State Office of Vital Records Fetal and Infant

State Office of Vital Records Fetal and Infant Death Registration Webinar January 23 rd, 2017

VITAL RECORDS IN GEORGIA: THE HEART OF PUBLIC HEALTH DATA Lara Jacobson, MD Director of Health Promotion

Vital Records (VR) Data: Case Studies from Maternal-Child Health • Case study 1: Where are premature babies delivered in Georgia? • Case study 2: How do we know which children may need early intervention services? • Case study 3: What is the pregnancy checkbox and why does it matter?

Case 1: Premature Births

Where you deliver matters Georgia’s Regional Perinatal Centers

VR is a critical source of data to understand if babies are delivered in hospitals equipped for their care

Case 2: Identifying Children in Need of Services

Children’s First (C 1 st) • Entry point into all public health services for children, birth – 5 years old • Facilitates early identification of at-risk children and links them with early interventions services • More than 15, 000 children receive developmental screenings each year

Birth worksheets provide an important source of referrals to C 1 st

IN 2013 Case 3: Pregnancy Checkbox MATERNAL MORTALITY GEORGIA RANKS # 48 NATIONALLY

Maternal Mortality in the US Source: The Pew Charitable Trusts

Accuracy of Pregnancy Checkbox Critical for Maternal Mortality

For Consideration: Why Fetal Death Records Matter • World Health Organization: “Every pregnancy counts, so count every pregnancy. ” • Georgia Code specifies ‘all products of conception’ precisely for the purpose of obtaining a more complete and actionable picture of maternal/child health, and was a function of (then Governor) President Carter’s initiatives in the early 70’s. • Collecting feto-infant mortality – Prevents misclassification between early neonatal infant mortality and late fetal mortality. – Allows for calculation of more accurate pregnancy rates

Why Fetal Death Records Matter- continued • Not collecting fetal deaths <20 weeks would potentially mean not knowing about ~7, 000 women in need of primary health care and/or public health services • Early fetal loss and emerging science: Fetal loss <20 weeks can be an indicator of environmental or infectious exposure, such as Zika, Fetal Alcohol Syndrome, or Lead. • Finally – there are many cases of very early fetal loss that will not be known. The key however is to focus on the outcome of pregnancies where contact has already been made with a healthcare provider.

Infant & Fetal Death Registration New Reports for 2018 Chris Harrison, MPH Deputy Director, Vital Records

Background • 2014 Birth quality report Great improvement! • Time to register a birth: 7. 5 days to 4. 1 days, a 45% improvement • Opportunity for improvement: Fetal Deaths: 53 days Infant Deaths: 89 days

GA Code Ann. , 31 -10 -18 “A report of spontaneous fetal death for each spontaneous fetal death which occurs in this state shall be filed with the local registrar of the county in which the delivery occurred within 72 hours after such delivery in accordance with this Code section unless the place of fetal death is unknown, in which case a fetal death certificate shall be filed in the county in which the dead fetus was found within 72 hours after such occurrence”

GA Code Ann. , 31 -10 -15 “A certificate of death for each death which occurs in this state shall be filed with the local registrar of the county in which the death occurred or the body was found within ten days…”

GA Regulation 511 -1 -3 -. 19 (updated 11/14/2017) (2) Manner of reporting. Death reports, including the certification of cause of death, shall be filed electronically with the Office of Vital Records in such manner as may be determined by the State Registrar. (5) Cause of death. The electronic death report filed in accordance with subsections (1) through (4) of this Rule shall be supplemented by an electronic report of the cause of death. (6) When reporting is due. (a) The report of death shall be made within three calendar days after death. (b)Certification of the cause of death shall be made within three calendar days after death, however, if the death occurred without medical attendance, or in cases subject to inquiry under Title 45, by the county coroner or medical examiner. (c) If for any reason the cause of death cannot be determined within 48 hours after death then “under review” shall be entered on the death report and amended promptly after the determination is made. Until the cause of death is certified, final disposition of the body shall not be made unless authorized by the attending physician or, with regard to a body subject to inquiry under Title 45, by the county coroner or medical examiner.

New Reports for 2018 • Objectives: – Track and understand – Increased awareness – Partner to improve data reporting

Fetal Death

Infant Death

Pilot Facilities • • Piedmont Athens Regional Medical Center Candler Hospital Memorial Health University Medical Center Northside Hospitals –Cherokee & Forsyth Piedmont Fayette Hospital St. Mary’s Healthcare System Wellstar Cobb Hospital

Thank You!

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