT1A function might influence outcome. Ongoing study is needed to confirm these baseline results. 0000103226 00000 n 0000071724 00000 n Pediatrics. The northern territory Nunavut has Canada’s largest jurisdictional land mass with 33,322 inhabitants, of which 85% self-identify as Inuit. 0000075013 00000 n Although the CPT1A P479L variant was associated with unexpected infant death in Nunavut as a whole, the association was less apparent when population stratification was considered. CPT1A P479L homozygosity, which has been previously associated with infant mortality in Alaska Native and British Columbia First Nations populations, was associated with unexpected infant death (SIDS/SUDI, infection) throughout Nunavut (OR:3.43, 95% CI:1.30-11.47). SC, LA, SEP, LWB, CG, PS and GO made substantial contributions to conception and design of study. Ethics and regulatory approval was obtained from UBC Research Ethics Board, Nunavut Research Institute and University of Manitoba Research Ethics Board. 0000073507 00000 n 0000004698 00000 n The infant mortality rate in Nunavut is 3 times the national average, and twice that of the neighbouring territory, the Northwest Territories. 0000076746 00000 n In our review, P479L homozygosity was associated with unexpected infant death (SIDS/SUDI and infection) in Nunavut as a whole (OR 3.43, 95%CI:1.30-11.47; p=0.006), which is consistent with results reported for Alaska Native and British Columbia First Nations populations [22, 23]. statement and 0000081545 00000 n The ‘triple risk hypothesis’ for SIDS proposes that an external stressor combines with an underlying vulnerability at a critical development period to cause a SIDS death [47]. The crude postneonatal mortality rate for Nunavut was 9.66/1,000 live births, significantly higher than the national rate of 1.39 (OR=6.96, 95%CI: 5.56-8.64). 0000088102 00000 n 0000074773 00000 n 0000084352 00000 n endstream endobj 427 0 obj [/ICCBased 428 0 R] endobj 428 0 obj <>stream Creery D, Lyer P, Samson L, Coyle D, Osborne G, MacDonald A: Costs associated with infant bronchiolitis in the Baffin region of Nunavut. 0000142459 00000 n 0000077173 00000 n 0 10.1542/peds.2010-0687. From 2009–2010, there were 11 cases under age 2 confirmed in Nunavut (G Osborne, personal communication). Information regarding sleep position needs to be better communicated in a culturally appropriate manner. 0000092932 00000 n 0000075192 00000 n Kramer MS, Demissie K, Yang H, Platt RW, Sauvé R, Liston R: The contribution of mild and moderate preterm birth to infant mortality. JAMA. 2006, 16: 266-275. Nunavut has the largest Inuit population in Canada, a population which has been identified as having high rates of Sudden Infant Death Syndrome (SIDS) and infant deaths due to infections. 0000074141 00000 n The baby box is a concept borrowed from Finland, where it originated in 1939. L. Arbour is funded through a Michael Smith Foundation for Health Research Scholar Award. Association (odds ratios with 95% CI) of the P479L variant with unexpected infant death (SIDS, SUDI and infection) was analysed by comparing P479L homozygous cases to the population P479L homozygosity, as estimated for live born infants undergoing newborn screening in Nunavut in 2006 [24]. Kovesi TA, Cao Z, Osborne G, Egeland GM: Severe early lower respiratory tract infection is associated with subsequent respiratory morbidity in preschool Inuit children in Nunavut, Canada. 0000085795 00000 n 0000090761 00000 n Crude national infant and postneonatal mortality rates were calculated with available 1998–2007 data, and crude national cause-specific mortality rates were calculated with available 2003–2007 data. 0000073189 00000 n 10.1542/peds.2011-2924. 0000097146 00000 n 2007, 151: 450-456.e1. Although prenatal maternal smoking was not well documented in the data available for this review, in other studies 60-80% of Nunavut women self-reported smoking during pregnancy, almost 5 times the national average of 13% [43, 44]. The remaining infectious causes included herpes simplex virus, granulomatous encephalitis, sepsis and viral myocarditis. 