Department of Health and Human Services Department Of Heallh Commissioner?s Office and Human Services 221 State Street Mame Female 11 State House Station 5010 Healthy and Produchvc live: Augusta, Maine Tel: (207) 287-3707; Fax (207) 287-3005 Paul R. lePoge, Governor Mary C. Mayhew, Commissioner TTY Users: Dial 711 (Maine Relay) March 23, 2016 Senator Eric Brakey, Chair Representative Andrew Gattine, Chair Joint Standing Committee on Health and Human Services 100 State House Station Augusta, Maine 04333-0100 Dear Senator Brakey, Representative Gattine and Members of the Joint Standing Committee on Health and Human Services: Enclosed is the 2015 Annual Report to the Legislature for the Maternal, Fetal and Infant Mortality Review Panel submitted by the Department of Health and Human Services. This report is required under Title 22 of the M.R.S.A., Chapter 261. The report discusses the Maternal, Fetal and Infant Mortality Review Panel activities and recommendations in State Fiscal Year 2015 as well as planned activities for State Fiscal year 201 6. Sincerel Mary C. Mayhew Commissioner MCM/klv Enclosure Maine CDC Maternal, Fetal and Infant Mortality Review Panel (MFIMR) July], 2014 - June 30, 2015 Submitted to the Joint Standing Committee 2015 Annual on Health and Human Services Report Maine Center for Disease Control and Prevention An Qifice 0? We ?pull/HEW" oi uri'J Human 591 Paul R. LePage, Governor Mary C. Mayhew, Commissioner Maine Maternal, Fetal and Infant Mortality Review Panel (MFIMR) 2015 Annual Report to the Legislature TABLE OF CONTENTS Executive Summary ..2 Panel Report ..3 Background and Panel ..3 Panel Activities in 2015 ..4 NFIMR Technical Assistance ..6 Plans for 2016 ..6 Appendix A: Data Highlights ..8 Appendix B: Indicators/Measures ..11 Appendix C: Panel Membership ..13 Appendix D: End Notes ..14 EXECUTIVE SUMMARY Background In 2005, the 122"d Legislature passed An Act to Establish a Maternal and Infant Death Review Panel to examine issues related to maternal and infant deaths in Maine. In 2010, the 124th Legislature amended this statute to authorize the Maternal and Infant Death Review Panel to review fetal deaths occurring after 28 weeks gestation, stillborn infants. With this change, the Panel is now referred to as the Maternal, Fetal and Infant Mortality Review Panel. Purpose The overall purpose of the Maine Maternal, Fetal and Infant Mortality Review Panel (MFIMR), using a public health approach, is to strengthen community resources and enhance State and local systems and policies affecting women, infants and families in order to improve health outcomes in this population and prevent maternal, fetal and infant mortality and morbidity. The infant mortality rate is a sensitive public health indicator of social health and well-being. By understanding the factors associated with maternal, fetal and infant deaths, we will improve our ability as a State to most effectively direct prevention efforts and to take actions to promote healthy mothers and infants. Highlights This 2015 report summarizes relevant data contributing to perinatal outcomes, challenges, activities and plans for the MFIMR Panel. The MFIMR Panel identi?ed the following issues as needing in?depth investigation over the next five years (2013 -2018): Factors that contribute to preterm birth, pregnancy loss, and strategies for prevention. Barriers to delivery of the highest risk infants g. very low birth weight/premature) at Level facilities. Sudden infant death and sudden unexpected infant death as emerging issues, including sleep-related deaths. Recommendations Increase awareness of MFIMR Panel and related activities and resources for healthcare providers and bereaved families. Distribute Rules related to Screening Newborns for Critical Congenital Heart Disease to hospitals and health care providers. Rules outline screening methodology, follow up and data collection to promote consistency and quality in screening systems. Determine which recommendations to implement from the technical assistance provided by the National Fetal Infant Mortality Review Technical Assistance in order to improve the MFIMR system. For more information on activities of the MFIMR Panel: Contact Ellie Mulcahy, Panel Coordinator, Maine CDC, eleanoramulcahy@maine.gov, or 207-287?4623 PANEL 2015 REPORT Background In 2005, the 122nd Legislature passed An Act to Establish a Maternal and Infant Death Review Panel to examine issues related to maternal and infant deaths in Maine. In 2010, the 124th Legislature amended this statute to authorize the Maternal and Infant Death Review Panel to review fetal deaths occurring after 28 weeks gestation, stillborn infants. With this change, the Panel is now referred to as the Maternal, Fetal and Infant Mortality Review Panel. The Legislature also repealed the sunset on the Panel