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. 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

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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

Collaborators


Infant Mortality

  • Death <1 year of age

  • Widely used measure of the health of a population


Infant Mortality Rate

Infant Mortality

Rate

Number of infant deaths

Number of births

=

x 1000


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

  • 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”


No birth record, no death record

X

X


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

  • Why is death record missing?

    • No certificate filed

      • By mistake

      • On purpose

    • Fetal death certificate filed instead

X


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

  • Are states following up?

  • If not, what is the impact on infant mortality rates?


Sources of data

  • 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 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 Ratesby Birth Weight and Follow Up

Follow up No follow

up

<500 gms.

Follow up No follow

up

500-750 gms.


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 Ratesby Birth Weight and Follow Up

Follow up

No follow up


Infant Mortality Ratesby Birth Weight and Follow Up

Yes No

<500 gms.

Yes No

500-749 gms.


Infant Mortality Ratesby Birth Weight and Follow Up

Yes No ???

<500 gms.

Yes No ???

500-749 gms.


Impact — National IMR

7.0

7.1 ??


Impact—State IMR

State X

IMR = 8.9


Impact—State Data

State X

IMR = 8.9

10.5


What about the neighbors?

State X

IMR = 8.9

10.5

State Y


Components of a Resident Vital Records File

Resident-

recorded

data

Resident data

from other

states

Resident data


What about the neighbors?

State X

State X

IMR = 8.9

10.5

State Y

IMR = 7.6


What about the neighbors?

State X

State X

IMR = 8.9

10.5

State Y

IMR = 7.6

7.8


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 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?

  • 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

  • Follow up policies unknown for 11 jurisdictions

  • 2002 birth and death data; 2006 survey data

  • Birth weight errors

  • Period vs. birth cohort data


NCHS may come knocking on your jurisdiction’s door…

…please agree to help.


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