Death rate of babies in Counties and Northland a concern - report

By Martin Johnston

From 2007-204, the neonatal mortality rate nationally was 2.8 for every 1000 live births. Photo / iStock
From 2007-204, the neonatal mortality rate nationally was 2.8 for every 1000 live births. Photo / iStock

The death rate of babies from mid-pregnancy to soon after birth has been found to be higher than average in several upper North Island health districts.

Data for 2014 has been released today by the Government's Perinatal and Maternal Mortality Review Committee.

"Perinatal-related" deaths are those of babies between 20 weeks of pregnancy and 28 days after birth, or weighing at least 400g if gestation is unknown. "Neonatal" is from live birth to 27 days.

The 2007-2014 national perinatal-related mortality rate was 10.7 deaths for every 1000 births. But the rates were statistically significantly higher in two health districts: Counties Manukau (13.4/1000) and Northland (12.5/1000).

Over the same period, the neonatal mortality rate nationally was 2.8 for every 1000 live births - but rates were significantly higher in the Bay of Plenty (3.9/1000) and Waikato (3.4/1000).

Counties Manukau's perinatal-related mortality rate has previously been reported as higher than average and this led to a major review of maternity services led by former Health and Disability Commissioner Professor Ron Paterson, whose panel in 2012 recommended financial incentives to encourage women to book early for pregnancy care, and other changes.

Waikato District Health Board's clinical leader for quality and patient safety, Dr Doug Stephenson, said there were 5270 births in Waikato in 2014 and, sadly, 18 of the babies died, three more than if the region's death rate was at the national average.

"We will review this report to understand why our rates are higher, review the cases in the report to see if there are any trends that we can learn from and identify areas where we can improve."

The DHB takes complex maternity cases from a large region including some of New Zealand's most remote areas.

"By the time a mother reaches a hospital or birthing unit, it may be too late to intervene and save the baby," the DHB says.

Dr Stephenson said: "We want to eliminate unnecessary delays, increase earlier detection of potential problems and ensure all health professional staff communicate well with patients and each other and are available to help at the right time."

The mortality review committee said today, following its analysis of maternity and newborn data for 2014, that 656 perinatal-related deaths were reported for the year. There had been no significant change in the overall perinatal-related mortality rate from 2007 to 2014.

There were four maternal deaths in 2014, the lowest number since the committee began reporting, in 2006, although the statistical rate of maternal mortalilty had not changed significantly since then.

The report also identified that the significant reduction in the number of stillbirths was persisting.

"It is very pleasing that the stillbirth rate reduced between 2007 and 2014," said committee chair Dr Sue Belgrave, an obstetrician and gynaecologist.

"There are a number of reasons for the falling number of stillbirths, including improved care before and after birth and lower smoking rates. Both are encouraging trends."

The report includes a review of amniotic fluid embolism, a rare and potentially-fatal condition in which amniotic fluid or fetal cells enter the mother's bloodstream and can lead to cardiac arrest and other problems. Last year's report recorded 12 deaths from this between 2006 and 2013, which was statistically a 5.6 times higher rate than in the UK.

The review looked into 13 maternal deaths from the condition from 2006 to 2013, including one first recorded as death from post-birth bleeding, and eight non-fatal cases from 2010 to 2013. The reviewers suggested improvements in recognition and resuscitation of mothers with amniotic fluid embolism may improve the chances of survival for some.

"AFE [amniotic fluid embolism] is an unpredictable, rare and often rapidly fatal complication of pregnancy," said Dr Belgrave.

"We are repeating our recommendation that clinicians involved in the care of pregnant women undertake regular multidisciplinary training in the management of obstetric emergencies. This will improve both the recognition of AFE and resuscitation of women who collapse and potentially prevent some AFE deaths in New Zealand."

The latest report has a special chapter on maternal suicide. It found many women who completed suicide had two or more risk factors for major depression, two-thirds had a prior psychiatric history, and most were experiencing relationship stress.

In some cases, the committee identified there had been a lack of recognition of risk factors and that communication between health care services could have been better.

"In the cases of maternal suicide reviewed by the [committee] there were instances where services involved in care may have been able to help. It is imperative clinicians work together to prevent the consistent leading cause of death among new and expectant mothers," Dr Belgrave said.

The committee emphasised that all maternity health workers caring for a woman must have a knowledge of her mental health history.

Mother and baby death review findings for 2014

• 656 - baby deaths nationally in the "perinatal-related" weeks before and after birth

• 11.2 - the number of baby deaths in those weeks per 1000 births

• 4 - maternal deaths

For 2007-2014:

Counties Manukau and Northland district health board areas had higher than average perinatal-related mortality

Waikato and Bay of Plenty DHB areas had higher than average neonatal mortality

- NZ Herald

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