Follow Up of Extremely Low Birth Weight Infants and the Impact on Infant Mortality

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Follow Up of Extremely Low Birth Weight Infants
and the Impact on Infant Mortality

• Isabelle Horon, Dr.P.H.
• Director, Vital Statistics Administration
• Maryland Department of Health and Mental Hygiene
• June 8, 2006

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Collaborators

• Garland Land
• Leesa Shem Tov
• Rose Trasatti

• Robert Hayman, Ph.D.
• Hal Sommers

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Infant Mortality

• Death lt1 year of age
• Widely used measure of the health of a population

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(No Transcript)
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Infant Mortality Rate

Infant Mortality Rate
Number of infant deaths Number of births

x 1000
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Infant Mortality Rate

Source of data--Death certificates
Source of data--Death certificates
Infant Mortality Rate
Number of infant deaths Number of births

x 1000
Source of data--Birth certificates
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Problem

• Hospitals dont always file certificates
  following the death of an extremely LBW infant
• Dont understand definitions
• Not necessary for non-viable infants
• Unlikely that a copies of certificates will be
  requested
• Funeral home often not involved
• Looks bad

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No birth record, no death record
X
X
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Death record, no birth record
X

• Solution--linkage of each infant death
  certificate to a birth certificate
• Requirement of VSCP contract
• NCHS is diligent about making states do this

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Birth record, no death record

• Why is death record missing?
• No certificate filed
• By mistake
• On purpose
• Fetal death certificate filed instead

X
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VSCP Contract

• The Contractorshall perform the following
  quality assurance activities
• Validate the discharge status of all infants
  with birth weights lt750 grams if no death record
  can be found. If discharged dead, assure death
  is registered.

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Questions

• Are states following up?
• If not, what is the impact on infant mortality
  rates?

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Sources of data

• NAPHSIS surveys

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NAPHSIS surveys
Yes N 25

• Does your jurisdiction follow-up on births under
  a specific birth weight to determine if the child
  died?

No N 15
??? N 11
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Sources of data

• NAPHSIS surveys
• 2002 Perinatal Mortality Data File
• Number of births and number of infant deaths by
  state of occurrence
• 4,000,000 birth records
• 28,000 infant death records
• Computed birth weight-specific mortality rates

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Infant Mortality Ratesby Birth Weight and Follow
Up
Follow up No follow up lt500
gms.
Follow up No follow up 500-750
gms.
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Infant Mortality Ratesby Birth Weight and Follow
Up
Follow up No follow up lt500
gms.
Follow up No follow up 500-750
gms.
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Infant Mortality Rates by Birth Weight and
Follow Up
Follow up
No follow up
19
Infant Mortality Rates by Birth Weight and
Follow Up
Yes No lt500 gms.
Yes No 500-749 gms.
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Infant Mortality Rates by Birth Weight and
Follow Up
Yes No ??? lt500 gms.
Yes No ??? 500-749 gms.
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Impact National IMR
7.0
7.1 ??
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ImpactState IMR
State X
IMR 8.9
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ImpactState Data
State X
IMR 8.9
10.5
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What about the neighbors?
State X
IMR 8.9
10.5
State Y
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Components of a Resident Vital Records File
Resident- recorded data
Resident data from other states
Resident data
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What about the neighbors?
State X
State X
IMR 8.9
10.5
State Y
IMR 7.6
27
What about the neighbors?
State X
State X
IMR 8.9
10.5
State Y
IMR 7.6
7.8
28
What about the neighbors?
County A IMR 11.4
State X
State X
IMR 8.9
10.5
State Y
IMR 7.6
7.8
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What about the neighbors?
County A IMR 11.4
State X
State X
12.3
IMR 8.9
10.5
State Y
IMR 7.6
7.8
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What should we be doing?

• Identify all infants with birth weights lt750 gms.
• Determine whether death certificate was filed
• If no death certificate filed, follow up
• Call hospital of delivery to determine status
• If infant died, make sure death certificate is
  filed
• If infant transferred, follow up
• Continue to follow up until infant is discharged
• Review out of state data for potential problems

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Limitations

• Follow up policies unknown for 11 jurisdictions
• 2002 birth and death data 2006 survey data
• Birth weight errors
• Period vs. birth cohort data

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NCHS may come knocking on your jurisdictions
door
please agree to help.