Northeast Florida FIMR Findings

Northeast Florida FIMR Findings

January 2005-December 2011

Laurie Lee, RN, BSN, CCMFIMR CoordinatorNortheast Florida Healthy Start Coalition

Overview of the Fetal & Infant Mortality Review Process

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.

Prepared by LleeNEFL FIMR

Healthy 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.



Resident Infant Mortality Rates-All RacesNortheast Florida and Florida2001-2011

2003 2004 2005 2006 2007 2008 2009 2010 20110

2

4

6

8

10

12

14

16

18

20

9.8 9.5 10.4

8.2 8 8.97.9 7.3

6.57.5 7 7.2 7.2 7.1 7.2 6.9 6.5 6.4

NE FL FL US

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

114 infant deaths in 2011

Resident White Infant Mortality RatesNortheast Florida and Florida 2001-2011

2003 2004 2005 2006 2007 2008 2009 2010 20110

2

4

6

8

10

12

14

16

18

20

6.7 6.6 7.6 6.2 5.9 6.3

4.9

5.6

4.025.8 5.5 5.3 5.6 5.2 5.5

5.84.9 4.6

NEFL FL


39 white infant deaths in 2011

Resident Nonwhite Infant Mortality Rates Northeast Florida and Florida2001-2011

2003 2004 2005 2006 2007 2008 2009 2010 20116

8

10

12

14

16

18

20

16.2

15.316.1

1211.9

13.8

10.59.64 10.3

12.411.5 12.5 11.8 12.2 11.8

12.110.8

11.1

13.7

15.9

18.8

12.812.9 14.1

12.310.6

12

NEFL FL Black


75 nonwhite infant deaths in 2011- ¾ black

Birth Weight in Infants That DiedNortheast Florida 2005-2011 n=1028

25%

33%14%

26%

2%

< 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)No info

58% of the babies that died weighed < 3.3 pounds at birth



Infant Age at DeathNortheast Florida2005-2011

2005 n=189

2006 n=158

2007 n=154

2008 n=165

2009 n=155

2010 n=127

2011 n=114

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

100%

61.4 64.6 64.3 67.3 68.8 69.3 77.8

38.6 35.4 35.7 32.7 31.3 30.7 22.2

Neonates Postneonates

63% of the neonatal deaths occurred in the 1st 24 hours Prepared by LleeNEFL FIMR


Cause of Death0%

10%

20%

30%

40%

50%50

%

13% 16

%13

%

13%

4% 6% 5%

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

*records may have more than one cause of death listed

Causes of Infant DeathNortheast Florida2005-2011 n=1028



Northeast Florida

Sleep related deaths

2005-2011

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

Total Number of Sleep Related DeathsNortheast Florida2005 – 2011

2005

2006

2007 2008 2009 2010 2011

# 33 23 27 27 22 16 14

% of death

s

17.5%

14.6%

17.6%

16.4%

15.1%

12.6%

12.3%



Distribution of Sleep Related Deaths in 2011

Baker Clay Duval Nassau

St Johns

# deaths

2 1 11 0 0

Duval county detail:

• The following zipcodes had one sleep related death: 04, 06, 08, 10,11, 23, 25, 57, 77

• The 06 zip was the only one with > 1 sleep related death and it had only 2



Rate Comparison2005

2006 2007 2008 2009 2010 2011

# NEFL SIDS cases

10 10 6 6 3 1 1

NEFL SIDS rate/1,000 live births

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

FL SIDS rate

.38 .39 .34 .35 .32 .30 .20

# NEFL Undetermined or other sleep related cases

23 13 21 21 19 15 13

NEFL sleeping infant death rate/1,000 live births

1.83 1.21 1.40 1.45 1.20 .90 .80Prepared by Llee

NEFL FIMRHealthy Start Coalition

Risk Factor ComparisonRisk Factor 2005 – 2011

n=162

Unsafe sleep surface 80%Not on back to sleep 66%Not in an infant bed 69%

Never breast fed 66%

Unsafe items in bed 60%

Second/third hand smoke

46%

Sharing sleep surface 55%Prepared by Llee

NEFL FIMRHealthy Start Coalition

Maternal DemographicsSleep Related Deaths

• 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

Resident Infant Mortality Rates by CountyAll Races2007-2011

0

2

4

6

8

10

12

Baker Clay Duval Nassau St. John's

10.5

5.2

8.5

5.94.1

State rate=6.8

Baker County-5 year summary

29 total fetal and infant deaths; 20 infants/9 fetals

61% single moms (highest) 40% infant deaths sleep related (highest) 39% with poor birth spacing (over 3 x higher) 38% all losses w/ congenital anomalies (highest) 32% with no HS diploma (highest) Second only to Duval for late or no pnc (32%) Low teen pregnancies and substance abuse

Zip City Total Fetal and Infant Deaths

32063 MacClenny 1332040 Glen St. Mary 12

Clay County-5 year summary

66% w/ unhealthy BMI (highest) 55% single 25% with late or no pnc 12% teens (second highest) 12% Hispanic (highest)

Zip City Deaths32068

Middleburg 30

32065

Orange Park

22

32073

Orange Park

30

32043

Green Cove

14

32003

Fleming Isl. 7

110 fetal and infant deaths; 58 infants/52 fetals

Nassau County-5 year summary

89% white (highest)27% w/out HS diploma

(second to Baker)Highest substance

abuse (33%-all tobacco)57% w/ unhealthy BMI

(96% of those high)Lowest congenital

anomalies

Zip City Deaths

32011 Callahan 10

32034 Fernandina 16

32097, 32041

Yulee 14

46 total deaths: 23 infant and 23 fetal

St. John’s County-5 year summary

Maternal Demographics: 80% white 56% married (highest) 52.3.2% w/ some college (highest) Best pnc, birth spacing and healthy

