News and Events
Planned Home Births in Ireland Annual Report 2016
The Planned Home Births in Ireland report published by the Health Service Executive in collaboration with the National Perintal Epidemiology Centre is to present an overview and national statistics on the home births service provided by SECMs in the Republic of Ireland for the year 2016. The report audits the home birth service by examining both the maternal and fetal outcomes of planned home births, including outcomes whereby the care of the woman is transferred for hospital care antenatally, during labour or postnatally.
This is the fifth national clinical audit on planned home births in Ireland under the care of Self Employed Community Midwives (SECMs). In 2016, 20 primary SECMs provided
a home birth service on behalf of the Health Service Executive (HSE). Anonymised data were reported by the five Designated Midwifery Officers on a total of 192 planned home births in 2016. This equates to a 16% reduction in the number of women who intended on having a home birth compared to figures from 2015.
This national clinical audit provides information on planned home births in Ireland. This report offers an informative resource for clinicians to inform mothers in a clear and transparent manner in relation to planned home birth as a delivery option in Ireland.
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National Clinical Programme for Paediatrics and Neonatology & National Perinatal Epidemiology Centre launches Neonatal Therapeutic Hypothermia in Ireland, Annual Report 2016-2017
This report is a collaborative initiative between the National Clinical Programme for Paediatrics and Neonatology (NCPPN) and the National Perinatal Epidemiology Centre (NPEC) with support from the National Women and Infants Health Programme (NWIHP) and the Clinical Strategy and Programme Division of the Health Services Executive.
Before or during birth, a small number of infants experience reduced oxygen or blood supply. After birth, some of these infants will show abnormal neurological behaviour, diagnosed as hypoxic-ischaemic encephalopathy (HIE).
Therapeutic Hypothermia (TH) is now the standard treatment for term infants (babies born after 36 completed weeks of gestation) with moderate to severe HIE. It is a therapy during which the infant is cooled within six hours of birth to a targeted core body temperature of between 33°C to 34°C for a duration of 72 hours. A normal core body temperature for infants is about 36.4°C, but this can vary slightly. Following the 72 hour period of cooling, the infant is rewarmed to normal body temperature over a 6-12 hour period. TH is regarded as the greatest single advance in Neonatology over the last 25 years as research has demonstrated it reduces the rate of death, severe disability and lifelong cerebral palsy reduction for these infants.
In Ireland, TH is administered in four tertiary maternity hospitals: National Maternity Hospital, Rotunda Hospital, Coombe Women and Infants University Hospital and Cork University Maternity Hospital). All infants born in other hospitals requiring this treatment are transferred to one of these four tertiary hospitals.
Measurement of the outcome of care is central to the development of safe and high quality healthcare services. The Neonatal Therapeutic Hypothermia in Ireland Annual Report 2016-2017 is the first report that incorporates comprehensive data on the maternal, infant and clinical characteristics associated with TH that occurred in 2016 and 2017. This report illustrates the logistical challenges faced with the delivery of a high acuity, uncommon treatment that has to be delivered on short notice.
- Sixty-three infants underwent TH in 2016 and 77 in 2017; a total of 140 in the two-year period. This suggests that one in 900 infants born in Ireland during 2016/2017 required TH. The survival rate for the TH cohort was 88%, as 17 of the 140 infants died.
- The data on maternal age, ethnicity and BMI broadly reflected that of the population of mothers who gave birth in Ireland in 2016.
- Of the range of maternal characteristics examined, parity showed some evidence of being associated with increased risk of the infant requiring TH. Almost 40% of all infants born in Ireland are born to nulliparous women, whereas this was the case for 60% of the TH cohort.
- One in three women whose infant required TH cohort had their labour induced (34%), compared to 29% of all deliveries in Ireland for 2016.
- At 47%, Caesarean Section was the most common mode of delivery for all 140 infants. Of the women who had a caesarean section:
- 47% of mothers had a pre-labour Caesarean Section
- 53% of mothers had a Caesarean Section after the onset of labour.
- Emergency caesarean section delivery was the most common type of caesarean section delivery, accounting for 90% of cases. Only two mothers had an elective caesarean section.
- The Apgar scoring system is used to assess an infant’s health at birth to determine the need for prompt intervention. At 1 minute of life, 79% of the TH infants had a low Apgar score indicating they required intervention
- 95% of infants required resuscitation
- 59% of all the TH infants required intubation at birth.
