Fetal Infant Mortality Review Workgroup

The Virginia Fetal Infant Mortality Review Workgroup, supported by Virginia Neonatal Perinatal Collaborative, is planning the process to review of fetal and infant deaths statewide to identify prevention strategies and improve outcomes. The process is planning to involve regional teams to help guide recommendations and strengthen collaboration across healthcare and community partners.

Overview

Between 2020 and 2022, Virginia experienced an increase in infant mortality, with rates climbing from 5.76 to 6.21 per 1,000 live births. On the other hand, rates of fetal mortality (spontaneous intrauterine deaths after 20 weeks’ gestation) are decreasing; between 2018 and 2022, fetal mortality rates decreased from 5.71 to 5.17 per 1,000 live births plus fetal deaths.

In Virginia, the leading cause of fetal deaths from 2018 to 2022 was “unspecified.” With fetal death of unspecified cause occurring at a rate of 2.40 per 1,000 live births, followed by newborn affected by other forms of placental separation and hemorrhage with a rate of 0.38, and newborn affected by premature rupture of membranes with a rate of 0.35, it is clear that there lies a large gap between known and unknown causes of fetal deaths.

As one of the innovations from the Maternal Health State Innovation grant awarded to the VNPC in 2023, the VNPC is examining the best strategies to resurrect the Fetal Infant Mortality Review Teams in Virginia that were disbanded in 2014.  According to the National Center for Fatality Review & Prevention (NCFRP), fetal infant mortality reviews (FIMR) is a community-based process that aims to improve the health and wellbeing of women, infants, and families.  At this point in the work, the VNPC has established a FIMR workgroup to develop the best plan for a successful and longstanding process for in-depth review of fetal and infant deaths. These reviews should provide a better understanding of leading causes, risk factors, and areas for improvement to improve care and outcomes for pregnant women and infants.

At present, the FIMR workgroup is led by a workgroup chair and is holding monthly meetings. A previous FIMR workgroup released this report in 2021 that is currently being adapted along with NCFRP planning documents for the renewed statewide initiative. The next steps for FIMR are to create a surveillance report and to gain legislative support.

Aim

The purpose of the Fetal Infant Mortality Review Workgroup is to cement a process for conducting reviews of natural fetal and infant deaths and for developing recommendations for improvement of fetal and infant health across Virginia.

For Participants

This workgroup provides a comprehensive collaborative approach that includes parents’ voices, providers and subject matter experts, government agencies, and regional distribution across the state. The review of fetal deaths from a multidisciplinary perspective will allow for key collaboration to ensure resources are directed where they can have the greatest impact. Additionally, engaging regional teams with central oversight will create standardization that encourages collaboration through cross-site membership.

Participation is planned to include regional case review teams that conduct reviews and make recommendations, and regional community action teams that will transform recommendations into improvement activities. These groups will report findings to the central team to provide annual reports. Monthly meeting participation, as well as monthly case reviews will be included.

Those interested in participating should email evan.isaacs@vcuhealth.org.

Represented Organizations

In addition, the following professional roles represented include but are not limited to: Midwife, grief counselor, maternal fetal medicine specialist, PICU nurse practitioner, neonatologist, VNPC neonatal advisory committee members

Periviability

The Virginia Periviability Data project, roughly based on the global project Tiny Baby Collaborative, seeks to expand access to periviability data and share insights into preterm infant care and outcomes in Virginia.

Overview

Data show survivability for this population is increasing with medical advancements. From 2020-2025, survivability was 51.6% for 22 week gestational age infants, and 82.4% for 23 week gestational age infants.  The Virginia Periviable Data project is focused on infants born between 22 0/7 and 23 6/7 weeks gestational age. New research has shown periviable infants have a stronger chance of survival with appropriate medical intervention and transfer to appropriate level of care hospital. The Virginia Periviable Data project will seek to create a data registry of periviable infants to better understand their level of care and outcomes in Virginia. Insights gained though this project can illuminate processes and care coordination opportunities to improve outcomes and survivability for this population.

The Virginia Periviable Data project is still in the early planning phase. Dr. John Galiote is serving as the workgroup chair, leading the workgroup with monthly meetings to plan the methods of the project. 

For Participants

Participants will develop a better understanding of periviability, preterm treatment options and care coordination pathways. Those interested in participating should email evan.isaacs@vcuhealth.org.

Represented Organizations

Patent Ductus Arteriosus Project

 The PDA project is aimed at identifying data elements such as PDA size and measurements, hemodynamic significance, treatment timing and options, as well as relevant perinatal characteristics such as magnesium administration regarding infants with PDAs. Early planning for this project is currently underway, and the team has begun identifying the most effective approach for data collection. 

Overview and  Aims

The PDA workgroup is currently holding monthly meetings under the leadership of Faculty Chair Dr. Zachary Goode and working through the early planning for this project.

For Participants

Those interested in participating should reach out to reagan.overeem@vcuhealth.org