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Avoidable mortality in small-for-gestational-age children in the Netherlands
Paul A O M De Reu1, Herman P Oosterbaan, Luc J M Smits
1Midden Brabant Midwifery Care Center, Boxtel, The Netherlands. penmdereu@vcmb.info
Journal of Perinatal Medicine
|February 4, 2010
Summary
Avoidable perinatal mortality in small-for-gestational-age (SGA) infants is significant. Improved diagnosis and timely interventions, particularly in low-risk pregnancies, could prevent nearly one-third of these deaths.
Area of Science:
- Perinatal Medicine
- Neonatology
- Public Health
Background:
- Small-for-gestational-age (SGA) infants are at increased risk of perinatal mortality.
- Substandard care factors (SSF) may contribute to avoidable deaths in this vulnerable population.
Purpose of the Study:
- To analyze avoidable perinatal mortality in small-for-gestational-age (SGA) infants.
- To identify factors contributing to substandard care in SGA perinatal deaths.
Main Methods:
- Evaluation of 2396 SGA newborns from 20,927 total births in the Netherlands (2003-2004).
- Perinatal audit groups assessed 55 cases of perinatal mortality for cause of death and SSF.
- Analysis of avoidable mortality in SGA cases with and without identified SSF.
Main Results:
- Of 59 SGA perinatal deaths, SSF by caregivers were found in 40% (22 cases), with a probable link to death in 29% (16 cases).
- In cases without SSF, 25% (15 cases) were deemed possibly avoidable.
- Failure to diagnose fetal growth restriction timely was a key issue, with suspicion only in 22% of SGA cases during the third trimester.
Conclusions:
- Adequate caregiver actions could reduce perinatal mortality in SGA infants by nearly one-third.
- Routine ultrasound biometry in pregnancy monitoring, especially for low-risk pregnancies, may improve growth deviation detection and reduce avoidable deaths.
