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Potentially Avoidable Deaths – What Could Neonatologists Do Better ?

Potentially Avoidable Deaths – What Could Neonatologists Do Better ?. Malcolm Battin Chair NE Working Group. Neonatologist’s role. Neonatologist’s role. Might include : Clinical Practice Advocacy Research or clinical review Education Aim to improve mortality.

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Potentially Avoidable Deaths – What Could Neonatologists Do Better ?

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  1. Potentially Avoidable Deaths – What Could Neonatologists Do Better ? Malcolm Battin Chair NE Working Group

  2. Neonatologist’s role

  3. Neonatologist’s role Might include : • Clinical Practice • Advocacy • Research or clinical review • Education • Aim to improve mortality

  4. Primary Neonatal Death Classification (PSANZ-NDC) 2009 Top 3 causes account for 77 % of neonatal deaths

  5. NND classification (Page 32) Extreme prematurity 31.3% • 1.5 % births < 32 wks GA • 0.4% births 24-27 wks GA • Lower range GA 20 wks (T. 17) • 114/165 (87%) deaths <24/40 (T. 21) • 20/165 deaths (12.1%) 24-27/40 (T. 21) • Plus respiratory, neurological, gastro (NEC)

  6. Survival of NW inborn babies by BW

  7. Survival of NW inborn babies by BW Liggins & Howie 1st surfactant report OSIRIS in NZ HFOV/CPAP/Trigger

  8. A progressive ceiling on potential developmental outcomes ? Wolke (Lagercrantz 2008)

  9. When Does Neonatal Death Occur ? Data from Table 6

  10. Prematurity • Concept of borderline in viability • Individualised approach < 24 weeks • Audit of neurodevelopmental outcomes • Publication of results for scrutiny ! • Spontaneous preterm birth & APH as antecedent causes associated with deprivation • Prematurity associated neonatal death risk highest in teenage mothers

  11. Teenage mothers • Half of teenage mothers whose babies died were Maori • risk increased across ethnicities • Half of teenage mothers whose babies died in highest deprivation quintile. • 45 % of teenage mothers whose babies died were smokers • More contact health system after birth • NICU nurses support

  12. Maternal age (Figure 18)

  13. Canadian studies what people know about risk associated with maternal age • 1,044 women, after first live-born, aware link with conception difficulties – 85.% • * Multiple birth 24%, c.section 18.8%, preterm delivery 22% and LBW 11% • Further survey 20-45 yrs without children • > 70% recognized link to conception • < 50 % knew that advanced maternal age increased the risk of stillbirth, c. section, *multiple birth and preterm delivery Tough 2002 and 2007

  14. NND classification Page 32 • Congenital abnormality 23.6% • Potentially avoidable – complex issue • Some benefit scale or special service • Neurological 22% • NE Working Group • Infection 6.6% • Cardio-respiratory 6% • Gastrointestinal 4.4%

  15. Neonatal Encephalopathy or Hypoxic Ischemic Death 2010 data collection • Thank you for completing forms • Please keep it up for 2011 • 5 % of babies had 1 min Apgar ≥ 9 • 23 % of babies had 5 min Apgar ≥ 7 • 15 % either no resus or oxygen only • Cooling – not all babies • Investigation, counseling for family

  16. Contributory Factors (T33)

  17. Organisation/people/skills

  18. Perinatal Mortality 2009 • Neonatal deaths with no obstetric antecedent are considerably more frequent in babies of Maori mothers • Seven cases of SUDI deaths • Four had a mother who smoked • 6 were co-sleeping • 10 cases in 2008

  19. Conclusion • Some contribution clinical practice • Major benefit is working across disciplines • Communication, best practice, lack of skills and knowledge

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