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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. Robert Hayman, Ph.D. Hal Sommers. Garland Land Leesa Shem Tov Rose Trasatti.

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follow up of extremely low birth weight infants and the impact on infant mortality

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

collaborators
Robert Hayman, Ph.D.

Hal Sommers

Garland Land

Leesa Shem Tov

Rose Trasatti

Collaborators
infant mortality
Infant Mortality
  • Death <1 year of age
  • Widely used measure of the health of a population
infant mortality rate
Infant Mortality Rate

Infant Mortality

Rate

Number of infant deaths

Number of births

=

x 1000

infant mortality rate1
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

problem
Problem
  • Hospitals don’t always file certificates following the death of an extremely LBW infant
    • Don’t understand definitions
    • Not necessary for non-viable infants
    • Unlikely that a copies of certificates will be requested
    • Funeral home often not involved
    • “Looks bad”
death record no birth record
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
birth record no death record
Birth record, no death record
  • Why is death record missing?
    • No certificate filed
      • By mistake
      • On purpose
    • Fetal death certificate filed instead

X

vscp contract
VSCP Contract

“The Contractor…shall perform the following quality assurance activities…

…Validate the discharge status of all infants with birth weights <750 grams if no death record can be found. If discharged dead, assure death is registered.”

questions
Questions
  • Are states following up?
  • If not, what is the impact on infant mortality rates?
sources of data
Sources of data
  • NAPHSIS surveys
naphsis surveys
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

sources of data1
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
infant mortality rates by birth weight and follow up
Infant Mortality Ratesby Birth Weight and Follow Up

Follow up No follow

up

<500 gms.

Follow up No follow

up

500-750 gms.

infant mortality rates by birth weight and follow up1
Infant Mortality Ratesby Birth Weight and Follow Up

Follow up No follow

up

<500 gms.

Follow up No follow

up

500-750 gms.

infant mortality rates by birth weight and follow up3
Infant Mortality Ratesby Birth Weight and Follow Up

Yes No

<500 gms.

Yes No

500-749 gms.

infant mortality rates by birth weight and follow up4
Infant Mortality Ratesby Birth Weight and Follow Up

Yes No ???

<500 gms.

Yes No ???

500-749 gms.

impact state imr
Impact—State IMR

State X

IMR = 8.9

impact state data
Impact—State Data

State X

IMR = 8.9

10.5

what about the neighbors
What about the neighbors?

State X

IMR = 8.9

10.5

State Y

components of a resident vital records file
Components of a Resident Vital Records File

Resident-

recorded

data

Resident data

from other

states

Resident data

what about the neighbors1
What about the neighbors?

State X

State X

IMR = 8.9

10.5

State Y

IMR = 7.6

what about the neighbors2
What about the neighbors?

State X

State X

IMR = 8.9

10.5

State Y

IMR = 7.6

7.8

what about the neighbors3
What about the neighbors?

County A

IMR = 11.4

State X

State X

IMR = 8.9

10.5

StateY

IMR = 7.6

7.8

what about the neighbors4
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

what should we be doing
What should we be doing?
  • Identify all infants with birth weights <750 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
limitations
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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