Northeast Florida FIMR Findings

1. January 2005-December 2011 Northeast Florida FIMR Findings Laurie Lee, RN, BSN, CCM FIMR Coordinator Northeast Florida Healthy Start Coalition

2. Overview of the Fetal & Infant Mortality Review Process • The FIMR Case Review Team meets bimonthly • Review process developed by the American College of Obstetrics & Gynecology is used. • Information abstracted from birth, death, prenatal care, Healthy Start, WIC, hospital and autopsy records. • Efforts are also made to interview the family. • All information is de-identified. • Purpose is to determine specific medical, social, financial and other issues that may have impacted the poor birth outcome. • Recommendations for community action drafted annually based on findings. Prepared by Llee NEFL FIMR Healthy Start Coalition

3. Overview of the Fetal & Infant Mortality Review Process • The purpose of FIMR is to examine cases with the worst outcomes to identify gaps in services that might be addressed through community action. • Cases selected for review based on specific criteria such as: • Zip codes with high infant mortality rates • Fetal losses over 36 weeks gestation or 2500 grams • Deaths in outlying counties, etc. Prepared by Llee NEFL FIMR Healthy Start Coalition

4. Resident Infant Mortality Rates-All RacesNortheast Florida and Florida2001-2011 Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats 114 infant deaths in 2011

5. Resident White Infant Mortality RatesNortheast Florida and Florida 2001-2011 Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats 39 white infant deaths in 2011

6. Resident Nonwhite Infant Mortality Rates Northeast Florida and Florida2001-2011 Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats 75 nonwhite infant deaths in 2011- ¾ black

7. Birth Weight in Infants That DiedNortheast Florida 2005-2011 n=1028 58% of the babies that died weighed < 3.3 pounds at birth Prepared by Llee NEFL FIMR Healthy Start Coalition

8. Infant Age at DeathNortheast Florida2005-2011 63% of the neonatal deaths occurred in the 1st 24 hours Prepared by Llee NEFL FIMR Healthy Start Coalition

9. Causes of Infant DeathNortheast Florida2005-2011 n=1028 Prepared by Llee NEFL FIMR Healthy Start Coalition *records may have more than one cause of death listed

10. Northeast Florida Sleep related deaths 2005-2011

11. Total Number of Sleep Related DeathsNortheast Florida2005 – 2011 Prepared by Llee NEFL FIMR Healthy Start Coalition

12. Distribution of Sleep Related Deaths in 2011 • Duval county detail: • The following zipcodes had one sleep related death: 04, 06, 08, 10,11, 23, 25, 57, 77 • The 06 zip was the only one with > 1 sleep related death and it had only 2 Prepared by Llee NEFL FIMR Healthy Start Coalition

13. Rate Comparison Prepared by Llee NEFL FIMR Healthy Start Coalition

14. Risk Factor Comparison Prepared by Llee NEFL FIMR Healthy Start Coalition

15. Maternal DemographicsSleep Related Deaths • 79% in their 20’s • 71% single • 63% white • about ½ had inadequate prenatal care • 42% with no high school diploma • about 1/3 are overweight or obese

16. Resident Infant Mortality Rates by CountyAll Races2007-2011 State rate=6.8

17. Baker County-5 year summary • 29 total fetal and infant deaths; 20 infants/9 fetals • 61% single moms (highest) • 40% infant deaths sleep related (highest) • 39% with poor birth spacing (over 3 x higher) • 38% all losses w/ congenital anomalies (highest) • 32% with no HS diploma (highest) • Second only to Duval for late or no pnc (32%) • Low teen pregnancies and substance abuse

18. Clay County-5 year summary • 66% w/ unhealthy BMI (highest) • 55% single • 25% with late or no pnc • 12% teens (second highest) • 12% Hispanic (highest) 110 fetal and infant deaths; 58 infants/52 fetals

