Indicators of fetal and infant health outcomes

doi:10.1016/j.ejogrb.2003.09.007

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 111, Supplement 1, 28 November 2003, Pages S66-S77

https://doi.org/10.1016/j.ejogrb.2003.09.007 Get rights and content

Abstract

Objective: To assess the ability of the member states of the European Union to produce the indicators recommended by the PERISTAT project on perinatal health indicators and to provide an overview of fetal and infant health outcomes for these countries according to the information now available. Methods: We used data from the PERISTAT survey of data providers to compute PERISTAT indicators of fetal and infant health. Results: National data on fetal mortality are available for all countries, but vary in their definitions. To adjust for these differences in definition, PERISTAT recommends presenting rates by gestational age and birth weight. Not all countries can provide neonatal mortality data by gestational age, birth weight or plurality, as recommended by PERISTAT. Few countries in Europe can report infant mortality rates by birth weight and gestational age. The other recommended indicators are available to varying degrees. Conclusions: This overview, which shows that Europe can produce a variety of indicators for monitoring the health of its new-borns, indicates that some key dimensions of perinatal health cannot now be measured with routine health statistics and reveals important disparities in health outcomes throughout Europe. For most indicators, the highest values are between 50 and 100% higher than the lowest values. The reasons for these variations and their importance for the surveillance of perinatal health are discussed.

Introduction

Fetal and infant health outcomes are important measures of the overall health of a population and of the quality of health care services for mothers and their babies. Further, they are key to monitoring and understanding the impact of changing health care practices. They are necessary, for example, for measuring the extent and impact of antenatal screening and for monitoring the effect of changing practices in the care of extremely preterm babies.

Ten of the PERISTAT indicators measure fetal and infant health outcomes. Five are included on the core list: C1—fetal mortality rate, C2—neonatal mortality rate, C3—infant mortality rate, C4—birth weight distribution, and C5—gestational age distribution. Many of these core indicators are already available in international databases, such those at WHO, EUROSTAT and OECD. PERISTAT recommends that these indicators be computed and presented differently. In particular, it recommends that they be presented by sub-groups to address methodological concerns and make them more specific and sensitive measures of overall health status and health care practices.

In addition to the set of core indicators, the PERISTAT list includes five recommended indicators of infant health: two are recommended for immediate implementation (R1—prevalence of selected congenital anomalies and R2—distribution of APGAR score at 5 min). Three require further work and development of data collection systems before they can be implemented at a European level (F1—causes of perinatal death, F2—prevalence of cerebral palsy and F3—prevalence of hypoxic-ischemic encephalopathy).

This analysis assesses the ability of European countries to produce these indicators and provides an overview of health outcomes according to the information now available.

Section snippets

Methods

The PERISTAT project collected data from the statistical offices and health departments of the participating countries to assess the feasibility of implementing the indicators recommended by its scientific advisory committee. The indicator selection process is described in Zeitlin et al. and the survey is presented in Macfarlane et al. (this issue). All data sources used below are referenced in Appendix A and described in more detail in Macfarlane et al.

Data are presented as numbers and rates

Indicator C1: fetal mortality rate

National data on fetal mortality are available for all countries, as Table 1 shows. The definition used by the PERISTAT project to define fetal deaths was ‘all fetal deaths occurring at or after 22 weeks of gestation’. If countries were not able to provide data on deaths according to this definition, we asked them to provide the information that they routinely collected. Most countries were able to provide data according to this gestational age limit, but others could provide these fetal deaths

Discussion

European countries can provide many of the PERISTAT core and recommended indicators of fetal and infant health and can report most of them by the analytic sub-groups of gestational age, birth weight and plurality. Using these sub-groups makes these indicators both more methodologically sound and more useful for the analysis of overall trends and variations between countries and over time. Most of these data are currently available from national statistical offices and other organisations, but

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Indicators of fetal and infant health outcomes

Abstract

Introduction

Section snippets

Methods

Indicator C1: fetal mortality rate

Discussion

J. Pediatr.

Semin. Perinatol.

BJOG

J. Pediatr.

BJOG

Prevention of the first occurrence of neural-tube defects by periconceptional vitamine supplementation

N. Engl. J. Med.

Ascertainment of congenital malformations: a comparative study of two systems

J. Epidemiol. Comm. Health