- TH is administered in four centres In Ireland. Forty percent of the infants who required TH in 2016/2017 were born in a local or regional hospital and were subsequently transferred to a tertiary centre. Of these, 89% were transferred by the National Neonatal Transport Programme and the remainder transferred by the HSE
- Based on available examinations, placental conditions were present for the majority of the infants (83%) indicating evidence of fetal compromise before delivery.
- The majority of infants had an MRI, and following assessment, 65% were found to have a normal MRI following TH
- While these findings support the existing evidence that hypoxia requiring TH is caused by antepartum and intrapartum complications and events, disentangling the role of these complications and events requires more extensive data and analysis, in particular relating to labour
This national report highlights efforts made in Ireland to investigate key adverse outcomes for mothers and babies. Some key recommendations from this report:
- Ongoing national review of therapeutic hypothermia infant cases is required.
- The development of a national Electronic-Register which will contribute to a body of evidence which will inform standardised clinical practice, public health interventions, service planning and counselling of prospective parents.
- The development and implementation of a standardised review tool for perinatal events, which incorporates a comprehensive review of adverse outcomes using a multidisciplinary team approach will enable the identification of potential risk factors for pregnant women, is advocated.
- All infants who are treated with therapeutic hypothermia should have a formal neurodevelopmental assessment at 2 years of age.
Mortality Risk Amongst Very Low Birth Weight Infants in the Republic of Ireland Report 2014-2016
The National Perinatal Epidemiology Centre, in association with the NICORE Group, publishes Mortality Risk Amongst Very Low Birth Weight Infants Born in the Republic of Ireland Report 2014-2016
This is the first national report to include three years of data on very low birth weight (VLBW) infants born in the Republic of Ireland (ROI) in the years 2014 to 2016. This report is produced by the Neonatal Intensive Care Outcomes Research and Evaluation (NICORE) ROI group and facilitated by the National Perinatal Epidemiology Centre (NPEC).
The Vermont Oxford Network (VON) Ireland database holds data on 1,812 very low birth weight (VLBW) infants born in Ireland in the years 2014-2016. The findings in this report are based on the 1,765 infants with a record from their hospital of birth: 580 infants born in 2014, 608 born in 2015 and 577 born in 2016.
- The gestational ages of the VLBW infants ranged from 21 weeks to 33 weeks and their birth weights ranged from 360g to 2,640g.
- Over the three years, more Irish VLBW infants died prior to discharge home or their first birthday than their VON counterparts (16.9% versus 14.5%, p=0.005).
- Following adjustment for differences in the profile of the Irish and VON populations, the standardised mortality rate (SMR) indicated that the mortality risk for VLBW infants born in Ireland was 1.17 times higher than expected and represented a statistically significant excess mortality (95% CI: 1.05, 1.29).
- The excess mortality diminished over the three years from 24% in 2014 (SMR=1.24, 95% CI: 1.03, 1.45) to 17% in 2015 (SMR=1.17, 95% CI: 0.95, 1.39) and 10% in 2016 (SMR=1.10, 95% CI: 0.89, 1.31).
- Infants born at 22-23 weeks had a 23% higher mortality risk than expected (SMR=1.23, 95% CI: 1.02, 1.44). This excess mortality was almost wholly due to the infants who were not administered resuscitation. At this gestational age, 60% of infants were not administered resuscitation in Ireland, which is higher than for the VON population.
- Infants born at 24-27 weeks in a tertiary unit did not experience higher than expected mortality (SMR=1.01, 95% CI: 0.80, 1.23) but those born in non-tertiary units had a 70% higher mortality risk (SMR=1.70, 95% CI: 1.25, 2.15), most of which arose from those born in peripheral units.
- Infants born with a gestational age of at least 28 weeks did not have a higher mortality risk than expected (SMR=1.19, 95% CI: 0.90, 1.48).
- All women anticipated to deliver at a gestational age of 23 weeks should be administered antenatal steroids and magnesium sulphate and the neonatology team should be alerted prior to delivery.
- Resuscitation should be administered to all infants born at 23 weeks who present in favourable condition i.e. without congenital anomaly, severely small for gestational age, severe hypoxia or severe infection.
- In line with the existing Model of Care for Neonatal Services in Ireland, infants born before reaching a gestational age of 28 weeks should ideally be delivered at one of the four tertiary neonatal units.
NPEC gratefully acknowledges the staff of 19 neonatal units in the country for their support in producing this report, and in particular, the commitment of those who co-ordinate the data collection process at unit level. We also thank the NICORE group and the team at the Vermont Oxford Network.
