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• The MBRRACE-UK perinatal surveillance report - clarification
  Elizabeth S Draper
  Published on: 22 March 2016

• Published on: 22 March 2016

  The MBRRACE-UK perinatal surveillance report - clarification

  • Elizabeth S Draper, Professor of Perinatal & Paediatric Epidemiology
  • Other Contributors:
    • Elizabeth S Draper, David Field, Lucy Smith, Jennifer J Kurinczuk, Pauline Hyman-Taylor, Bradley Manktelow

  We very much welcome Martin Ward Platt's review of the MBRRACE-UK perinatal surveillance report and would like to respond to a number of points that he has highlighted. The article focussed on the first perinatal surveillance report (1) from the MBRRACE-UK team and noted that it was produced from a new system of data collection after a three year gap in national perinatal surveillance. As well as changing the approach to...

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  We very much welcome Martin Ward Platt's review of the MBRRACE-UK perinatal surveillance report and would like to respond to a number of points that he has highlighted. The article focussed on the first perinatal surveillance report (1) from the MBRRACE-UK team and noted that it was produced from a new system of data collection after a three year gap in national perinatal surveillance. As well as changing the approach to data collection, MBRRACE-UK have introduced a number of changes to the nature of the data collected. In order to facilitate international comparisons WHO guidance was followed in terms of the inclusion criteria: i.e. all neonatal deaths resulting from a registered live births from 20 weeks gestation and all late fetal losses of 22 and 23 weeks gestation are now included. In addition the inclusion of these babies should facilitate the investigation of the wide variation in practices between units concerning whether such babies are registered as a live birth or not registered (2) which has a large impact on neonatal mortality rates. An overview of the new statistical method used to stabilise and adjust the mortality rates between populations was included in appendix 3 of the published report as well as in a short podcast which is downloadable from the MBRRACE-UK website: https://www.npeu.ox.ac.uk/mbrrace- uk/presentations. A broad summary of the methodology was presented at the report launch meeting as it was felt that the majority of the constituent audience would not be interested in the full detail of the statistical methods employed. However, although these methods are new to the UK they have been used in the US and are discussed in the references cited in the report (3,4). We agree that neonatal death is not a homogeneous group and over the next few years we will be developing different methods of exploring the various groups of deaths and this will be facilitated by the use of data for two or three years combined rather than a single year.

  The review queried the choice of the International Cause of Death and Associated Conditions (CODAC) classification system (5) by MBRRACE-UK. CODAC was chosen following consultation with an expert group primarily because it was felt it would provide a far better insight into the mechanisms involved with the various types of perinatal loss. In the past simple hierarchical systems have been used which failed to provide any insight into the cause of death for over half of all stillbirths. However, we acknowledge that this system is complex and we have established a working group to identify key problems and help produce the answers to frequently asked questions for users.

  The review highlighted the importance of moving to reports of outcomes based on individual Trusts and Health Boards. Dr Ward Platt would have been unaware at the time of writing that such reports were always intended to be produced but were delayed for this first report simply because of the time and resources needed to establish an appropriate approach in the first instance. All Trusts and Health Boards should now have received a report of their 2013 cases (based on the place of birth for all deaths) and in subsequent years this information will be produced at the same time as the geographical analysis (by commissioning or public health organisation).

  We would like to reassure readers that the methods used by MBRRACE-UK for perinatal confidential enquiries have been built on the learning from the Confidential Enquiry into Stillbirths and Deaths in Infancy and its successor bodies. Those who have been involved in the topic expert groups and panels for the enquiries carried out since 2012 will almost certainly have recognised that the enquiries have many features in common with those run by predecessor organisations.

  In this response we hope that we have addressed the concerns presented in the editorial and clarified how we have developed the MBRRACE -UK programme of work building on previous experience but using new methodologies where appropriate.

  References

  1. https://www.npeu.ox.ac.uk/downloads/files/mbrrace- uk/reports/MBRRACE-UK%20Perinatal%20Surveillance%20Report%202013.pdf 2. Smith L, Draper ES, Manktelow BN, Pritchard C, Field DJ. Comparing regional infant death rates: the influence of preterm births <24 weeks of gestation. Archives of Disease in Childhood Fetal & Neonatal Edition. 2013;98(2):F103-7. 3. The COPSS-CMS White Paper Committee, Ash AS, Fienberg SE, Louis TA, Normand S-LT, Stukel TA, et al. Statistical issues in assessing hospital performance: Committee of Presidents of Statistical Societies; 2012 [cited 2015 8 Apr]. Available from: http://www.cms.gov/Medicare/Quality- Initiatives-Patient-Assessment- Instruments/HospitalQualityInits/Downloads/Statistical-Issues-in-Assessing -Hospital-Performance.pdf 4. Mohammed MA, Manktelow BN, Hofer TP. Comparison of four methods for deriving hospital standardised mortality ratios from a single hierarchical logistic regression model. Statistical Methods in Medical Research. 2012:published online 6 November 2012. 5. Froen JF, Pinar H, Flenady V, Bahrin S, Charles A, Chauke L, et al. Causes of death and associated conditions (Codac) - a utilitarian approach to the classification of perinatal deaths. BMC Pregnancy and Childbirth. 2009;9(1):22.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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