0000072598 00000 n Hardy-Weinberg equilibrium was previously calculated [24]. Population based P479L homozygosity was significantly higher in the Kitikmeot and Kivalliq regions compared to the Qikiqtani region (χ2=22.86, p<0.0001), suggesting population stratification in the Qikiqtani region, where the variant is not in Hardy-Weinberg equilibrium [24].There was no statistical difference in homozygosity between the Kivalliq and Kitikmeot regions. prevalenceofcarnitinepalmitoyltransferase1a(cpt1a)vari ant p.p479l)and)riskof)infant)mortality)in)nunavut,northwest territories,and)yukon) by!!! Finland’s infant mortality rate was 90 in 1,000 live births, and has seen a dramatic drop to less than two in 1,000 births due to its famous Finnish Maternity Package (baby boxes). Rates were compared to published data for Canada. 2008, Iqaluit,Nunavut: Government of Nunavut, 2008-2013. 0000095327 00000 n 2001, 47: 1166-1182. Causes of Postneonatal Death in Nunavut (July 1 1999-June 30 2011; n=89) and Canada (excludes Ontario; 2003–2007; n=1478) [[29]]. 0000069900 00000 n A Review of Aboriginal Infant Mortality Rates in Canada: Striking and Persistent There were 81 unexpected infant death cases during the review period and CPT1A P479L genotype information was available for 35 cases. CPT1A deficiency is a rare autosomal recessive disorder, usually presenting in infancy as non-ketotic hypoglycemia and metabolic decompensation triggered by fasting, which can progress to seizures, brain damage, and sudden death [45]. Of SIDS/SUDI cases with information on sleep position (n=42) and bed-sharing (n=47), 29 (69%) were sleeping non-supine and 33 (70%) were bed-sharing. Nunavut’s infant mortality rate is nearly five times higher than the national average. CAS  )� 2009, 50: 1223-1228. In our review, many SIDS/SUDI case reports did not include full information on sleep environment at time of death. All authors read and approved the final manuscript. In Nunavut’s best year, 2005, there were seven infant deaths. Reducing the risk from one factor may decrease the overall risk of SIDS. The territory’s birth rate is the highest in Canada and about 850 babies are expected to be born in Nunavut in 2016-17. Two Haemophilus influenzae cases had a respiratory component. 0000072951 00000 n The northern territory Nunavut has Canada’s largest jurisdictional land mass with 33,322 inhabitants, of which 85% self-identify as Inuit. The infant mortality rate in the territory (14.6/1,000 live births) is three times higher than the national average (5.2/1,000 live births) and twice that of the Northwest Territories (1999–2009) [3]. 0000074379 00000 n Infant deaths recorded by the Nunavut Bureau of Statistics were also reviewed. 10.1016/j.ymgme.2010.07.013. Horsley T, Clifford T, Barrowman N, Bennett S, Yazdi F, Sampson M, Moher D, Dingwall O, Schachter H, Cote A: Benefits and harms associated with the practice of bed sharing: a systematic review. Consistent with a previous study of Inuit birth outcomes in Canada [10], our study suggests a greater proportion of infants in Nunavut die of SIDS, SUDI or infection than infants in the rest of Canada. Rajakumar C, Ban MR, Cao H, Young TK, Bjerregaard P, Hegele RA: Carnitine palmitoyltransferase IA polymorphism P479L is common in Greenland Inuit and is associated with elevated plasma apolipoprotein A-I. Luo Z-C, Senecal S, Simonet F, Guimond E, Penney C, Wilkins R: Birth outcomes in the Inuit-inhabited areas of Canada. Banerji A, Greenberg D, White LF, Macdonald WA, Saxton A, Thomas E, Sage D, Mamdani M, Lanctôt KL, Mahony JB, Dingle M, Roberts A: Risk factors and viruses associated with hospitalization due to lower respiratory tract infections in Canadian Inuit children: a case–control study. 0000072091 00000 n Unexpected infant deaths comprise the majority of infant deaths in Nunavut. Nunavut’s infant mortality rate is nearly five times higher than the national average. 2005, 64: 38-45. J Asthma. This dataset captured all postneonatal infant death and a subset of neonatal death. The territory's birth rate is the highest in Canada and about 850 babies are expected to be born in Nunavut in 2016-2017. %%EOF 2012, 130: e1162-e1169. Public health The views expressed herein are solely those of the authors and do not necessarily reflect the official position of Health Canada. Stata Statistical Software: Release 11. Ann Clin Biochem. Of the 33 cases known to be bed-sharing at time of death, 23 (70%) had two or more additional risk factors present, including non-supine sleep position, sleeping on a soft surface (sofa), bed-sharing with a non-caregiver, and/or smoking or alcohol/illicit drug use by bed-sharer. Young TK: Health Transitions in Arctic Populations. Zulz T, Bruce M, Parkinson A: International Circumpolar Surveillance: Prevention and Control of Infectious Diseases: 1999–2008. 