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THA /TIPQC OB EED Webinar

August 28, 2017

A THA/TCPS TIPQC Collaborative Inter-institutional Quality Improvement Project

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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

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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

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Objecti Objective ves

Introduce TN Birth Defects Surveillance System
Discuss our program goals
Discuss how to report neurologic birth defects

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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

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Tenness Tennessee ee Birth Defects Birth Defects Surveil Surveilla lanc nce System e System

US Zika Pregnancy Registry

Pregnant women with lab evidence

f possible Zika

exposure and their children

Zika-Related Birth Defects Surveillance

Infants with Zika-related birth defects

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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

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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

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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

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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

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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

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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

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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

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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.

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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

r a representative of the department in the proper

discharge of his or her official duties under these Rules.”

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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…”

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Online case Online case report reportin ing system g system

Click here: https://tdhrc.health.tn.gov/redcap/surveys/?s =TDEYPYCHET

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For For more more informa informati tion

n
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

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Supplemental pplemental Slides ides

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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)

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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

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TNBDSS TNBDSS Reporta Reportabl ble Birth e Birth Defects Defects

Conseq sequen ences of cent ntral al nervou

us s

system (CNS) d dysfunct unction

n

– Congenital contractures (e.g., arthrogryposis, club foot, congenital hip dysplasia) ONLY with associated brain abnormalities – Congenital deafness documented by postnatal testing

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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

Neurologic Birth Defect Monitoring

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Questions?

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OB EED Data Trends

Working toward our goal of 5% or less

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