1. January 2005-December 2010 Laurie Lee, RN, BSN FIMR Coordinator Northeast Florida Healthy Start Coalition

2.  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.

3. 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 rates Fetal losses over 36 weeks gestation or 2500 grams Deaths in outlying counties, etc.

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

8. * records may have more than one cause of death listed N=938

9. 38 – 44% of neonates represented above died at < 24 hours of age

10. Northeast Florida Sleep related deaths 2005-2010

12. Total Number of Sleep Related Deaths Northeast Florida 2005 – 2010 200520062007200820092010 #332327 2216 % of deaths 17.5%14.6%17.6%16.4%15.1%12.6% Prepared by Llee NEFL FIMR Healthy Start Coalition

13. 200520062007200820092010 # NEFL SIDS cases 10 6631 NEFL SIDS rate/1,000 live births.55.53.31.32.16.06 FL SIDS rate.38.39.34.35.32 # NEFL Undetermined or other sleep related cases 231321 1915 NEFL sleeping infant death rate/1,000 live births 1.831.211.401.45 1.20.91 Prepared by Llee NEFL FIMR Healthy Start Coalition

14. BakerClayDuvalNassauSt Johns # deaths 13831 Baker-1 in Glen St. Mary Clay-2 in Keystone Heights and 1 in Middleburg Nassau-2 in Bryceville and 1 in Callahan St. Johns- 1 in Saint Johns

15. Maternal Demographics Sleep 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

16. Risk Factor Comparison Risk Factor2005 – 2009 n=132 2010 n=16 Unsafe sleep surface79%80% Not on back to sleep66%63% Not in an infant bed67%63% Never breast fed67%63% Unsafe items in bed61%56% Second/third hand smoke 46%44% Sharing sleep surface58%31%

17. State rate

18.  40 total fetal and infant deaths; 28 infants/12 fetals  78% white; 12% black  65% single moms (highest)  > half moms w/ unhealthy BMI  30% with no HS diploma; 15% w/ college  ¼ with poor birth spacing ZipCityTotal Fetal and Infant Deaths 32063MacClenny21 32040Glen St. Mary14

19. Maternal demographics:  51% single  18% teens (highest-was Nassau)  10% Hispanic (highest)  71% white  52% w/ unhealthy BMI—1/3 of those underweight (highest) ZipCityDeaths 32068Middleburg45 32065Orange Park26 32073Orange Park37 143 fetal and infant deaths; 75 infants/68 fetals

20. Maternal Demographics 86% white, 11 % black, 48% single ¼ w/out HS diploma More smokers 1/2 w/ unhealthy BMI ZipCityDeaths 32011Callahan12 32034Fernandina16 32097Yulee21 57 total deaths: 32 infant and 25 fetal

21. Maternal Demographics:  80% white (highest)  60% married (highest)  43.2% w/ some college (highest)  Best pnc, birth spacing and healthy BMI’s  More variety in substance abuse ZipCityDeaths 32082Ponte Vedra11 32084Downtown St Aug 34 32086St Aug Shores18 32092Palmo23 32145Hastings9 109 total deaths: 45 infants 64 fetals (all other counties had fewer fetals than infants)

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

23. Birth CohortDeath Cohort RaceW=58%; B=35%W=40%; B=50% AgeTeens @ 11%; 20’s –high 50%Teens trending down since 2007 approaching birth cohort; 20 year olds represent 50-60%; slight upward trend in 40 year olds Single Marital Status 47% last 3 yearsDecreased from 65% to 57% last 3 years Education-HS or higher 82%Increase over last 3 years from 60 to 70%

24. Birth CohortDeath Cohort Smoking8%12-17% Unhealthy BMI46%52% Inadequate prenatal care24%Trending down over last 3 years but still @ 34% in 2010 Pregnancy Interval < 12 mos15%17%

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

28. Contributing Factors in FIMR Cases July 2006-June 2011 N=142 Prepared by L.Lee Source: FIMR/CRT case reviews

29. Contributing Factors in FIMR Cases July 2006-June 2011 N=142 Prepared by L.Lee Source: FIMR/CRT case reviews

30. Contributing Factors in FIMR Cases July 2006-June 2011 N=142 Prepared by L.Lee Source: FIMR/CRT case reviews

31. Black N=49 Contributing FactorWhite N=31 36.7%Obesity25.8% 35.7%Previous fetal or infant loss22.6% 26.5%Previous preterm and/or low birth weight baby (< 5.5 pounds) 6.5% 18.4%Previous STD or other genitourinary infection 6.5%

32. Black N=49 Contributing Factor White N=31 65.3%Unplanned pregnancy 32.3% 14.29%Inadequate birth spacing 0%

33. Black N=49 Contributing FactorWhite N=31 55.1%Infections other than STD’s 45.2% 59.2%Preterm Labor51.6% 34.7%Anemia19.4% 24.5%PPROM/PROM0% 26.5%Placental Abruption9.7% 26.5%STD’s3.2%

34. Black N=49 Contributing FactorWhite N=31 38.8%Late Entry after 13 th week 16.1% 26.53%No prenatal care12.9% 16.33%Noncompliance0%

35. Black N=49 Contributing FactorsWhite n=31 51.1%Life Course Perspective Issues22.6% 36.7%Poverty12.9% 10.2%Lack of support systems during pregnancy or infant’s life 0% 32.7%Other emotional stressors during pregnancy or infant’s life such as loss of loved one, loss of job, incarceration, natural disaster, etc. 12.9% 24.49%Maternal age < 2112.9%

36.  No significant differences between races with provider issues  White mom’s had more pre-existing conditions, placenta previa, substance abuse and noncompliance/lack of understanding w/ kick counts  Black mom’s had more contributing factors in each category  Black babies had more infections and prematurity

37. Frequency of Contributing Factors by Race FIMR Cases 2008-2010 # of contributing factors per case # of cases

38. 1. Continue to focus on preventing sleep related deaths ▪ 80% unsafe sleep surface ▪ 63% not on backs or in infant beds ▪ 50% exposure to second/third hand smoke

39. 2. Focus on Family Planning with prenatal and interconceptional care ▪ Contraception in the immediate postpartum period ▪ Birth spacing ▪ Smoking ▪ Timely Medicaid 3. “Did you know?” campaign to educate consumers and providers re: key facts ▪ Reinforce importance of prenatal care ▪ Expand Baker County’s prenatal fan project into all counties. ▪ Improve dissemination of FIMR findings to all providers.