january - december 2013 laurie lee, rn, bsn, ccm fimr coordinator

Northeast Florida FIMR FindingsJanuary - December 2013

Laurie Lee, RN, BSN, CCMFIMR Coordinator

Overview of the Fetal & Infant Mortality Review Process

The FIMR Case Review Team meets 9x/year. 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 FIMRHealthy Start Coalition

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 ratesFetal losses over 36 weeks gestation or 2500

gramsDeaths in outlying counties, etc.

Prepared by LleeNEFL FIMR

Healthy Start Coalition

FloridaInfant Mortality Rate Trends

Florida, 1990-2013

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

9.6

6.17.5

4.6

16.7

10.6

Total

White

Black

Rate

per

1,0

00 L

ive

Birt

hs

Source: Florida Vital Statistics

Resident Infant Mortality Rates-All RacesNortheast Florida and Florida2004-2013

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

2

4

6

8

10

12

14

16

18

20

9.510.4

8.28

8.97.9 7.3 6.5 7.3 7.96

7 7.2 7.2 7.1 7.2 6.9 6.5 6.4 6 6.1

NE FL FL US

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

141 infant deaths in 2013

Resident White Infant Mortality RatesNortheast Florida and Florida 2004-2013

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

2

4

6

8

10

12

14

16

18

20

6.6 7.66.2 5.9 6.3

4.95.6 4.02

4.65.965.5 5.3 5.6

5.2 5.5 5.8 4.94.6

4.6 4.6

NEFL FL


68 white infant deaths in 2013

Resident Black Infant Mortality Rates Northeast Florida and Florida2004-2013

2004 2005 2006 2007 2008 2009 2010 2011 2012 20136

8

10

12

14

16

18

20

11.512.5

11.8 12.212.9 13.2 11.8 12

10.7 10.6

15.9

18.8

12.8 12.914.2

13.2

12.5

13.4 13.2

FL Black


65 black infant deaths in 2013

3 Year Infant Mortality RatesAll Counties2011 – 2013

Infant Deaths

Births

IM Rate

Baker 13 1031 12.6

Clay 31 6258 5.0

Duval 305 37413 8.2

Nassau 10 2254 4.4

St .Johns 23 5695 4.0Prepared by Llee

NEFL FIMR


Infant Age at DeathNortheast Florida2009-2013

2009 n=155

2010 n=127

2011 n=108

2012 n=127

2013 n=141

0%10%20%30%40%50%60%70%80%90%

100%

69% 69% 78% 70% 58%

31% 31% 22% 30% 42%

Neonates Postneonates

Cause of Death0%

10%

20%

30%

40%

50% 58%

20%

18%

9% 7% 4% 2%

5%

PrematurityCongenital AnomaliesSleep relatedRDS/BPD/Pul-monary Hy-poplasiaInfectionIVHNECMultiple Organ Failure

*records may have more than one cause of death listed n=141

Causes of Infant DeathNortheast Florida2013

Birth Weight in Infants That DiedNortheast Florida 2013-n=141

30%

37%13%

20%

< 500 grams (< 1.1 pounds)500-1499 grams (1.1-3.29 pounds)1500-2499 grams (3.3 - 5.49 pounds)2500+ grams (> 5.5 pounds)

Northeast Florida

Sleep related deaths

http://images.google.com/imgres?imgurl=http://static.desktopnexus.com/wallpapers/55035-bigthumbnail.jpg&imgrefurl=http://people.desktopnexus.com/wallpaper/55035/&usg=__cv8cWJWAYPvIjCUTp16nO-t866g=&h=338&w=450&sz=14&hl=en&start=14&tbnid=_kvCG3j5P4F6KM:&tbnh=95&tbnw=127&prev=/images?q=sleeping+babies&gbv=2&ndsp=20&hl=en

Sleep Related Infant DeathsNortheast Florida2009 – 2013

2009 2010 2011 2012 2013

# 22 16 14 21 25

% of deaths

15.1% 12.6% 12.9% 16.5% 17.7%

Prepared by Llee

NEFL FIMR


Baker Clay Duval Nassau

St Johns

# deaths

1(Macclenny

)

2(Fleming

Island and Middleburg)

18 0 4(3

different zips in St. Aug; 1-

Hastings

Distribution of Sleep Related Deaths in 2013

Duval county detail:

•In 2013, there were 18 deaths in 14 zips. No zip with > 2. Target area had 6.

Risk Factor Comparison2008-2010 + 5 cases from 2011

Risk Factor N=70

Unsafe sleep surface 80%Not on back to sleep 63%Not in an infant bed 70%

Never breast fed 63%

Unsafe items in bed 63%

Second/third hand smoke

47%

Sharing sleep surface 63%

Prepared by LleeNEFL FIMR


Maternal FindingsSleep Related Deaths-2013

•84% single•60% in their 20’s; 24%-30’s; 16%-teens•60% black; all others white •64% inadequate prenatal care•12 % with no high school diploma•48% are overweight or obese; only 4 of these involved co-sleeping