allowing the Panel to continue its work beyond the original end date of January 1, 2011. Purpose The overall purpose of the Maine Maternal, Fetal and Infant Mortality Review Panel (MFIMR), using a public health approach, is to strengthen community resources and enhance State and local systems and policies affecting women, infants and families in order to improve health outcomes in this population and prevent maternal, fetal and infant mortality and morbidity. The infant mortality rate is a sensitive public health indicator of social health and well-being. By understanding the factors associated with maternal, fetal and infant deaths, we will improve our ability as a State to most effectively direct prevention efforts and to take actions to promote healthy mothers and infants. The Panel The Maine CDC MFIMR Panel is a multidisciplinary group of health care and social service providers, public health officials, law enforcement of?cers, parents and other persons with professional expertise on maternal and infant health and mortality. The Panel is supported by a dedicated revenue account for a portion of the Panel coordinator?s time. All Panel members are volunteers. The Panel takes a broad, holistic approach to improving the quality of life for all of Maine?s women, infants and families. The Panel gathers and reviews information relevant to infant and maternal mortality, including factors contributing to mortality, considers the and weaknesses of the current maternal and infant health care delivery system and makes recommendations to prevent future deaths and improve the overall health and safety of Maine?s infants and mothers. The Panel identified the following issues as needing in-depth investigation over a ?ve?year period (2013 to 2018): Factors that contribute to preterm birth, pregnancy loss and strategies for prevention. Barriers to delivery of the highest risk infants g. very low birth weight/premature) at hospitals with appropriate facilities and professionals to provide the best chance of survival for the infant Level facilities). Sudden infant death and sudden unexpected infant death as emerging issues, including sleep related deaths. Maine MFIMR Activities in State Fiscal Year 2015 The Maine CDC MFIMR Panel met three times in SFY 2014; it did not meet in 2015. Because of the challenges to ascertain cases the MFIMR Panel requested technical assistance from the National Fetal and Infant Mortality Review (N FIMR) on proven case ascertainment practices. Summary of Strategies and Activities: MFIMR-reviewed cases have generated the following activities to reduce infant deaths: Community Strategy: In 2013, the Maine CDC worked with the March of Dimes and the Perinatal Leadership Council to implement a quality improvement initiative to reduce the number of early deliveries at less than 39 weeks gestation of the pregnancy. Twenty one of the twenty seven birth hospitals in Maine voluntarily reported data on the rate of elective deliveries before 39 weeks of pregnancy during calendar year 2014 to Leapfrog Group*. Four of these hospitals met the goal of having less than 5 percent of births between 37-39 completed weeks being delivered by cesarean section or induction without a medical indication. Three of these hospitals have shown progress over the past year. *(Leapfrog Group is a non-pro?t organization that compares hospitals on national standards of safety and quality.) Community Strategy: A series of training sessions was developed by the Maine CDC through a contract with Maine Medical Center to use with community partners including: Maine Families Home Visiting, child abuse/neglect prevention councils, Community/Public Health Nursing, Of?ce of Child Family Services staff, case managers and Medication Assisted Treatment Center staff. Training was provided in four locations; Portland, Augusta, Rockland and Lewiston with 190 participants. Others in Maine received training via grand rounds presentations at hospitals, and at the Perinatal Nurse Leadership Collaborative. These sessions included infant mandated reporting, abusive head trauma (shaken baby) prevention and safe sleep. Community Strategy: Birth hospital staff were surveyed to identify methods of educating families regarding safe sleep environments. Respondents stated that approaches included discussion: at prenatal classes, during tours of the unit and during birth hospitalization. Perinatal hospital representatives from across Maine held discussions about safe sleep and educating families. A Maine Chapter of Cribs for Kids was developed with Dr. Jennifer Hayman from Maine Medical Center through the Maine Children?s Trust and is available statewide, primarily through local child abuse /prevention councils and the network of Maine Families Home Visiting programs. A family or a healthcare provider that