northeast florida fimr findings
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January 2005-December 2010. Northeast Florida FIMR Findings. Laurie Lee, RN, BSN FIMR Coordinator Northeast Florida Healthy Start Coalition. Overview of the Fetal & Infant Mortality Review Process. The FIMR Case Review Team meets bimonthly - PowerPoint PPT PresentationTRANSCRIPT
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.