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Today’s webinar will begin in a few minutes.
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THA /TIPQC OB EED Webinar
August 28, 2017
A THA/TCPS TIPQC Collaborative Inter-institutional Quality Improvement Project
Welcome! Agenda for today:
• Birth Defect Reporting and Birth Defect Advisory Committee
• EED Data • Crib Cards • Breastfeeding Survey Reminder • Maternal and Neonatal Sepsis • Open Discussion and Team Sharing • Reminders and Upcoming Events
Tennessee Birth Defects Surveillance System (TNBDSS)
THA OB Webinar
Carolina Clark, MD, MPH | August 28, 2017
Objectives
• Introduce TN Birth Defects Surveillance System • Discuss our program goals • Discuss how to report neurologic birth defects
Tennessee Birth Defects Registry
• Established June 2000 (TCA 68-5‐506)
1. Annual report on birth defects prevalence and trends 2. Possible association of environmental hazards and other potential
causes of birth defects 3. Evaluate current birth defect prevention
initiatives 4. Provide families of children with birth
defects information on available public services
Tennessee Birth Defects Surveillance System
US Zika
Pregnancy Registry
Pregnant women with lab evidence
of possible Zika exposure and their
children
Zika-Related Birth Defects Surveillance
Infants with Zika-related birth defects
US Zika Pregnancy Registry
• Pregnant women – laboratory evidence of Zika virus infection – Both symptomatic AND asymptomatic
• Infants born to these women – Exposed periconceptionally, prenatally or perinatally
• All infants with laboratory evidence of Zika virus infection – Both symptomatic AND asymptomatic
• The mothers of these infants – Both symptomatic AND asymptomatic
Zika in Tennessee
• 66 travel-related cases in 2016 – 51 confirmed (0 pregnant women) – 15 probable (6 pregnant women) – Microcephaly: 0 Zika related
• 0 travel-related cases in 2017
Tennessee Birth Defects Surveillance System (TNBDSS)
• Recipient of CDC cooperative agreement (Epidemiology and Laboratory Capacity – ELC) grant
• Expand capacity of neurologic birth defect monitoring • Investment in IT infrastructure, personnel, training/capacity
building Program Goals: • Enhance surveillance capacity • Ensure linkage to services • Evaluate health outcomes for children
CDC Enhanced Birth Defects Surveillance
• Rapid population-based surveillance for all infants born with birth defects potentially associated with Zika virus infection during pregnancy
• Partner Agencies – Children’s Special Services (CSS) – Tennessee Early Intervention System (TEIS) – Vanderbilt Consortium LEND (Leadership Education in
Neurodevelopmental Disabilities) – Office of Vital Records – TN Perinatal Centers
Case Numbers
• Neurologic birth defects: 194 cases as of 8/25 • US Zika Pregnancy Registry: 7 cases, 7 births with no currently confirmed
birth defects – 2 women were symptomatic, 5 were asymptomatic
Neurologic Birth Defects Reporting
• In February 2016, TDH mandated reporting of all new cases of microcephaly
• January 1, 2017 expanded surveillance to central nervous system (CNS) birth defects associated with congenital Zika virus infection – Brain abnormalities with and without microcephaly – Neural tube defects and other early brain malformations – Eye abnormalities – Consequences of central nervous system (CNS) dysfunction
Tennessee Birth Defects System (TNBDSS)
• Integrated into Newborn Screening and Children’s Special Services programs
• Referrals to services and family support agencies • Case management for 3 years or up to 5 years of age
– Clinical outcomes – Functional/developmental outcomes
Reporting of neurologic birth defects
is necessary to assure connection to care for these infants
How do healthcare providers participate?
1. Identify pregnant women with potential exposure to Zika virus and infants with suspected congenital exposure to Zika virus.
2. Report cases of Zika associated birth defects. 3. Collect pertinent clinical follow-up information about these pregnant
women and infants. 4. Quickly notify [email protected] of
adverse events, such as spontaneous abortion, fetal death, or birth defects.