Report & Lay Summary
Mortality Risk Amongst Very Low Birth Weight Infants in the Republic of Ireland Report 2014-2016
Mortality Risk Amongst Very Low Birth Weight Infants in the Republic of Ireland Report 2014-2016 Lay Summary
Perinatal Mortality in Ireland Annual Report 2016
National Perinatal Epidemiology Centre publishes Perinatal Mortality in Ireland Annual Report 2016
A total of 407 perinatal deaths in 2016 were recorded, arising from 64,133 births of at least 24 weeks gestation or at least 500 grams in birthweight. Stillbirths, early neonatal and late neonatal deaths accounted for 250 (61.4%), 124 (30.5%) and 33 (8.1%) of the 407 deaths, respectively.
- The perinatal mortality rate (PMR) was 5.8 deaths per 1,000 births or 1 in 172 births. Corrected to exclude deaths due to major congenital anomaly, the PMR was 3.6 per 1,000 births.
- A statistically significant decrease in the PMR was recorded in 2016 compared to 2015 (15% decrease). The 2016 rate also represents the lowest PMR since recordings began. The most significant rate decrease was in early neonatal deaths.
- Along with the reduction in the national PMR, there was less variation in the individual rates across Irish maternity units than that observed in previous years.
- Major congenital anomaly remains the main cause of death of stillbirth, early neonatal death and late neonatal death.
- Fetal growth restriction continues to appear as a significant associated factor with perinatal mortality. Improved antenatal detection is a potentially modifiable factor.
Key recommendations from the 2016 report include:
- Improved antenatal detection of fetal growth restriction (FGR) with timely delivery is a preventative strategy to reduce perinatal mortality. NPEC recommends a national standardised approach be adapted by all units in the detection of FGR, and outlines methodologies to be considered.
- A public health education programme on perinatal deaths and modifiable risk factors should be developed.
- Further research exploring factors impacting on autopsy rates is warranted.
- Funding should be provided by the Health Service Executive to ensure that staffing levels allow protected time for clinical audit.
NPEC gratefully acknowledges the midwives, obstetricians, paediatricians, pathologists and administration staff who have contributed data to this audit. This report would not be possible without their dedicated support and co-operation.
Severe Maternal Morbidity in Ireland Annual Report 2016
National Perinatal Epidemiology Centre publishes Severe Maternal Morbidity in Ireland Annual Report 2016
This is the fifth report from the national clinical audit of severe maternal morbidity (SMM) in Ireland. It reports on 406 cases of SMM that occurred in all 19 Irish maternity units in 2016. It also reports on findings from the third and final year of the Confidential Audit of Critical Care in Obstetrics in Ireland. Fifteen of the 19 Irish maternity units contributed data to the critical care in obstetric audit in 2016, including two large tertiary referral maternity units and thirteen smaller maternity units.
Severe Maternal Morbidity
The SMM rate is a composite rate of a group of clearly defined severe morbidities.
- There was a statistically significant increase in the rate of Severe Maternal Morbidity (SMM) and major obstetric haemorrhage (MOH) in 2016 compared to the base year 2011.
- The rate of SMM was 6.46 per 1,000 maternities or one in 155 maternities.
- MOH remains the most commonly reported morbidity.
- Variation in rates of SMM and MOH were identified between units.
- Multiple pregnancy was associated with an almost fourfold increased risk of SMM.
- The perinatal mortality rate among infants in women experiencing SMM is approximately seven times the rate observed for all births in Ireland.
Confidential Audit of Critical Care in Obstetrics in Ireland
- One in 109 women required either Level 2 Care and/or Level 3 Care.
- The need for higher levels of maternal care is not predictable in approximately half of cases and thus has implications for resource planning.
- NPEC encourages all units to collect Robson Ten Group Classification System data in order to facilitate local and national audit.
- A public health education programme on maternal morbidity and modifiable risk factors should be developed.
- Maternal Newborn Clinical Management System (MN_CMS) data from Irish maternity units should be collated to identify the influence of risk factors for SMM in Ireland including: ethnicity, maternal age, body mass index (BMI), smoking and employment status.
The findings of this national audit highlight the clear need for on-going prospective audit in order to identify adverse maternal outcomes. Although SMM may reflect the complexity of the pregnant population, it also acts as a surrogate measure of quality of care in the maternity services.
