Transcript Slide 1

January 2005-December 2009
Overview of the Fetal & Infant Mortality
Review Process
 One of the outcome measures included in the
Coalition’s contract with the state is that our infant
mortality rate not be higher than the state rate when
adjusted for mother’s age, race and education level.
 In order to address our high infant mortality rates, the
Coalition started its FIMR project in 1995. We receive
funding from the Florida Department of Health and the
Coalition itself.
 The purpose of FIMR is to examine cases with the worst
outcomes to identify gaps in services that might be
addressed through community action.
 We select cases for review based on specific criteria such
as those from areas where the infant mortality rates are
the highest, fetal losses over 36 weeks gestation or 2500
grams, outlying counties, etc.
Overview of the Fetal & Infant Mortality
Review Process
 The FIMR Case Review Team meets every other month and
uses a process developed by the American College of
Obstetrics & Gynecology. Information is abstracted from
birth, death, prenatal care, Healthy Start, hospital and
autopsy records. Efforts are also made to interview the
family.
 All the information we examine is de-identified. Our
purpose is to determine specific medical, social, financial
and other issues that may have impacted the poor birth
outcome.
 Every year, we draft recommendations based on our
findings for community action.
Resident Infant Mortality Rates-All Races
Northeast Florida and Florida
2000-2009
Prepared by L.Lee
Source: Birth and Death
Certificates/Vital Stats
Resident White Infant Mortality Rates
Northeast Florida and Florida
2000-2009
Prepared by L.Lee
Source: Birth and Death
Certificates/Vital Stats
Resident Nonwhite Infant Mortality Rates
Northeast Florida and Florida
2000-2009
Prepared by L.Lee
Source: Birth and Death
Certificates/Vital Stats
NEFL Infant Birth weight
2005-2009
N=811
NEFL Causes of Infant Death
2005-2009
*records may have more than one cause of death listed
N=811
NEFL Infant Age at Death
2005-2009
N=811
Nearly ½ of
post neonatal
deaths are
sleep related
63% of neonates die
w/in 1st 24 hours
1/3 of those die w/ in 1st
hour
Northeast Florida
Sleep related deaths
2005-2009
Causes of Infant Death
January 2005 – December 2009
15.1% for 2009
n for all deaths = 811
Prepared by L.Lee
Source: Birth and Death
Certificates
n for sleep related
deaths=132
Total Number of Sleep Related Deaths
Northeast Florida
2005 – 2009
2005
2006
2007
2008
2009
33
23
27
27
22
17.5%
14.6%
17.6%
16.4%
15.1%
Prepared by Llee
NEFL FIMR
Healthy Start Coalition
Rate Comparison
2005
2006
2007
2008
2009
# NEFL SIDS cases
10
10
6
6
3
NEFL SIDS
rate/1,000 live
births
.55
.53
.31
.32
.16
FL SIDS rate
.38
.39
.34
.34
# NEFL
Undetermined or
other sleep related
cases
23
13
21
21
19
1.83
1.21
1.40
1.45
1.21
NEFL sleeping
infant death
rate/1,000 live
births
Prepared by Llee
NEFL FIMR
Healthy Start Coalition
Risk Factor Comparison
2005 - 2008
n=110
2009
n=22
79%
82%
56%
77%
Not on back to sleep
67%
55%
Not in an infant bed
68%
68%
Risk Factor
Unsafe sleep surface (includes any noninfant bed, presence of unsafe items, soft surface,
etc.)
Unsafe items in bed (includes presence
of pillows, stuffed animals, bumper pads,
comforters, etc.)
Risk Factor Comparison (cont)
2005 - 2008
n=110
2009
n=22
Never breast fed
70%
50%
Sharing sleep surface
56%
68%
Second hand smoke
53%
82%
Maternal demographics
2009 sleep related deaths
 71% single
 67% white/33% black
 90% in 20’s (9% teens)
 Just over 1/2 with no HS diploma (one of these was 8th
grade or less)
 About 1/4 with HS diploma
NEFL Causes of Fetal Death
2005-2009
N=670
Resident Fetal and Infant Deaths
# of Cases by County
All Races
2005-2009
N=1479
Resident Infant Mortality Rates by County
All Races
2005-2009
State rate =
7.2
Prepared by L.Lee
Source: Birth and Death
Certificates/Vital Stats
Baker County-5 year summary
 35 total fetal and infant deaths; 24 infants/11 fetals
Zip
City
32063
MacClenny
20
32040
Glen St. Mary
10
Maternal Demographics:
 75% white; 15% black
 65% single moms
 35% with no HS diploma
 Only 5 had any college
 14.5% teens
Total Fetal and
Infant Deaths
Baker County (con’t)
Maternal behavior:
 41.2% w/ unhealthy
pregravid bmi-lowest
in project; highest %
w/ normal pregravid
bmi
 29% late or no pnc (2nd
worst)
 1/5 with poor birth
spacing (highest)
 21% w/ substance
abuse
Infants:
 Even split neonatal and
postneonatal deaths
 Sleep related death
make up 42% of all
infant deaths
 70% unsafe items
 60% not on back
 60% 2nd hand smoke
 50% bedsharing
Clay County-5 year summary
128 fetal and infant deaths; 67
infants/61 fetals
Zip
City
32068
Middleburg
41
32065
Orange Park
20
32073
Orange Park
30
Maternal demographics:
 51% single
 14.5% teens
 9% hispanic
 72% white
 26.6% with no HS diploma and 35% w/ some college
Deaths
Clay county (con’t)
Maternal behavior:
 23.4% substance
abuse
 23.4% late or no pnc
 51% unhealthy
pregravid bmi
(highest)
 Good birth spacing
Infant deaths:
 Nearly 40% are < 29
weeks
 61% are neonatal
 ½ of these
occurred in 1st 24
hrs
 low sleep related
 Highest occurrence
of congenital
anomalies
Nassau County-5 year summary
44 total deaths: 25 infant and
19 fetal
Maternal Demographics
 84% white, 12% black,
 54% single
 26% w/out HS diploma
 28% w/ some college
 16% teen mothers
(highest)
 54% single
Zip
City
Deaths
32011
Callahan
8
32034
Fernandina
10
32097
Yulee
19
Nassau County (con’t)
Maternal behavior:
.
 30% w/ self reported substance abuse
(highest)
 46.5% w/ unhealthy pregravid BMI
 Lowest birth spacing issues (only 1 case)
 16.3% late or no pnc
Infants:
72% neonates
•44% < 29 weeks
•25% had some type of congenital anomaly
•Lowest sleep related
St. John’s County-5 year summary
100 total deaths:
•45 infants
•55 fetals (all other
counties had fewer fetals
than infants)
Zip
City
Deaths
32082
Ponte Vedra
9
32084
Downtown
St Aug
25
32086
St Aug Shores
15
32092
Palmo
19
32145
Hastings
6
Maternal Demographics:
 81% white (highest)
 60% married (highest)
 15% teens
 43.2% w/ some college (highest)
St. Johns county (con’t)
Maternal behavior:
 30% self reported
substance abuse
(highest)
 21.6% late or no pnc
 42% unhealthy
pregravid bmi
 Good birth spacing
Infant s
•46% < 29 weeks
•12% multiples
(highest)
•57% neonates-3/4 of
those died w/in 1st
24hrs
•19% sleep related:
•86% 2nd hand smoke
•57% bedsharing, not
in infant bed, not on
back and had unsafe
items
Resident Infant Mortality Rates by Race
Duval County
2000-2009
Prepared by L.Lee Source:
Birth and Death
Certificates/Vital stats
70
35
65
97
41 46
60
27
102
51
36
19
55
23
35
33
93
22
25
19
Death Cohort
Maternal Race
Duval County 2005-2009
Maternal Age
Duval County 2005-2009
Birth and Death Cohort Comparison
Maternal Marital Status
Duval County 2005-2009
Single marital status
Death Cohort
Birth and Death Cohort Comparison
Maternal Education
Duval County 2005-2009
Births
with
HS
dip. or
more
Births
with
NO HS
diploma
Birth and Death Cohort Comparison
Maternal Health
Duval County 2005-2009
*
Smoking
Birth and Death Cohort Comparison
Maternal Health
Duval County 2005-2009
Birth and Death Cohort Comparison
Prenatal Care
Duval County 2005-2009
Late or no prenatal care
Contributing Factors in FIMR Cases
July 2005- June 2010
N=143
Contributing Factors in FIMR Cases
July 2005- June 2010
N=143
Prepared by L.Lee
Source: FIMR/CRT case
reviews
Contributing Factors in FIMR Cases
July 2005 – June 2010
N=143
Prepared by L.Lee
Source: FIMR/CRT case
reviews
Contributing Factors in FIMR Cases
July 2005-June 2010
N=143
Prepared by L.Lee
Source: FIMR/CRT case
reviews
Contributing Factors in FIMR Cases
July 2005-June 2010
N=143
Prepared by L.Lee
Source: FIMR/CRT case
reviews
Contributing Factors in FIMR Cases
July 2005-June 2010
N=143
Prepared by L.Lee
Source: FIMR/CRT case
reviews
2010 FIMR Recommendations
(based on 2009 data)
1.




