BMJ 1999;319:77 ( 10 July )

News
Suboptimal care implicated in many infant deaths in UK
Mark Pownall , London

Better care would "probably" or "almost certainly" have made a difference to the outcome in half of the cases of stillbirths and infant deaths in England, Wales, and Northern Ireland, suggested the annual report of the confidential inquiry into stillbirths and deaths in infancy, which was published this week.

The report analysed the results of detailed investigations into the deaths of 573 infants, randomly selected as a "1 in 10" sample of the stillbirths and neonatal deaths reported to the inquiry in 1996-7. Selected cases were reviewed by a multidisciplinary panel of at least six specialists. The panel judged that suboptimal care was provided in 28%of the cases and concluded that a different approach "might have made a difference" in the outcome of these cases. For a further 22%of the cases, suboptimal care "would reasonably have been expected to make a difference to the outcome."

The association between death and suboptimal care was found to be strongest for neonatal death, with the link being identified in 61%of the cases reviewed. The link was particularly strong for intrapartum deaths, and 73%of cases reviewed were judged to have been associated with suboptimal care. The main cause of death was unexplained for 81%of stillbirths, while immaturity, birth related causes, and infection were the most important causes of neonatal deaths.

The panel identified the main problems contributing to the provision of suboptimal care in the cases of stillbirth as a failure to act appropriately, a failure to recognise problems, and a failure of communication. The report's authors warned: "Stillbirth ... is often thought of as `unavoidable.' A review of these cases has shown that this is often not the case."

The authors suggested that the most common shortfall identified by the review panel was in fetal surveillance, in particular the interpretation of cardiotocograms.

The panel noted that poor record keeping had occurred in one third of the cases of stillbirth and neonatal death that they had reviewed.

Confidential Enquiry into Stillbirths and Deaths in Infancy, 6th Annual Report is available from CESDI, Chiltern Court, 188 Baker Street, London NW1 5SD (tel: 0171 486 1191), price £6.