State Law
• From Rule 1200-14-.26: • “No person shall interfere with or obstruct… the
examination of any relevant record, by the responsible health officer, his duly authorized agent or a representative of the department in the proper discharge of his or her official duties under these Rules.”
Federal Law
• PURSUANT TO 45 CFR § 164.512 (b) of the Privacy Rule, “covered entities such as hospitals may disclose, without individual authorization, protected health information to a public health authority that is authorized by law to collect or receiving such information for the purpose of preventing or controlling disease, injury, or disability, including, but not limited to, the reporting of disease, injury, vital events such as birth or death and the conduct of public health surveillance, public health investigations, and public health interventions…”
Online case reporting system
Click here: https://tdhrc.health.tn.gov/redcap/surveys/?s
=TDEYPYCHET
For more information
• Contact the TNBDSS team at [email protected]
• Carolina Clark, MD, MPH, Pediatric Consultant • Katherine Lolley, MPH, CPH, Program Director • Tori Ponson, MPH, CPH, Epidemiologist • Laura Price, RN, Nurse Case Manager
Supplemental Slides
TNBDS Reportable Birth Defects
Brain abnormalities with and without microcephaly – Confirmed or possible congenital microcephaly – Intracranial calcifications – Cerebral atrophy – Abnormal cortical formation
• e.g., polymicrogyria, lissencephaly, pachygyria, schizencephaly, gray matter heterotopia
– Corpus callosum abnormalities – Cerebellar abnormalities – Porencephaly – Hydranencephaly – Ventriculomegaly / hydrocephaly – Fetal brain disruption sequence (collapsed skull, overlapping sutures, prominent occipital
bone, scalp rugae) – Other major brain abnormalities, including intraventricular hemorrhage in utero (excluding
postnatal IVH)
TNBDS Reportable Birth Defects
Neural tube defects and other early brain malformations – Anencephaly / Acrania – Encephalocele – Spina bifida – Holoprosencephaly / Arhinencephaly
Eye abnormalities – Microphthalmia / Anophthalmia – Coloboma – Cataract – Intraocular calcifications – Chorioretinal anomalies involving the macula (e.g., chorioretinal atrophy and
scarring, macular pallor, gross pigmentary mottling and retinal hemorrhage); excluding retinopathy of prematurity
– Optic nerve atrophy, pallor, and other optic nerve abnormalities
TNBDSS Reportable Birth Defects
Consequences of central nervous system (CNS) dysfunction – Congenital contractures (e.g., arthrogryposis, club foot, congenital hip dysplasia)
ONLY with associated brain abnormalities – Congenital deafness documented by postnatal testing
• Reporting fields: – Infant information
• MR # • Name/sex/DOB • Gestational age • Pregnancy outcome (live birth, fetal death/stillbirth) • Diagnosis • Date of diagnosis • Provider
– Maternal information • Name/DOB/SSN • Address (County and State) • Travel history • Reporter information • Provider
Neurologic Birth Defect Monitoring
Questions?
OB EED Data Trends Working toward our goal of 5% or less
Crib Cards
Breastfeeding Survey Reminder: Breastfeeding Survey Ongoing
We need your input
https://www.surveymonkey.com/r/LQQ9ZKH
Upcoming Events
“Obstetric Care for Women with Opioid Use Disorder Patient Safety Bundle
Presentation” Wednesday, September 6, 2017
beginning at 12:30pm CT/1:30pm ET
Presenters:
Elizabeth Krans, MD, MSc and Miskha Terplan, MD, MPH
http://safehealthcareforeverywoman.org/registration/
Save the Date!!!
“Updates to the Joint Commission’s Perinatal Care Core Measures” Webinar
Susan Yendro of the Joint Commission, Presenting Monday, October 30th beginning at 10am CT
EED Data Due Date! Monthly data due by last date of following month!
Reminder! Our Next Monthly OB Webinar will be held on Monday September 25, 2017
at 10:00am CT/11:00am ET