identi?es a family with a need for a crib to significantly reduce the risk of an unsafe sleep situation can make a referral to the Maine Families Home Visiting Program. Maine Families staff will conduct a home visit to determine eligibility and to establish a relationship with the family for support and education. Approximately 500 cribs have been distributed to families in need since July 2010. In follow up with families receiving cribs, most people answer ?always? or ?almost always? to questions about sleep setting: baby sleeps alone, baby sleeps on back, baby sleeps on firm mattress, the crib is free of toys, bumpers and blankets and the Pack and Play is used for all sleeps and naps. Funding for Cribs for Kids in Maine has been provided through small grants by the Kohl?s Cares for Kids Foundation and Maine Families/Maine Children?s Trust for future distribution. Community Strategy: The Maine CDC convened a multi-disciplinary workgroup, the Continuum of Care Collaborative, to focus on high-quality obstetric and newborn care for families planning a home birth. The Continuum of Care Collaborative developed a communication tool for the transfer of care that has a potential impact for any transfer of care (home to hospital, community hospital to tertiary care center). 0 Policy Strategy: Screening for Critical Congenital Heart Defects (CCHD) for all newborns offers early identi?cation of at?risk infants with the opportunity for further evaluation and potential to reduce infant deaths from some congenital heart diseases. Legislation was enacted by Public Law 397, An Act to Protect Newborns from Critical Congenital Heart Disease. Education has been provided to birthing hospitals in Maine to promote consistent and quality screening. All Maine birth hospitals were screening babies for CCHD as of September 2013. 0 System Strategy: A review was conducted of infant deaths that occurred in unsafe sleep environments for 2009-2012 of cases from the Chief Medical Examiner?s Of?ce. Maine continues to have ten to ?fteen deaths ?tting this de?nition per year. The data collected was analyzed and compared to a previous study for the time period 2002-2006. There continue to be multiple unsafe aspects of the sleep setting in each death (multiple items in crib plus known substance use or bed? sharing). One new risk was identi?ed in two cases with wearable blankets that were used to swaddle the infants over two months of age. Further data collection will occur in State Fiscal Year 2016. 0 System Strategy: Another activity to reduce infant mortality in Maine includes participation in the US. DHHS, Health Resource Services Administration (HRSA) Collaborative Improvement and Innovation Network which brought teams from states together to facilitate collaborative learning and adoption of proven quality improvement principles and practices to reduce infant mortality and improve birth outcomes. Maine, as part of the rollout of the national initiative, reviewed infant mortality data and prioritized strategies to reduce the infant mortality rate (IMR) utilizing 24 months of Plan Do Study Act (PDSA) cycles of change. The two projects selected for Maine are safe sleep and reducing smoking by pregnant women. The HRSA Maternal Child Health Block Grant requires states to conduct a comprehensive strength and needs assessment every ?ve years. The qualitative data collection process began during and assessed the health of Maine women, pregnant women, infants and children, teens and young adults and children with special health needs. This assessment and the Collaborative Improvement and Innovation Network work align with the work of MFIMR and will facilitate activities of the MFIMR Panel, including reducing low risk cesarean births, increasing breastfeeding and the percentage of babies who sleep in a safe sleep environment. Challenges Experienced bv the MFIMR Panel No MFIMR Panel meetings were held during State Fiscal Year 2015 due to the very limited number of cases available for Panel review. Multiple issues contributed to the limited number of cases: identi?cation of cases, reaching families to obtain consent, and staff time for record review. Statutory requirements providing a four-month waiting period before contacting the family and requiring family consent to review records present challenges to inviting families to participate in the review process. Experience has shown that: 0 some families have moved since the death, 0 many have unlisted phone numbers or only use cell phones, and 0 research to ensure a valid mailing address is a time consuming process, using web and programmatic resources to avoid sending materials to the wrong family. All cases reviewed by the Panel since the start of the Panel were referred to the Panel coordinator by a healthcare provider or the family contacted the Panel