HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Read responses to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in ADC Online Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Draper, E S Articles by Field, D Search for Related Content PubMed PubMed Citation Articles by Draper, E S Articles by Field, D Topic Collections Relevant Article

A confidential enquiry into cases of neonatal encephalopathy

¹ Department of Epidemiology and Public Health, University of Leicester, Leicester, UK
² Department of Reproductive Medicine, University of Nottingham, Nottingham, UK
³ Department of Child Health, University of Leicester, Leicester, UK

Correspondence to:
Correspondence to:
Elizabeth S Draper, Department of Epidemiology and Public Health, University of Leicester, 22–28 Princess Road West, Leicester, LE1 6TP, UK;
msn{at}le.ac.uk

Objectives: To assess the quality of care and timing of possible asphyxial events for infants with neonatal encephalopathy; to compare the quality of care findings with those relating to the deaths from the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI); and to assess whether the confidential enquiry method is a useful clinical governance tool for investigating morbidity.

Design: Independent, anonymised, multidisciplinary case reviews.

Setting: Trent Health Region, UK.

Patients: All cases of grade II and III neonatal encephalopathy born in 1997, excluding those due to congenital malformation, inborn error of metabolism, or infection. All CESDI deaths thought to have resulted from intrapartum asphyxia in 1996 and 1997.

Main measures: Quality of care provided, timing of possible asphyxial episodes, and the source and timing of episodes of suboptimal care.

Results: Significant or major episodes of suboptimal care were identified for 64% of the encephalopathy cases and 75% of the deaths. An average of 2.8 and 2.5 episodes of suboptimal care were identified for the deaths and encephalopathy cases respectively. Over 90% of episodes involved the care provided by health professionals. Results were fed directly back to the units concerned on request and changes in practice have been reported.

Conclusions: The findings were very similar for the encephalopathy cases and the deaths. We have demonstrated that with minor adaptations the CESDI process can be applied to serious cases of morbidity. However, explicit quality standards, control data, and a more formal mechanism for the implementation of findings would strengthen the confidential enquiry process as part of clinical governance.

Keywords: clinical governance; confidential enquiry; infant death; stillbirths; neonatal encephalopathy

Relevant Article

Fantoms

Ben Stenson
Arch. Dis. Child. Fetal Neonatal Ed. 2002 87: F235. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				D. Acolet, D. Elbourne, N. McIntosh, M. Weindling, M. Korkodilos, J. Haviland, J. Modder, M. Macintosh, and on behalf of the Confidential Enquiry Into Materna Project 27/28: Inquiry Into Quality of Neonatal Care and Its Effect on the Survival of Infants Who Were Born at 27 and 28 Weeks in England, Wales, and Northern Ireland Pediatrics, December 1, 2005; 116(6): 1457 - 1465. [Abstract] [Full Text] [PDF]

				V Pierrat, N Haouari, A Liska, D Thomas, D Subtil, P Truffert, and on behalf of the Groupe d'Etudes en Epidemiologie Prevalence, causes, and outcome at 2 years of age of newborn encephalopathy: population based study Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2005; 90(3): F257 - f261. [Abstract] [Full Text] [PDF]

				Y. W. Wu, K. H. Backstrand, S. Zhao, H. J. Fullerton, and S. C. Johnston Declining Diagnosis of Birth Asphyxia in California: 1991-2000 Pediatrics, December 1, 2004; 114(6): 1584 - 1590. [Abstract] [Full Text] [PDF]

eLetters: