Perinatal death audits to improve newborn survival

Introduction

To improve the survival of babies, we need to know more about how many stillbirths and newborn deaths take place, where and why they occur, what are the contributing factors and what can be done to prevent similar events. 

Maternal death surveillance and response (MDSR) is a mortality audit cycle that can highlight breakdowns at different levels health services from local to national levels. the system aims to ultimately improve civil registration and vital statistic systems and quality of care. It is used in many countries, while less information has been captured and assessed on stillbirths and neonatal deaths. 

Country experiences of implementation suggest perinatal death audits may be a useful tool for reducing stillbirths and neonatal deaths in facilities, and can improve quality of care, as long as the audit loop can be closed.

The ability to respond effectively to recommendations identified through audits is pivotal to reducing mortality. When successful, audits can result in a 30% reduction in perinatal deaths.

The five experts are:

• Dr Animesh Biswas, Senior Scientist at the Centre for Injury Prevention and Research, Bangladesh
• Ms Kate Kerber, Senior Technical Specialist with Save the Children’s Save Newborn Lives programme based in Canada.
• Dr Natasha Rhoda, neonatologist in South Africa.
• Dr Nathalie Roos, gynaecologist and obstetrician, and Program Officer at the Maternal, Newborn, Child and Adolescent Health Department at the World Health Organization
• Dr Tunde Segun, public health physician and Country Director for the MamaYe-Evidence for Action programme in Nigeria

Questions and Answers

Q: What are your thoughts on investing in a perinatal death surveillance and response (PDSR) system, particularly where MDSR already exists but is not fully functional?

Kerber: At the facility level, ideally, perinatal death review should take place anywhere that maternal death reviews are happening. A full death review isn’t as feasible at the community level given the additional number of stillbirths and neonatal deaths compared to maternal deaths. All systems should be looking to at least count stillbirths and newborn deaths, and collect basic information on each of these.

Roos: Yes – as the mother and baby share the same periods of risk, there are lessons to be learnt from perinatal deaths as well as maternal deaths to save the lives of both mothers and their babies. The information should therefore not be separated.

Segun: I agree; perinatal deaths should be included in the review process. That makes sense. However, the challenges (in incorporating a perinatal component when healthcare providers are struggling with maternal death reviews) are in the implementation. We need to ask: are there enough human resources to review the deaths? If we are reviewing all maternal deaths, can we also review all perinatal deaths knowing that the numbers are higher?

Rhoda: The 18-years of experience of MDSR in South Africa has given the participating clinical staff (doctors and nurses) insight into the importance of reviewing maternal deaths with the main focus on prevention and improvement of the quality of care provided. On the back of this, we have extended this review system to the perinatal population, starting with the review of all neonatal deaths. For us, it is the correct time to invest in perinatal deaths. We have the data, [we have identified the] avoidable causes and now people who understand a MDSR process can see the benefit of including perinatal death. 

Click here to read the full article originally published on the Maternal Death Surveillance and Response (MDSR) Action Network website.