CNY Fetal-Infant Mortality/Morbidity Review/Registry (FIMMRR)

Pam Parker,
Central New York Data Coordinator
Email: parkerp@upstate.edu

The County and the Central New York region both have unacceptably high rates of poor pregnancy outcome, especially among the racial/ethnic/socio-economically disadvantaged minorities. To implement this standard process within the Quality Assurance system at affiliate birth hospitals, we have implemented a standardized case review process for all spontaneous late fetal deaths ( 300 Grams) and all neonatal deaths within these institutions.

Additionally, we have implemented a standardized case review process for all infant deaths (including post-discharge deaths, up to 1 year of age) and all Extremely Low Birth Weight babies (<1000 Grams) born to Onondaga county residents within the three county birth hospitals.

Background Infant Mortality

  • The Infant Mortality Rate (IMR) remains a critical problem in the United States as reflected by recent data showing an actual increase in the nationwide IMR.
  • Local statistics (20082010) are also striking with an IMR of 7.1 in Onondaga County, which is significantly higher than the New York State rate of 5.3.
  • Racial and ethnic disparity remains unresolved and in Onondaga County African American infants die over twice as often as white infants.
  • Syracuse (Onondaga Countys urban center) has the second-highest child poverty rate in the US for Hispanics and the worst rate in NY for Blacks.
  • The same disparity in birth outcome is found among the economically disadvantaged throughout Central New York.

Fetal Mortality

  • Fetal mortality is about as frequent and disparate as infant mortality but has been less adequately studied.
  • Examining fetal and infant mortality together is necessary to properly perceive the overlapping etiologies.

Morbidities

  • Infant morbidity, as reflected by the surviving ELBW babies (<1000 gm), is also the product of the same reproductive problems that exhibit racial/ethnic/ socioeconomic disparity.
  • In most cases of fetal/infant mortality/morbidity, there is inadequate detail regarding the cause of death/morbidity or the contributing factors on the part of the patient, provider, health systems and/or community supports.

Impact

  • Society cannot improve the current poor fetal and infant mortality and morbidity without being able to measure systems and evaluate the processes of care as well as the detailed causes and contributing factors.
  • In-depth review of individual and aggregate fetal/infant death and morbidity cases when studied as sentinel events will shed great light on the root causes of poor pregnancy outcomes and thus the means to improve them.
  • It will also improve the health of the children that survive.

Fetal-Infant Mortality Review

While Fetal and Infant Mortality Review (FIMR) programs have been implemented in 220 sites in 42 US states, the methodology that they have used has limited the extent to which they can provide evidence-based clinical feedback to health care providers and
Regional Prenatal Centers.

Innovative Aspects of the FIMMRR:

  • Includes Very Low Birth Weight survivors
  • Includes detailed medical root cause analysis of each fetal and infant mortality as well as Very Low Birth Weight morbidity
  • Utilizes a Registry mechanism for analysis and evaluation
  • Embodies the potential for action plans that include the full spectrum of participantsconsumers, providers, health and related agencies
  • It has great generalizability throughout the State of New York and even nationally.

The FIMMRR Team

  • Richard H. Aubry, MD, MPH, FACOG, Principal Investigator
    Professor of Obstetrics and Gynecology, SUNY Upstate Medical University
    Division of Maternal-Fetal Medicine
    Director, Academic and Community Obstetrics
    Medical Director, Center for Maternal & Child Health (C-MATCH)
  • Michelle Bode, MD, MPH,
    Neonatal Associates, Crouse Hospital
  • Martha Wojtowycz, PhD,
    SUNY Upstate Medical University,
    Department of Obstetrics and Gynecology, C-MATCH
  • Pamela Parker, BA,
    SUNY Upstate Medical University,
    Department of Obstetrics and Gynecology, C-MATCH