coordinator after viewing the website. None of the referrals were attributed as the result of a letter from the Maine CDC to the family. Currently there are too few cases reviewed by the Panel to identify recommendations that can be generalized. The small number of cases creates a biased sample representing those families that have already accessed services and do not represent underserved and minority populations. In order to have recommendations that can be generalized, the NF IMR recommends that states with less than 100 deaths per year should review all deaths. A recommendation is for the Panel to begin with reviewing the approximately 30 fetal deaths that are over 27 weeks gestation, plus half of the infant deaths and all of the maternal deaths in a given year. That would result in the Panel reviewing a minimum of 75 cases per year. Preliminary infant mortality statistics for 2013 show an increase in infant deaths in Maine with 7.1 deaths per 1,000 live births. This demonstrates a 31% increase from 5.40 in 2010. With the statutory restrictions requiring consent to review medical records and dif?culty contacting families, it is extremely challenging to assess preventable deaths and to identify speci?c public health approaches to prevent ?iture deaths. Assessment and Technical Assistance from NFIMR The Maine CDC MFIMR Panel engaged the NF IMR Program, at the American College of Obstetrics and Gynecology (ACOG), with the goal of identifying improvements that can be made to Maine?s MFIMR system to increase the number of cases available to be reviewed by the Panel. Recommendations from the National Fetal Infant Mortality Review: 0 Implement multiple overlapping processes for case identi?cation. 0 Expand partnerships with organizations and individuals (birth hospitals, advocacy groups, providers and bereavement counselors) to increase awareness by bereaved families of the work of the Panel. 0 Identify a spokesperson for MFIMR with possible public service announcements on topics related to the prevention of fetal and infant mortality. 0 Improve the system of accessing death certi?cates. 0 Identify dedicated staff to coordinate panel and related activities. Recommendations were reviewed by the Maine CDC and Division of Population Health leadership and discussed with the Panel. The Panel supports actions to implement these recommendations to more completely understand the factors surrounding maternal, fetal and infant deaths in Maine. Plans for Maine CDC MFIMR Panel in 2016 Past Panel discussions identi?ed several activities to be addressed in the coming year: 0 Continue to monitor statistical data for trends in maternal, fetal and infant mortality. Speci?cally the Panel will look at the timing and adequacy of prenatal care, access to care for pregnant teens, impact of substance abuse and the appropriateness of care for infants with very low birth weight, including distance from a Level facility. Complete a comprehensive analysis of data related to preterm births, including relevant risk factors such as smoking, substance abuse and chronic disease, such as diabetes. 0 Form a collaborative workgroup with representatives from Maine CDC, MFIMR, the DHHS Sentinel Events Program, and the Child Death and Serious Injury Panel to review the analysis and identify opportunities for reducing preterm births. Include Panel coordinator participation in activities to address factors contributing to infant mortality, specifically prenatal smoking and unsafe sleep environments. Emphasize Panel coordinator work with the Division of Population Health leadership to follow up on recommendations and develop plans to implement system improvements. Explore options to allow more ?exibility in the review of records related to maternal, fetal and infant deaths. Appendix A: Data Highlights Summaries of indicators related to several birth trends and infant mortality are provided below.1 The Maine Center for Disease Control and Prevention (Maine CDC) Maternal Fetal and Infant Mortality Review Panel (MFIMR) monitors statistical data for trends in maternal, fetal and infant mortality. Sources of Maine information include data compiled for the annual Maternal and Child Health (MCH) Title Block Grant report and the MCH and Needs Assessment, which is updated every ?ve years.i MFIMR will have more timely access to Maine?s infant birth/death datasets in the near future. Maine has developed a list of indicators from the birth and linked infant birth/death datasets that will be calculated on a ?real?time? basis when provisional vital statistics data become available. These indicators are part of the national Collaborative Improvement Innovation Network Infant Mortality Initiative. Infant Mortality Rate in Maine Maine?5 igfant mortality has Single Year Data 19992013 1ncreased In recent years. Whlle the Malne CDC generally 6,6 6-9 7?0 produces ?ve-year rates to 5.7 5.6 55 5.4 4? stabilize yearly ?uctuations, a 3 Jo 4-7 3. display of single year rates is useful in assessing overall 3? 