Potentially Avoidable Deaths – What Could Neonatologists Do Better ? Malcolm Battin Chair NE...
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Transcript of Potentially Avoidable Deaths – What Could Neonatologists Do Better ? Malcolm Battin Chair NE...
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
Primary Neonatal Death Classification (PSANZ-NDC) 2009
Top 3 causes account for 77 % of neonatal deaths
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)
01020
3040506070
8090
100
1959
1961
1963
1965
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2008
%501-1000 g 1001-1500 g
Survival of NW inborn babies by BW
01020
3040506070
8090
100
1959
1961
1963
1965
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2008
%501-1000 g 1001-1500 g
Survival of NW inborn babies by BW
Liggins & Howie
1st surfactant report
OSIRIS in NZ HFOV/CPAP/Trigger
A progressive ceiling on potential developmental outcomes ?
Wolke (Lagercrantz 2008)
When Does Neonatal Death Occur ? Time of death
0
10
20
30
40
50
60
70
80
90
100
<1 2-7 8-14 15-21 22-28
Days
Perc
en
tag
e
20-23
24-27
>28/40
Data from Table 6
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
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
Maternal age (Figure 18)
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
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%
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
Contributory Factors (T33)
Neonatal deaths
n=182
Contributory factors
n %
Yes 61 34
No 103 57
Not stated 18 10
Potentially avoidable
35 19
Organisation/people/skills
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
Conclusion
Some contribution clinical practice
Major benefit is working across disciplines
Communication, best practice, lack of skills and knowledge