BMI’s Highest underweight though-

1/3 of those w/ unhealthy BMI’s Highest cocaine use

Zip City Deaths

32081 & 2

Ponte Vedra 10

32084 DowntownSt Aug

33

32086 St Aug Shores

14

32092 Palmo 1932145 Hastings 6

92 total deaths:• 37 infants• 55 fetals (all other

counties had fewer fetals than infants)

Resident Infant Mortality Rates by RaceDuval County2003-2011

2003 2004 2005 2006 2007 2008 2009 2010 20110

5

10

15

20

25

1

6.9

7.5 7.9

7.2 6.7 7.15.5 5.8

2.8

10.5 10.9 11.69.5 9 9.7

8.48 7.3

7.57 7.2 7.2 7.1 7.2 6.9 6.5 6.4

16.8

16.4

20.1

14.6 15.4 15.3 15.9

8.8

13.315.5

15.316.9

12.9 12.914

13.1 11.312.8

WhiteTotal CountyFloridaTarget AreaBlack

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

90 infant deaths in 2011

Duval CountyWhite Births2007-2011

2007 2008 2009 2010 20116200

6400

6600

6800

7000

7200

7400

7600

7800

8000 78947777

7474

71286889



Duval CountyBlack and Other Births2007-2011

2007 2008 2009 2010 20115100

5200

5300

5400

5500

5600

5700

5800

5900

6000

5878

5657 5667

5416 5431

Birth versus Death Cohorts: Demographics

Birth Cohort Death Cohort

Race W=56%; B=43% W=30%; B=63%Age Teens trended down over

last 3 yrs, currently at 8.3%; 20’s –mid to high

50%

Teens w/ slight trend up 12-13%; 20 year olds represent 55-60%; slight upward trend in 40 year olds

Single Marital Status

48% last 3 years Decreased from 65% to 61% last 3 years

Education-HS or higher

85% 68%

Birth versus Death Cohorts:Behavior

Birth Cohort Death Cohort

Smoking 8% Trend 17 – 11% over last 3 yrs

Unhealthy BMI 50% 61%

Inadequate prenatal care 24% Trending down over last 3 yrs-40 to

36%

Pregnancy Interval < 12 mos

14% 17%

Contributing Factors in FIMR Cases2009-2011N=87

0%

10%

20%

30%

40%

50%

60%

Maternal Medical and OB History

56%

31%

20%

15%11%

Pre-existing conditions such as hypertension, diabetes, asthma, etc.

History of fetal or infant loss

History of previous preterm or low birth weight baby

History of STD or other GU infection

History of elective termination

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)

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


0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Socioeconomic

41%

28%

39%

24%

Life Course Perspective Issues

Maternal Age < 21 or > 35

Poverty

Other emotional stressors during pregnancy such as loss of job, loss of loved one, incarceration, divorce, natural disaster, etc.)




0%

10%

20%

30%

40%

50%

60%

Medical Conditions During Pregnancy

48%

23%

52%

28%

Maternal Infections other than STD's

STD's

Preterm Labor

PROM/PPROM






-10%

0%

10%

20%

30%

40%

50%

60%

Parental Knowledge/Compliance Issues

53%

13%

67%

30%

Inadequate pnc

Kick counts; signs of decreased fetal movement and when to call MD

Family Planning

Substance abuse




0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Service Issues

3%

5%

11%

Medical and social services/community inadequate to meet needs

Medical and social services/community resources available, but not used

Patient fear of/dissatisfaction with system




0%

10%

20%

30%

40%

50%

60%

Fetal/Infant Medical Issues

51%

33%

6%

Prematurity

Infection

Cord Problem

2012 FIMR Recommendations

(based on 2011 data)

Continue to focus on preventing sleep related deaths. Of the 114 infant deaths in Northeast Florida in 2011, 14were sleep related. This represents 12.3 % of all deaths and 58% of deaths after the first month of life. Focus on safe sleep surface and bedsharing. Develop additional Cribs 4 Kids programs in region and

take advantage of cash matching program. Develop regional Safe Sleep Campaign in collaboration

with TPC Advocacy Center at Wolfson Children’s Hospital.

2012 FIMR Recommendations (based on 2011 data)

Focus on safe sex, STD prevention and family planning. Implement jail education program; take advantage of having a

captive audience. Within the FIMR cases, STDs during pregnancy increased from

9% in 2009 to 35% in 2011. Duval County ranks 5th in the state based on 2012 data in STD rates.

Contraception in the immediate postpartum period is a priority for action. In the FIMR reviewed cases, only one-third of the mothers received a Depo shot or prescription for contraceptives prior to hospital discharge.

More than two-thirds (67%) of the FIMR cases involved family planning issues including unplanned pregnancies and inadequate birth spacing.

2012 FIMR Recommendations (based on 2011 data)

Continue to focus on dangers of smoking during pregnancy. In 2011, 13% of the mothers in the death cohort self-

reported some type of substance abuse; 83% of these were tobacco users. In 2010, 17% of the death cohort self-reported some type of substance abuse. Ninety-three percent of these were tobacco users.

The Community Action Team is implementing an anti-smoking campaign in the target area (Health Zone 1) based on prior recommendations.

Healthy Start program in St. Johns County is also piloting SCRIPT, an evidence-based smoking cessation program for pregnant women. Based on pilot results, this program should be considered for replication throughout the region.

Northeast Florida FIMR Findings

Documents