Very Low Birth Weight Infants in the Republic of Ireland: Annual Report 2016
National Perinatal Epidemiology Centre in association with the NICORE Group publishes Very Low Birth Weight Infants in the Republic of Ireland Annual Report 2016
This is the third Very Low Birth Weight Infants in the Republic of Ireland (ROI) Annual Report, produced by the Neonatal Intensive Care Outcomes Research and Evaluation (NICORE) ROI group and facilitated by the National Perinatal Epidemiology Centre (NPEC). This report focuses on all babies born ≤1500g and/or ≤29 weeks gestation in the Republic of Ireland for the calendar year 2016.
- A total of 593 very low birth weight (VLBW) infants were born in the Republic of Ireland (ROI) in 2016, of which 25 infants were ≥1500g but ≤29 weeks gestation.
- In all, 250 infants were born with a birth weight ≤1000g and 182 infants were born with a gestational age ≤26 weeks 6 days.
- 84% of Very Low Birth Weight infants born in Ireland in 2016 survived to discharge home.
- Three years of data on VLBW infants born in Ireland have now been collected, for the years 2014 through to 2016. In order to draw meaningful conclusions, a national report on the aggregated data of over 1,800 VLBW infants born in Ireland in the years 2014 to 2016 is forthcoming. It is hoped that specific recommendations addressing clinical care and patient safety in the Irish context can thus be made.
NPEC gratefully acknowledges the neonatal nurses, neonatologists, paediatricians and administration staff who have contributed data.
Island of Ireland Perinatal Mortality Report 2014 and 2015
National Perinatal Epidemiology Centre (NPEC) in collaboration with Northern Ireland Maternal and Child Health office (NIMACH) publishes: Island of Ireland Perinatal Mortality Report 2014 and 2015
This is the first report on perinatal mortality occurring across the Island of Ireland. Comparative data is included on perinatal deaths in the Republic of Ireland (ROI) and Northern Ireland (NI) arising from live births and stillbirths that occurred in the combined years 2014 and 2015 with a gestational age of 24 weeks or more. Anonymised data from all maternity units was collated and analysed by the NPEC in the ROI and by the NIMACH in NI.
• There were 182,600 births that were ≥24 weeks gestational age at delivery across the Island of Ireland in 2014-2015. Stillbirths and early neonatal deaths accounted for 753 (66.3%) and 383 (33.7%) of 1,136 perinatal deaths respectively. A further 81 late neonatal deaths occurred.
• The 2014 and 2015 perinatal mortality rate (PMR) for the ROI and NI were similar. The All-Ireland perinatal mortality rate was 6.2 deaths per 1,000 births; adjusted to exclude perinatal deaths due to congenital anomaly, the rate was 3.85 per 1,000 births.
• The 2014 and 2015 stillbirth rate for the ROI was 4.35 per 1,000 births as compared to a rate of 3.50 per 1,000 births for NI. In contrast the neonatal mortality rate in the ROI was lower, at 2.39 per 1,000 live births, compared to NI, at 3.00 per 1,000 live births. The differences in both stillbirth and neonatal death rates between the ROI and NI was found to be statistically significant.
• Major congenital anomaly was the primary cause of perinatal death in both the ROI and NI; present in 24.3% and 63.6% of all stillbirths and neonatal deaths respectively.
• The distribution of customised birth weight centiles was similar in the ROI and NI. Approximately 40% of perinatal deaths were severely small for gestational age (• Across the Island of Ireland, a post-mortem examination was undertaken more often
in stillbirths than in neonatal deaths in 2014 and 2015 - 54% of stillbirths and 40% of neonatal deaths in the ROI and 70% of stillbirths and 33% of neonatal deaths in NI.
• Establish a process for biennial reporting on perinatal mortality for the Island of Ireland as a resource to support service improvement, audit and benchmarking
• Improve awareness among professionals of the impact of fetal growth restriction on perinatal mortality. The generation of customised birth weight centile charts for
every woman during pregnancy should be considered.
• A post mortem examination carried out by a specialist pathologist should be offered for all perinatal deaths.
This is the first assessment of Perinatal Mortality across the Island of Ireland. Similarities in factors associated with perinatal death occurring in ROI and NI illustrates the importance of working in a collaborative way in order that we can learn and work together to reduce avoidable perinatal mortality in the future.
We would like to extend our sincere thanks to all the contributors and health care
professionals across the Island of Ireland for providing data to both the NPEC and NIMACH. This report would not be possible without their support and cooperation