3'0 trends. A workgroup at the 20 Maine CDC is currently 10 conducting an in?depth review ?1 0,0 of Maine?s infant mortality ?90) ?99? ?gs? ?99? ?350 ?59? $597 ?$99 #959 +3 was? rates, trends and causes. Year of Infant Death 1 Maine birth data (preliminary) from 2013 and fetal death data and infant mortality data from 2013 were the most recent data available at the time of these analyses. Five?year averages were used for some analyses with small numbers of events. Note that numbers and statistics may differ from other reports due to factors such as data file version and the analytic methods used such as handling of missing data and case definitions. Indicators of Fetal, Infant and Maternal Mortality Indicator Maine Maine Maine Current Prior Period? Period Period Fetal Mortality Measures Tlme Perm? 2009-2013 2013'ii 2008-2012 2007-2011 Fetal mortality rate (per 1,000 live births and fetal deaths) 20+ weeks gestation 4.4 6.0 42 4_4 Number of fetal deaths per year (20+ weeks gestation) Range 48-62 -- 48-62 ?'65 Average 57 23,595 56 6O Gestational age at death Between 20 and 27 weeks 45.9% 51.2% 46.8% 48.0% At 28 weeks or more 54.1% 48.8% 53.2% 52.0% Infant Mortal'ty Measures . . 2009-2013? 2009-2013v 2008-2012? 2007-2011 Time Period Infant mortality rate (number of deaths under year of age per 1,000 live births) Neonatal mortality rate (number of deaths infants less than 28 days per 1,000 live births) Number of infant deaths per year Five-year range 70-90 -- 70-87 70-87 Five-year average 81 24,416 78 78 Distribution of timing of death (percent) Early neonatal (Less than 24 hours) 403% 410% 42.3% 447% Early neonatal (1?6 days) 13.8% 12.6% 12.2% 13.1% Late ?60113131097 days) 11.6% 13 12.4% 11.9% Post neonatal (28 days or older) 34.5% 333 4% 32.9% 301% Gestational age at birth among infant deaths (percent) Early preterm infant 34 weeks gestation) 504% 56_7% 561% 61.0% Preterm (34-36 weeks gestation) 11_0% 9_7% 94% 8.6% Not preterm (37 weeks or more) 386% 32.7% 345% 304% Unknown - Maternal Mortal'ty Measures. . 2004-2013? 2007? 2003-2012ix 2002-2011 Time Period Number of maternal deaths due to pregnancy- 4 548 4 3 related causes Number of maternal deaths, women who died . . 38 -- 38 39 w1thm one year of pregnancy, due to any cause Infant Birth Measures . . 2013): 201310 2012in 2011ini Tlme Perlod Number of live births to Maine residents 12,777 3,932,181 12,692 12,700 Indicator Maine Maine Maine Current Prior Prim? Periodii Period ?10d Percent of very low birthweight infants States range delivered at facilities for high-risk deliveries 81.3% 80.5% 82.6% and neonates (Level facility) Percent low birthweight births, <2500 grams 7.1 8.0% 6.7% 6.7% Low birthweight birth status Very low birth weight (<1500 grams) 1.1% 1.1% Moderate low birth weight (1500-2499 grams) 6.6% 7 3% 5.6% 5.6% Normal birth weight (2500+ grams) 92.8% 919% 93.2% 93.2% Unknown Percent of women w1th ?rst trlmester prenatal 88.1% 89.4% care Percent preterm (less 37 weeks gestatlon 81% 7.8% 8.3% based on chnical estimate of gestatlon) Infant Health Time Period 2012 2011 2011 2010 Slee osition ercent and 95% con?dence intergfl) (p 83.0% ?i 26 ?me/?m 81.2% 80.9%xix Percent of new moms who most often placed (793-86. 53 $35; their infants on their backs to sleep Drug?affected newborns - Number of drug 31% 2.2% 2.2% w1thdrawal 1n newborn coded on 38 5 -- 279 280 Maine birth hospitalization discharge records *Based on records collected in the ?rst 8 months of 2013 using the non-revised certi?cate. Maine implemented the 2003 US. Standard Certi?cate of Live Birth in mid-2013. Although prenatal care measures are collected on both versions of the birth certi?cate, they have been substantively modi?ed. Therefore, data for these items are not considered comparable between revisions and are not combined in tabulations or national data ?les.xxi 10 Appendix B: Indicators/measures monitored by MFIMR Critical to the work of the MFIMR Panel is maintaining an awareness of data and trends related to fetal, infant and pregnancy-related maternal deaths and birth outcomes in Maine, as well as nationally. The insights gained through case reviews coupled with population level data guide the efforts of the MFIMR Panel to improve the overall health and safety of Maine?s infants and mothers. Fetal Mortality Although the majority of fetal deaths occur before 20 weeks gestation for unknown reasons, it is important to look at the timing and causes we have the ability to impact for better pregnancy outcomes. In Maine, fetal mortality rates are based on deaths that occur in utero beyond 19 weeks gestation. An average of 57 fetal deaths occur each year in Maine; nearly