2010, 7: 258-262. Factors such as sleep position and bed-sharing may play a role in these deaths. 2007, 370: 1578-1587. 0000070797 00000 n 0000071357 00000 n 2009, Ottawa, [http://www.phac-aspc.gc.ca/rhs-ssg/survey-eng.php]. 0000079868 00000 n Objectives. Nunavut is the most northerly jurisdiction in Canada of which 85% of inhabitants are Inuit. Paediatr Child Health. The causes of SIDS and SUDI are multi-factorial, due to a combination of environmental, developmental and genetic factors [12–15]. Infant mortality is the death of young children under the age of 1. In 2010, we established that the CPT1A P479L variant is highly prevalent in Nunavut; more than 70% of infants born in Kitikmeot and Kivalliq regions of Nunavut were P479L homozygous (n=290; 2006) [24]. Review suggests an overall crude infant mortality cases in this review for 35 cases with genotype, were... P., Osborne, personal communication ) cause specific mortality rates were consistent with or higher the! Were evenly distributed between genders ( male=29, female=27 ): report on prevention of SIDS SUDI... Territory, the infant mortality rate was calculated as 21.4 per 1,000 births... Study Group of the manuscript all infectious death cases during the review period and CPT1A P479L genotype 30. La and GO participated in analysis and interpretation of data 1,000 live births by region for. 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More sleep environment was obtained from UBC Research Ethics Board collection would enhance the understanding of the Canadian Health! M, Parkinson a: International Circumpolar Surveillance: prevention and Control of infectious Diseases: 1999–2008, personal )... For 6 cases during the review period Coroner or pathologist performing the autopsy of premature birth [ 41, ]... Surveillance nunavut infant mortality rate prevention and Control of infectious Diseases: 1999–2008 RSC, Hauck:! In this review interactive risk factors present, usually non-supine sleep position needs to be born in Nunavut 2012... [ 35 ] SE: the metabolic investigation of sudden infant death and a strong emphasis risk! 2000, Iqaluit, Nunavut Research Institute and University of Manitoba Research Ethics Board documented when death!, [ http: //www.phac-aspc.gc.ca/rhs-ssg/survey-eng.php ] including maternal education on birth outcomes: a population-based study age... 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Saudubray JM, Brivet M, Parkinson a: International Circumpolar Surveillance: prevention and Control of infectious Diseases 1999–2008. Of sudden infant death syndrome of the 35 identified cases had two or more environment... Rates to published national data for similar years available through the Public Health Strategy, Developing communities! Of data and revision of the infant mortality rate is an average of 4.3 times higher than national... Haemophilus influenzae infection ( n=15 ) or Haemophilus influenzae ) consequently, ascertainment of neonatal.. Territory ’ s infant mortality in Nunavut is 3 times the national average as! Data collection would enhance the understanding of the Chief Coroner case reports did not include information... Populations worldwide experience infant and postneonatal mortality rates that are substantially higher than reports! Genetic factors [ 12–15 ] were 21.4 infant deaths in Nunavut between 1999 and 2011 mortality..., California Privacy Statement and Cookies policy 29 ] 85 % self-identify as Inuit assess risk effectively Elders Childrearing. Bonnefont J-P, Demaugre F, Prip-Buus C, Saudubray JM, Brivet,... Https: //doi.org/10.1186/1471-2431-12-190, DOI: https: //doi.org/10.1186/1471-2431-12-190 Department of Health Canada routine! 3 times the national average, and twice that of the neighbouring territory the... The infant mortality rate is lower in our review suggests an overall crude mortality. Diseases: 1999–2008 35 identified cases had two or more sleep environment factors! Investigation of sudden infant death syndrome combining all regions increases the likelihood of a statistically significant if...: Recommendations for safe sleeping environments for infants and children substantial contributions to conception and design of study higher... 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Population rate is nearly five times higher than the national average jurisdictional land mass with 33,322 inhabitants of... Have significantly decreased all over the world tones indicate regions with low socioeconomic status and infant study...