California is the only state in the US where the number of newborns dying each year fell between 2014 and 2016, the CDC’s latest data reveals.
Compared to other wealthy nations, women giving birth and the babies they carry face dismal odds.
There are more stillbirths and babies that die within their first few days of life in the US than in any of the top 20 developed nations in the world – and things have not improved in the last three years.
Except in California, where doctors first noticed the alarming phenomenon 20 years ago, and have been working methodically ever since to improve newborns’ chances at life.
Their work paid off: The perinatal mortality rate in California fell by eight percent, from 5.22 deaths per 1,000 births in 2014 to 4.79 deaths per 1,000 in 2016.
US infant mortality rates remain high, and unchanged since 2014 (white), except in Missouri (blue) where they have risen, and in California (green) where mortality rates fell eight percent
Most infants are still dying of the same causes that they have been for decades: birth defects, premature birth, sudden infant death syndrome, pregnancy complications and injuries.
And there remains much about the risk factors and medical failures involved in these deaths that we don’t know.
Technological shortfalls seem an obvious scapegoat for poor health outcomes, but at least one 2016 paper suggests that, if anything, the US is in a better position in terms of these resources.
That research identified two areas to focus on in order to lower the nation’s overall infant mortality rates: the deaths of babies born preterm and those that happen in the postneonatal period, after a baby’s first 28 days of life.
In the 1990s, Dr Jeffrey Gould, a neonatal specialist in San Francisco began approaching neonatal intensive care units in his home state to discuss the formation of a network.
This became the California Perinatal Quality Care Collaborative (CPQCC), which now includes 140 of the state’s neonatal intensive care units (NICU), accounting for 90 percent of the hospitals there.
All of these partnered facilities submit their own data and have access to one another’s. The aggregate is key.
‘The ability for NICUs to see the data and manage the data, the constant of everything, that has really elevated the quality of care here above what most other states have,’ says Dr Jochen Profit, the CPQCC’s chief scientific officer.
California has an inherent advantage too: it is a big state where more than 470,000 babies are born each year, plus CPQCC’s data now covers 20 years.
‘We have more babies, so it’s easier to spot trends,’ says Dr Profit.
Though the CDC reports that preterm births are the top cause of overall infant mortality, but there actually are surprisingly few studies on particular causes of death for these babies.
But with a comprehensive set of data, the CPQCC comes together annually to decide which ‘trends’ to address, and how.
Dr Elizabeth Rogers of the University of San Francisco (UCSF) noticed anecdotally that 15 percent of the premature babies born at her hospital were having brain bleeds in 2014, she told the Huffington Post.
These bleeds often prove fatal for babies born early, and even if they survive they may face cognitive delays down the road.
She and her colleagues checked their observations against the CPQCC list, and found that that proportion was way out of the range of normal for hospitals their size.
They swiftly implemented new programs, including steroid shots and quiet practices to help reduce the stress the already fragile newborns faced.
Within three years, the number of preemie brain bleeds fell to a quarter of what it had been at UCSF.
In California, ‘neonatology is really uniquely organized in the sense that a lot of places have committed to working on improvement. Compared to a large national group, there is more cohesion,’ says Dr Profit.
Joining CPQCC costs hospitals $13,000 to $15,000 a year, but California state believes it is worth it.
The state has a program that gives hospitals funding for perinatal programs, but in order to get the money the facilities have to get certified.
In order to get certified, they have to join the CPQCC.
‘The state wants to see the data, so the hospitals are kind of forced to join if they want to be certified, but [the hospitals] get an additional reimbursement and it’s probably a net positive to participate,’ says Dr Profit.
‘So it’s kind of a win-win-win for everybody.’
Now, there are perinatal quality care collaboratives in most states in the US, and the CDC even provides funding to some.
Few have so many partnerships and such a robust data set as California’s, but following the state’s example could give policy experts and doctors more precise targets to focus on in their fight to lower infant mortality rates.