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Enhancing Neonatology: Addressing Potentially Avoidable Deaths in Neonates

This document discusses the critical role of neonatologists in reducing potentially avoidable neonatal deaths. It emphasizes clinical practice, advocacy, research, education, and the importance of understanding mortality classification, specifically the PSANZ-NDC 2009. The top causes of neonatal deaths, including extreme prematurity and congenital abnormalities, are highlighted. The document also notes the significance of addressing maternal factors like teenage pregnancies and smoking, which increase neonatal death risks. The aim is to enhance neonatal care through communication, collaboration, and comprehensive practices.

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Enhancing Neonatology: Addressing Potentially Avoidable Deaths in Neonates

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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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