half (46 percent) of Maine?s recorded fetal deaths occur between 20 and 27 weeks gestation. Four leading causes of death account for 46 percent of recorded fetal deaths in Maine. By rank, the leading causes of fetal deaths in Maine between 2008 and 2012 were: 1. Complications of the placenta, umbilical cord and membranes 2. Congenital malformations, deformations, chromosomal abnormalities 3. Maternal complications of pregnancy 4. Disorders related to short gestation and low birth weight Infant Mortality The infant mortality rate includes all deaths of infants from birth to 365 days of life. An average of 81 Maine babies die before their ?rst birthday. Five leading causes of death account for 62 percent of infant deaths in Maine. By rank, the leading causes of infant deaths in Maine?ii between 2009 and 2013 were: 1. Congenital malformations, deformations and chromosomal abnormalities 2. Disorders related to short gestation and low birth weight, not elsewhere classi?ed (low birth weight) 3 Sudden infant death (SIDS) 4. Newborn affected by maternal complication of pregnancy (maternal complications) 5. Unintentional injuries Maternal Mortality Across the country for every 100,000 births there are about 13 maternal deaths per year related to or aggravated by pregnancy or pregnancy management?. Maternal deaths attributed to direct obstetric causes include eclampsia and pre-eclampsia, hemorrhage and placenta previa, obstetrical tetanus, obstetric embolism and other direct causes. Possible explanations for an observed national increase include a rise in the number of caesarean sections, particularly among women who have undergone several previous C-sections and the rise in obesity. Maternal mortality can also be measured using a more inclusive de?nition, that is, deaths to women within one year of pregnancy from any cause. Between 2004 and 2013 there were 38 deaths to Maine women who died in Maine within one year of pregnancy; 47.4 percent of these deaths were attributed to 11 illness or disease, 34.2 percent to unintentional injuries such as motor vehicle crashes or unintentional poisonings, 15.8 percent to assault or suicide and 2.6 percent of undetermined intent. Of the deaths directly related to pregnancy or childbirth in the last decade in Maine, one death was due to an obstetric embolism, two deaths resulted from peripartum cardiomyopathy and one death from postpartum coagulation defect. Infant Birth and Health Maine?s MFIMR Panel examines local, State and national data on risk factors for poor birth and infant health outcomes to inform case selection and review. Many infant birth and health indicators are associated with infant health, illness, disability and death and they are among the objectives of Healthy People 2020"", Healthy Maine 2020 and the Maternal and Child Health Bureau?s Title Program.?v Emerging issues and those with the potential to improve infant outcomes through public health and policy approaches are monitored on a regular basis. Three of these issues are summarized below. Delivery Facility for High Risk Births: Research has shown that very low birth weight and very pre-term infants not born in level 111 hospitals are at increased risk of neonatal or pre-discharge death.mi Increasing the number of very low birth weight babies born at Level 111 hospitals may improve health outcomes for these infants. In Maine, 81.3 percent of very low birth weight infants were delivered at a Level facility in 2013. MFIMR Panel members have reviewed high-risk infant delivery patterns to determine the feasibility of system-related improvements in access to appropriate birth facilities. Sleep position: The American Academy of Pediatrics (AAP) has recommended that infants be placed on their backs to sleep, because infants who sleep prone have an increased risk of dying from sudden infant death (SIDS). More than eight of ten Maine mothers most often placed their infants on their backs to sleep (83.0 percent) in 2012. In Maine, no statistically signi?cant differences are observed with use of the recommended sleeping position among mothers based on educational attainment, age, income or insurance status. Drug a?ected babies: Another emerging issue that may impact infant and maternal health is the number of infants born who have been exposed to drugs in utero. This population is of concern because they are at increased risk for preterm birth, sudden unexpected infant death (SUID) and other causes of death. Based on Maine hospital discharge data, ?drug withdrawal in newborn? (based on ICD-9-CM 779.5) was noted on 385 (3.1 percent) of the Maine birth hospitalization discharges in 2012"? This represents a 30-fold increase since 2000, when 13 birth hospitalization discharges were noted to involve drug withdrawal It is dif?cult to determine whether this noted increase represents true change in the incidence of drug withdrawal in newborns or is due, at least in part, to required reporting resulting in better recognition and diagnostic coding of the in more recent years. 