Infant FindingsSleep Related Deaths-2013

•All singletons except one twin•88% Medicaid•84% term•52% male

Resident Infant Mortality Rates by RaceDuval County2009-2013

2009 2010 2011 2012 20130

5

10

15

20

25

5.5 5.8

2.84.9

6.1

15.9

8.812.6

14.1 13.813.611.7

12.8 14.1 14.1

8.4 8.1 7.3 8.3 8.8

White Target Area Black Total

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

111 deaths:43-W; 62-B; 20-T

Duval CountyWhite Births2009-2013

2009 2010 2011 2012 20136400660068007000720074007600

Births

Duval CountyBlack Births2009-2013

2009 2010 2011 2012 20134200

4300

4400

4500

4600

4700

4800Births

Birth versus Death Cohorts: Demographics Duval County

Birth Cohort Death Cohort: n=190Race W=56%; B=35% W=37%; B=58%Age Teens trended down since

2007, currently about 7%; 20-29 year olds represent

55%; 30’s has steady increase over last 20 yrs,

currently at 35%; 40+ varies, but overall, increase in last 20 years, currently

at 3%

Slightly higher % of teens (8.6%) and 20’s (58%); slightly lower 30’s and 40’s (32% and <1 %, respectively).

Single Marital Status

48% last 5 years Had decreased from 65% to 57% last 5 years; now 70%

No HS Diploma

13.8% Was about 30%, now at 16.2%

Birth versus Death Cohorts: BehaviorDuval County

Birth Cohort Death Cohort

Smoking 6.9% Was trending down 17 – 12% over last

4 yrs; now 15%Overweight/Obese BMI 50.3% 42.8% (plus 8%

underweight)Inadequate prenatal care 28.2% Was trending down

over last 5 yrs-40 to 33%; now at

36%

Pregnancy Interval < 12 mos

State tracks < 18 mos; now

39.5%

Was trending down 22-14% last 6

years; now 20%

Contributing Factors in FIMR Cases2011-2013N=81

0%

10%

20%

30%

40%

50%

60%

Maternal Medical and OB History

56%

33%

17%15% 17%

Pre-existing conditions suchas hypertension, diabetes,asthma, etc.

History of fetal or infantloss

History of previous pretermor low birth weight baby

History of STD or other GUinfection

History of electivetermination

79% all FIMR cases had medical history issues

http://spokanepublishing.files.wordpress.com/2009/02/pregnant-woman1.jpg

0%

5%

10%

15%

20%

25%

30%

35%

Pre-existing Nutritional Issues

Obesity

Inadequate Nutrition

(underweight BMI or anemia at 1st trimester

pnc visit)

37%

17%


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


0%

5%

10%

15%

20%

25%

30%

35%

Socioeconomic

35%

27%

32%

25%

Life Course Perspective Issues

Maternal Age < 21 or > 35

Poverty

Other emotional stressorsduring pregnancy such as loss ofjob, loss of loved one,incarceration, divorce, naturaldisaster, etc.)




0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Medical Conditions During Pregnancy

44%

26%

48%

29%

23% 21%

Maternal Infections other thanSTD'sSTD's

Preterm Labor

PROM/PPROM

Anemia

Placental Abruption






-10%

0%

10%

20%

30%

40%

50%

60%

Parental Knowledge/ComplianceIssues

70%

16%

75%

32%

Inadequate pnc

Kick counts; signs ofdecreased fetal movementand when to call MD

Family Planning

Substance abuse




0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Service Issues

2%

5%

12%

Medical and socialservices/community inadequate tomeet needs

Medical and socialservices/community resourcesavailable, but not used

Patient fear of/dissatisfaction withsystem




0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Fetal/Infant Medical Issues

46%

40%

11%

Prematurity

Infection

Cord Problem

2014 FIMR Recommendations (based on 2013 data)

• Continue to focus on preventing sleep related deaths.

• The number of sleep related deaths has increased over the last 3 years. The number of deaths for years 2011, 2012 and 2013 were 14, 21 and 25 respectively. When compared to all causes of death in infants for years 2011, 2012 and 2013, this represents 13%, 16.5%, and 18%, respectively.

• Education should focus on babies sleeping alone on a safe sleep surface.


The following are potential partners:• Healthy Mothers Healthy Babies to revive the Cribs 4 Kids

programs • Americorp• Faith based organizations for “Safe Sleep Sundays”• Make a Noise, Make a Difference

• Curriculum for health advisors• Baptist Community Health

• Video link• Safe Kids Coalition• National SIDS Foundation

• Free educational materials• WIC

• Include safe sleep in breast feeding courses• CDC

• Video to use in educational settings• City Match

• LifeCourse board game• The Players Center For Child Health at Wolfson Children’s

Hospital- Ready, Set Sleep program

Continue to focus on dangers of smoking during pregnancy. ◦ The Community Action Team’s “Don’t Blow

Smoke” campaign is gaining momentum. Phase I (target area-Health Zone 1) Phase 2 (social media and expansion outside the

target area to include the 32218 and 32244 zip codes) have been implemented.

◦ The percentage of moms in the death cohort that self-reported tobacco use was 12% in 2012. It rose to 15% in 2013. Self-reported tobacco use in the 2013 birth cohort is 6.9%.


Any questions?

Thank you!

january - december 2013 laurie lee, rn, bsn, ccm fimr coordinator

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