northeast florida fimr findings

January 2005-December 2010

Laurie Lee, RN, BSNFIMR CoordinatorNortheast Florida Healthy Start Coalition

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.

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 ratesFetal losses over 36 weeks gestation or 2500

gramsDeaths in outlying counties, etc.

Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats

Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats

Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats

*records may have more than one cause of death listed N=938

38 – 44% of neonates represented above died at < 24 hours of age

Northeast Florida

Sleep related deaths

2005-2010

2005

2006

2007 2008 2009 2010

# 33 23 27 27 22 16

% of death

s

17.5%

14.6%

17.6%

16.4%

15.1%

12.6%

Prepared by Llee

NEFL FIMR

Healthy Start Coalition

2005 2006 2007 2008 2009 2010

# NEFL SIDS cases

10 10 6 6 3 1

NEFL SIDS rate/1,000 live births

.55 .53 .31 .32 .16 .06

FL SIDS rate .38 .39 .34 .35 .32

# NEFL Undetermined or other sleep related cases

23 13 21 21 19 15

NEFL sleeping infant death rate/1,000 live births

1.83 1.21 1.40 1.45 1.20 .91

Prepared by LleeNEFL FIMR

Healthy Start Coalition

Baker Clay Duval Nassau

St Johns

# deaths

1 3 8 3 1

•Baker-1 in Glen St. Mary•Clay-2 in Keystone Heights and 1 in Middleburg•Nassau-2 in Bryceville and 1 in Callahan •St. Johns- 1 in Saint Johns

•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

Risk Factor 2005 – 2009n=132

2010n=16

Unsafe sleep surface 79% 80%

Not on back to sleep 66% 63%

Not in an infant bed 67% 63%

Never breast fed 67% 63%

Unsafe items in bed 61% 56%

Second/third hand smoke

46% 44%

Sharing sleep surface 58% 31%

State rate

40 total fetal and infant deaths; 28 infants/12 fetals

78% white; 12% black 65% single moms (highest) > half moms w/ unhealthy BMI 30% with no HS diploma; 15% w/ college ¼ with poor birth spacing

Zip City Total Fetal and Infant Deaths

32063 MacClenny 21

32040 Glen St. Mary 14

Maternal demographics: 51% single 18% teens (highest-was Nassau) 10% Hispanic (highest) 71% white 52% w/ unhealthy BMI—1/3 of those underweight

(highest)

Zip City Deaths

32068 Middleburg 45

32065 Orange Park

26

32073 Orange Park

37

143 fetal and infant deaths; 75 infants/68 fetals

Maternal Demographics86% white, 11%

black, 48% single¼ w/out HS diplomaMore smokers1/2 w/ unhealthy BMI

Zip City Deaths

32011 Callahan 12

32034 Fernandina 16

32097 Yulee 21

57 total deaths: 32 infant and 25 fetal

Maternal Demographics: 80% white (highest) 60% married (highest) 43.2% w/ some college (highest) Best pnc, birth spacing and

healthy BMI’s More variety in substance abuse

Zip City Deaths

32082 Ponte Vedra 11

32084 DowntownSt Aug

34

32086 St Aug Shores

18

32092 Palmo 23

32145 Hastings 9

109 total deaths:•45 infants•64 fetals (all other counties had fewer fetals than infants)

Prepared by L.Lee Source: Birth and Death Certificates/Vital stats

Birth Cohort Death Cohort

Race W=58%; B=35% W=40%; B=50%

Age Teens @ 11%; 20’s –high 50%

Teens trending down since 2007 approaching birth cohort; 20 year olds represent 50-60%; slight upward trend in 40 year olds

Single Marital Status

47% last 3 years Decreased from 65% to 57% last 3 years

Education-HS or higher

82% Increase over last 3 years from 60 to 70%

Birth Cohort Death Cohort

Smoking 8% 12-17%

Unhealthy BMI 46% 52%

Inadequate prenatal care 24% Trending down over last 3 years but still

@ 34% in 2010

Pregnancy Interval < 12 mos

15% 17%

Prepared by L.Lee Source: FIMR/CRT case reviews

Prepared by L.Lee Source: FIMR/CRT case reviews

Prepared by L.Lee Source: FIMR/CRT case reviews

Contributing Factors in FIMR CasesJuly 2006-June 2011N=142

Prepared by L.Lee Source: FIMR/CRT case reviews

Prepared by L.Lee Source: FIMR/CRT case reviews

Contributing Factors in FIMR CasesJuly 2006-June 2011N=142

Prepared by L.Lee Source: FIMR/CRT case reviews

Prepared by L.Lee Source: FIMR/CRT case reviews

Contributing Factors in FIMR CasesJuly 2006-June 2011N=142

Prepared by L.Lee Source: FIMR/CRT case reviews

Prepared by L.Lee Source: FIMR/CRT case reviews

Black

N=49

Contributing Factor White

N=31

36.7% Obesity 25.8%

35.7% Previous fetal or infant loss 22.6%

26.5% Previous preterm and/or low birth weight baby (< 5.5 pounds)

6.5%

18.4% Previous STD or other genitourinary infection

6.5%

Black

N=49

Contributing Factor

White

N=31

65.3% Unplanned pregnancy

32.3%

14.29% Inadequate birth spacing

0%

Black

N=49

Contributing Factor White

N=31

55.1% Infections other than STD’s

45.2%

59.2% Preterm Labor 51.6%

34.7% Anemia 19.4%

24.5% PPROM/PROM 0%

26.5% Placental Abruption 9.7%

26.5% STD’s 3.2%

Black

N=49

Contributing Factor White

N=31

38.8% Late Entry after 13th week

16.1%

26.53% No prenatal care 12.9%

16.33% Noncompliance 0%

Black

N=49

Contributing Factors White

n=31

51.1% Life Course Perspective Issues 22.6%

36.7% Poverty 12.9%

10.2% Lack of support systems during pregnancy or infant’s life

0%

32.7% Other emotional stressors during pregnancy or infant’s life such as loss of loved one, loss of job, incarceration, natural disaster, etc.

12.9%

24.49% Maternal age < 21 12.9%

No significant differences between races with provider issues

White mom’s had more pre-existing conditions, placenta previa, substance abuse and noncompliance/lack of understanding w/ kick counts

Black mom’s had more contributing factors in each category

Black babies had more infections and prematurity

Frequency of Contributing Factors by RaceFIMR Cases 2008-2010

# of contributing factors per case

# of

cas

es

1. Continue to focus on preventing sleep related deaths▪ 80% unsafe sleep surface▪ 63% not on backs or in infant beds▪ 50% exposure to second/third hand smoke

2. Focus on Family Planning with prenatal and interconceptional care

▪ Contraception in the immediate postpartum period▪ Birth spacing▪ Smoking▪ Timely Medicaid

3. “Did you know?” campaign to educate consumers and providers re: key facts

▪ Reinforce importance of prenatal care

▪ Expand Baker County’s prenatal fan project into all counties.

▪ Improve dissemination of FIMR findings to all providers.