Continue to address the sleep-related deaths in NE Florida through the
implementation of an awareness and information campaign.
Information should include: proper sleep positioning, dangers of bed
sharing, impact of second and third hand smoke, importance of
breastfeeding and appropriate use of infant beds.
Continue Safe Sleep Partnership activities to target providers,
expectant and new parents/families, and the general public.
In 2009, smoke exposure was documented in 82% of our sleep related
deaths.
2010 FIMR Recommendations
(based on 2009 data)
 Focus provider and community education on age of vulnerability (2-4
months). Utilize WIC clinics, pediatricians, family practitioners, etc to
re-education caregivers on all visits during this time frame. Encourage
them to ask specifically about sleep positioning, sleep location, etc.
during the baby's visit. Implement education and awareness strategies
to address life course perspective, including preconceptional health
and planned pregnancies, as well as social determinants that impact
birth outcomes
2010 FIMR Recommendations
(Based on 2009 data)
2. Since there are so many factors relating to preconceptional health,
we will continue to focus our efforts on smoking cessation of all
types (tobacco, marijuana, crack, etc.)



Include the general public, women of child bearing age and
providers in educational efforts.
Share local FIMR statistics.
Focus on education regarding risks of smoking.
3. Improve Healthy Start Screening and referral rates:
 Recruit an obstetrician to serve on the FIMR CRT Committee
 Encourage providers not to “pre-screen” patients. Offer the screening
to all patients
2010 FIMR Recommendations
(Based on 2009 data)
 The second area of focus for preconceptional health will be obesity.
 Twenty seven percent of all moms in the 2008 death cohort and
twenty nine percent in the 2009 death cohort had obese pregravid
BMI's.
 Healthy Start services for the baby should also focus on the mom in
helping her to lose her weight postpartum.
 All healthcare students such as nursing and medical should be
educated re: the prevalence of obesity and the importance of
incorporating this general health focus into all aspects of care.
 The education re: healthy lifestyle should begin during childhood and
continue through all ages.
Questions?