12 Appendix C: Panel Membership Maternal, Fetal and Infant Mortality Review Panel Members SFY 2015 Cheri Sarton, Instructor, University of Maine Christopher Pezzullo, Chief Medical Of?cer, DHHS Denise Yob, Epidemiologist, USM/Maine CDC Doug Drans?eld, Retired Neonatologist Ellen Bridge, Methodist Minister Ellie Mulcahy, Director, Genetics Program/MFIMR Panel Coordinator, Maine CDC Jay Naliboff, Maine Chapter, American College of Obstetrics and Gynecology, Panel Co-Chair Jennifer Hayman, Hospitalist, Maine Medical Center Kathy O?Connor, Perinatal Nurse, Southern Maine Medical Center Kelley Bowden, Perinatal Outreach Education, Maine Medical Center, Panel Co-Chair Mary Connolly, Neonatology Section Kelley 6, Eastern Maine Medical Center Peg Bradstreet, Clinical Nurse Specialist Rick Hobbs, Maine Chapter, Academy of Family Physicians Shannon Bonsey, Chief Operating Of?cer, Penquis CAP Shannon King, Women?s Health, Maine DHHS CDC Ad Hoc members Anna Love, State Police Public Safety Michael Pinette, Associates 13 Appendix D: End Notes i Maine Department of Health and Human Services, Division of Family Health, Maternal and Child Health Services Title Block Grant, State Narrative for Maine: Application for 2015. Available from Health Resources and Services Administration. ii Maine Center for Disease Control Prevention, Maine Vital Records Data (Fetal Death Certificates). 2007-2013. and Centers for Disease Control and Prevention. National Center for Health Statistics. VitalStats. on 12/2/ 2015. User Guide to the 2012 Fetal Death Public Use File, Reproductive Statistics Branch, Division of Vital Statistics, NCHS. Hyattsville, MD: Accessed 10/18/14 from Statistics/NCHS/Dataset uidepdf. and Centers for Disease Control and Prevention, National Center for Health Statistics, VitalStats, on 12/2/2015. MacDorman MF, Kirmeyer SE, Wilson EC. Fetal and perinatal mortality, United States, 2006. National vital statistics reports; vol 60 no 8. Hyattsville, MD: National Center for Health Statistics. 2012. Accessed 11/22/12 from 08.pdf. iv United States Department of Health and Human Services (US DHHS), Centers of Disease Control and Prevention (CDC), National Center for Health Statistics (N CHS), Division of Vital Statistics (DVS). Linked Birth Infant Death Records 2007-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program, on CDC WONDER On?line Database. Query for Maine based on years 2009-2013. Accessed at on 1 2/2/20 1 5 . United States Department of Health and Human Services (US DHHS), Centers of Disease Control and Prevention (CDC), National Center for Health Statistics (N CHS), Division of Vital Statistics (DVS). Linked Birth Infant Death Records 2007-2013, as compiled from data provided by the 5 7 vital statistics jurisdictions through the Vital Statistics Cooperative Program, on CDC WONDER On?line Database. Query based on years 2009-2013. Accessed at on 12/2/2015. Vi United States Department of Health and Human Services (US DHHS), Centers of Disease Control and Prevention (CDC), National Center for Health Statistics (N CHS), Division of Vital Statistics (DVS). Linked Birth Infant Death Records 2007-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program, on CDC WONDER On?line Database. Query for Maine based on years 2008-2012. Accessed at on 1 2/2/ 20 1 5 . Vii Maine Center for Disease Control Prevention, Maine Vital Records Data (Death Certi?cates). 2000- 2013. mi Xu I Q, Kochanek KD, Murphy SL, Tej ada?Vera B. Deaths: Final data for 2007. National vital statistics reports; vol 58 no 19. Hyattsville, MD: National Center for Health Statistics. 2010. Accessed 12/ 05/ 12 from 9/nvsr59_l 0.pdf. 14 Murphy SL, Xu Q, Kochanek KD. Deaths: Final data for 2010. National vital statistics reports; vol 61 no 4. Hyattsville, MD: National Center for Health Statistics. 2013. Accessed 10/8/ 13 from 04.pdf. ix Maine Center for Disease Control Prevention, Maine Vital Records Data (Death Certificates). 2000- 2012. Maine Center for Disease Control Prevention, Maine Vital Records Data (Birth Certificates). 2013 non-revised certi?cate ?les (?rst 8 months) and United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (N CHS), Division of Vital Statistics, Natality public-use data 2007-2013, on CDC WONDER Online Database, January 2015. Accessed at on 12/2/2015. Xi Hamilton BE, Martin A, Osterman K, Curtin SC. Births: Preliminary data for 2013. National vital statistics reports; vol 63 no 2. Hyattsville, MD: National Center for Health Statistics. 2014. Accessed 10/18/14 from 02.pdf. Xii Maine Center for Disease Control Prevention, Maine Vital Records Data (Birth Certi?cates). 