19. Nassau County-5 year summary • 89% white (highest) • 27% w/out HS diploma (second to Baker) • Highest substance abuse (33%-all tobacco) • 57% w/ unhealthy BMI (96% of those high) • Lowest congenital anomalies 46 total deaths: 23 infant and 23 fetal

20. St. John’s County-5 year summary Maternal Demographics: • 80% white • 56% married (highest) • 52.3.2% w/ some college (highest) • Best pnc, birth spacing and healthy BMI’s • Highest underweight though-1/3 of those w/ unhealthy BMI’s • Highest cocaine use • 92 total deaths: • 37 infants • 55 fetals (all other counties had fewer fetals than infants)

21. Resident Infant Mortality Rates by RaceDuval County2003-2011 Prepared by L.Lee Source: Birth and Death Certificates/Vital stats 90 infant deaths in 2011

22. Duval CountyWhite Births2007-2011 Prepared by Llee NEFL FIMR Healthy Start Coalition

23. Duval CountyBlack and Other Births2007-2011

24. Birth versus Death Cohorts: Demographics

25. Birth versus Death Cohorts:Behavior

26. Contributing Factors in FIMR Cases2009-2011N=87

27. Contributing Factors in FIMR Cases2009-2011N=87 Prepared by L.Lee Source: FIMR/CRT case reviews

28. Contributing Factors in FIMR Cases2009-2011N=87 Prepared by L.Lee Source: FIMR/CRT case reviews Prepared by L.Lee Source: FIMR/CRT case reviews

29. Contributing Factors in FIMR Cases2009-2011N=87 Prepared by L.Lee Source: FIMR/CRT case reviews Prepared by L.Lee Source: FIMR/CRT case reviews

30. Contributing Factors in FIMR Cases2009-2011N=87 Prepared by L.Lee Source: FIMR/CRT case reviews Prepared by L.Lee Source: FIMR/CRT case reviews

31. Contributing Factors in FIMR Cases2009-2011N=87 Prepared by L.Lee Source: FIMR/CRT case reviews Prepared by L.Lee Source: FIMR/CRT case reviews

32. Contributing Factors in FIMR Cases2009-2011N=87 Prepared by L.Lee Source: FIMR/CRT case reviews Prepared by L.Lee Source: FIMR/CRT case reviews

33. 2012 FIMR Recommendations (based on 2011 data) • Continue to focus on preventing sleep related deaths.  Of the 114 infant deaths in Northeast Florida in 2011, 14were sleep related. This represents 12.3 % of all deaths and 58% of deaths after the first month of life.  • Focus on safe sleep surface and  bedsharing.  • Develop additional Cribs 4 Kids programs in region and take advantage of cash matching program. • Develop regional Safe Sleep Campaign in collaboration with TPC Advocacy Center at Wolfson Children’s Hospital.

34. 2012 FIMR Recommendations (based on 2011 data) • Focus on safe sex, STD prevention and family planning.  • Implement jail education program; take advantage of having a captive audience.  • Within the FIMR cases, STDs during pregnancy increased from 9% in 2009 to 35% in 2011.  Duval County ranks 5th in the state based on 2012 data in STD rates. • Contraception in the immediate postpartum period is a priority for action.  In the FIMR reviewed cases, only one-third of the mothers received a Depo shot or prescription for contraceptives prior to hospital discharge.  • More than two-thirds (67%) of the FIMR cases involved family planning issues including unplanned pregnancies and inadequate birth spacing.

35. 2012 FIMR Recommendations (based on 2011 data) • Continue to focus on dangers of smoking during pregnancy. • In 2011, 13% of the mothers in the death cohort self-reported some type of substance abuse; 83% of these were tobacco users.  In 2010, 17% of the death cohort self-reported some type of substance abuse.  Ninety-three percent of these were tobacco users. • The Community Action Team is implementing an anti-smoking campaign in the target area (Health Zone 1) based on prior recommendations. • Healthy Start program in St. Johns County is also piloting SCRIPT, an evidence-based smoking cessation program for pregnant women. Based on pilot results, this program should be considered for replication throughout the region.