1. Potentially Avoidable Deaths – What Could Neonatologists Do Better ? Malcolm Battin Chair NE Working Group

2. Neonatologist’s role

3. Might include : Clinical Practice Advocacy Research or clinical review Education Aim to improve mortality

4. Primary Neonatal Death Classification (PSANZ-NDC) 2009 Top 3 causes account for 77 % of neonatal deaths

5. NND classification (Page 32) Extreme prematurity 31.3% 1.5 % births < 32 wks GA 0.4% births 24-27 wks GA Lower range GA 20 wks (T. 17) 114/165 (87%) deaths <24/40 (T. 21) 20/165 deaths (12.1%) 24-27/40 (T. 21) Plus respiratory, neurological, gastro (NEC)

6. Survival of NW inborn babies by BW

7. Liggins & Howie 1 st surfactant report OSIRIS in NZ HFOV/ CPAP/ Trigger

8. A progressive ceiling on potential developmental outcomes ? Wolke (Lagercrantz 2008)

9. When Does Neonatal Death Occur ? Data from Table 6

10. Prematurity Concept of borderline in viability Individualised approach < 24 weeks Audit of neurodevelopmental outcomes Publication of results for scrutiny ! Spontaneous preterm birth & APH as antecedent causes associated with deprivation Prematurity associated neonatal death risk highest in teenage mothers

11. Teenage mothers Half of teenage mothers whose babies died were Maori risk increased across ethnicities Half of teenage mothers whose babies died in highest deprivation quintile. 45 % of teenage mothers whose babies died were smokers More contact health system after birth NICU nurses support

12. Maternal age (Figure 18)

14. Canadian studies what people know about risk associated with maternal age 1,044 women, after first live-born, aware link with conception difficulties – 85.% * Multiple birth 24%, c.section 18.8%, preterm delivery 22% and LBW 11% Further survey 20-45 yrs without children > 70% recognized link to conception < 50 % knew that advanced maternal age increased the risk of stillbirth, c. section, *multiple birth and preterm delivery Tough 2002 and 2007

15. NND classification Page 32 Congenital abnormality 23.6% Potentially avoidable – complex issue Some benefit scale or special service Neurological 22% NE Working Group Infection 6.6% Cardio-respiratory 6% Gastrointestinal 4.4%

16. Neonatal Encephalopathy or Hypoxic Ischemic Death 2010 data collection Thank you for completing forms Please keep it up for 2011 5 % of babies had 1 min Apgar ≥ 9 23 % of babies had 5 min Apgar ≥ 7 15 % either no resus or oxygen only Cooling – not all babies Investigation, counseling for family

17. Contributory Factors (T33) Neonatal deaths n=182 Contributory factors n% Yes6134 No10357 Not stated1810 Potentially avoidable 3519

19. Organisation/people/skills

20. Perinatal Mortality 2009 Neonatal deaths with no obstetric antecedent are considerably more frequent in babies of Maori mothers Seven cases of SUDI deaths Four had a mother who smoked 6 were co-sleeping 10 cases in 2008

21. Conclusion  Some contribution clinical practice  Major benefit is working across disciplines  Communication, best practice, lack of skills and knowledge