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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 B nessee Birth D h Defects ects Surveillance veillance S System ( tem (TNBDSS) BDSS) THA OB Webinar Carolina Clark, MD, MPH | August 28, 2017
Objecti Objective ves • Introduce TN Birth Defects Surveillance System • Discuss our program goals • Discuss how to report neurologic birth defects
Tenness Tennessee ee Birth Defects Registr 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
Tenness Tennessee ee Birth Defects Birth Defects Surveil Surveilla lanc nce System e System US Zika Zika-Related Birth Pregnancy Defects Surveillance Infants with Zika-related Registry birth defects Pregnant women with lab evidence of possible Zika exposure and their children
US Zika Pregna US Zika Pregnanc ncy y Registr 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 Zika in Tennes in Tennesse see • 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
Tenness Tennessee ee Birth Defects Birth Defects Surveil Surveilla lanc nce System (TNBDSS e 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 Enhance CDC Enhanced d Birth Birth Defect Defects s Surveil Surveilla lanc nce • 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 Case Numbers 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
Neurolo Neurologi gic Birth c Birth Defects Defects Reportin 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
Tenness Tennessee ee Birth Defects System Birth Defects System (TNBDSS 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 healthc How do healthcar are e provide providers rs partici participa pate te? 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 birth.defects@tn.gov of adverse events, such as spontaneous abortion, fetal death, or birth defects.
State State Law 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 Federal Law 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 Online case report reportin ing system g system Click here: https://tdhrc.health.tn.gov/redcap/surveys/?s =TDEYPYCHET
For For more more informa informati tion on • Contact the TNBDSS team at birth.defects@tn.gov • Carolina Clark, MD, MPH, Pediatric Consultant • Katherine Lolley, MPH, CPH, Program Director • Tori Ponson, MPH, CPH, Epidemiologist • Laura Price, RN, Nurse Case Manager
Supplemental pplemental Slides ides
TNBDS TNBDS Reporta Reportable le Birth Birth Defect Defects Brai ain ab abno normalities wi with and h and wi witho hout 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 TNBDS Reporta Reportable le Birth Birth Defect Defects Ne Neur ural tube d defects ts a and other e er early rly b brain m malform rmati tions – Anencephaly / Acrania – Encephalocele – Spina bifida – Holoprosencephaly / Arhinencephaly Eye a e abnorm rmaliti ties es – 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 TNBDSS Reporta Reportabl ble Birth e Birth Defects Defects Conseq sequen ences of cent ntral al nervou ous s system (CNS) d dysfunct unction on – Congenital contractures (e.g., arthrogryposis, club foot, congenital hip dysplasia) ONLY with associated brain abnormalities – Congenital deafness documented by postnatal testing
Neurologic Birth Defect Monitoring Rep eportin ing f fiel elds: • – 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
Questions?
OB EED Data Trends Working toward our goal of 5% or less
Crib Cards
Contact Rachel Heitmann at rachel.heitmann@tn.gov
Contact Rachel Heitmann at rachel.heitmann@tn.gov
Contact Rachel Heitmann at rachel.heitmann@tn.gov
Contact Rachel Heitmann at rachel.heitmann@tn.gov
Contact Rachel Heitmann at rachel.heitmann@tn.gov
Contact Rachel Heitmann at rachel.heitmann@tn.gov
Breastfeeding Survey Reminder: Breastfeeding Survey Ongoing We need your input https://www.surveymonkey.com/r/LQQ9ZKH
Upcoming Events
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