2012. mi Maine Center for Disease Control Prevention, Maine Vital Records Data (Birth Certi?cates). 2011. Maternal and Child Health Bureau. Title Information System. National Performance Measure #17: Percent of very low birth weight infants delivered at facilities for high?risk deliveries and neonates. As reported by States in the Title Block Grant FY 2012 Annual Report and FY 2014 Application; Form 11. (Most states reporting 2012 data). Accessed 10/ 18/14 from XV March of Dimes 2015Premature Birth Report Card. (Note? based on US. 2014 ?nal natality data). Accessed from ?i Maine Department of Health and Human Services Maine Center for Disease Control and Prevention, Pregnancy Risk Assessment Monitoring System, 20] 0, 201 1, 2012 PRAMS data. Accessed 10/22/2013, 10/02/2014 and 11/15/2015 ?ii Centers for Disease Control and Prevention, Division of Reproductive Health, PRAM Stat System Online Data, Sleep Behaviors, 2011 All State data. Accessed 11/20/15 from A8&islTopicId=TOP23&go=GO. Maine Department of Health and Human Services Maine Center for Disease Control and Prevention, Pregnancy Risk Assessment Monitoring System, 20]] PRAMS data. Accessed 10/22/2013 from 15 Xi" Maine Department of Health and Human Services Maine Center for Disease Control and Prevention, Pregnancy Risk Assessment Monitoring System, 2010 PRAMS data. Accessed 11/3 0/2012 from xx Mervis C. Neonatal Abstinence and Maternal Antepartum Opiate Use. Maine, 2000-2012. 2015. (Under internal review). Analyzed by University of Southern Maine and prepared for Maine Center for Disease Control and Prevention. ?i United States Department of Health and Human Services (US DHHS), Centers of Disease Control and Prevention (CDC), National Center for Health Statistics (N CHS). User Guide to the 2013 Natality Public Use File. Accessed at ?ii United States Department of Health and Human Services (US DHHS), Centers of Disease Control and Prevention (CDC), National Center for Health Statistics (N CHS), Division of Vital Statistics (DVS). Linked Birth Infant Death Records 2007-2013, as compiled from data provided by the 5 7 vital statistics jurisdictions through the Vital Statistics Cooperative Program, on CDC WONDER On?line Database. Query based on Maine infant deaths between 2009-2013. Accessed at on 12/2/2015. Xu Q, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. National Vital Statistics Reports 2009, vol 58 no 19. Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System: Hyattsville, MD.2010. gov/nchs/data/nvsr/nver 8/ nvsr5 8 l9.pdf. ?iv Department of Health and Human Services. Healthy People 2020. 2011. Accessed 11/29/11 from x? Maternal and Child Health Bureau. Title Information System. Performance Measure and Indicators. Accessed from ?Vi Lasswell S. M., et a1, Perinatal Regionalization for Very Low Birth Weight and Very Preterm Infants, JAAJA. 2010; 304(9): 992-1000. Moon American Academy of Pediatrics, Task Force on Sudden Infant Death Policy statement: SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 1030 ?103. Available at 1/10/12/peds.201 1-2284 Accessed 1 1/2/201 1. ?ix Maine Department of Health and Human Services Maine Center for Disease Control and Prevention, Pregnancy Risk Assessment Monitoring System, 2012 PRAMS data. Accessed 11/15/2015 from maine. research/pramS/rabl 8520] 2/ 72 %205/eepposi lion] 2. Mervis C. Neonatal Abstinence and Maternal Antepartum Opiate Use. Maine, 2000-2012. 2015. (Under internal review). Analyzed by University of Southern Maine and prepared for Maine Center for Disease Control and Prevention. 16 Department of Health and Human Services Mame People living Safe, Hoolihy and Produclive lives Paul R. tePoge, Governor Mary C. Mayhew, Commissioner The Department of Health and Human Services (DHHS) does not discriminate on the basis of disability, race, color, creed, gender, sexual orientation, age, or national origin, in admission to, access to, or operations of its programs, services, or activities, or its hiring or employment practices. This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and in accordance with the Civil Rights Act of 1964 as amended, Section 504 of the Rehabilitation Act of 1973, as amended, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 and the Maine Human Rights Act and Executive Order Regarding State of Maine Contracts for Services. Questions, concerns, complaints or requests for additional information regarding the ADA may be forwarded to ADA Compliance/EEO Coordinators, 11 State House Station 221 State Street, Augusta, Maine 04333, 207-287-4289 207-287-3488 TTY users call Maine relay 711. Individuals who need auxiliary aids for effective communication in program and services of DHHS are invited to make their needs and preferences known to the ADA Compliance/EEO Coordinators. This notice is available in alternate formats, upon request. 17