An evaluation of a risk related intervention programme to reduce the rate of possibly preventable postperinatal deaths (including sudden infant deaths) in Portsmouth and South East Hampshire health district

Abstract

The programme of risk related intervention (RRI) was prompted by a sharp and sustained rise in the rate of possibly preventable postperinatal deaths (PPPD) in Gosport from 1977-81. A preliminary study which included the dead infants indicated that the `Sheffield' Scoring System identified those at risk of sudden death. The Portsmouth Study comprised an initial phase in Gosport 1.1.82-31.3.83, then it was extended to include all infants born 1.4.83-31.3.85 to women resident in Portsmouth and South East Hampshire Health District. The `Sheffield' system was used in Gosport to identify infants at high risk (HR), then was modified to include local factors and select a very high risk (VHR) group. Two other risk groups were identified: non accidental injury; families with previous experience of child death. All infants were `scored' by computer then the risk factors were notified to health visitors and general practitioners. RRI by health visitors included: a programme of home visiting in the infants' first year - 5 visits for low risk, 11 for HR (9% of total), 21 for VHR (1%); provision of room thermometers for HR and VHR; leaflets and advice to all parents regarding hyperthermia; naked weighing of all infants and plotting weights on percentile charts. RRI appears to have been effective as during the study period there was a significant reduction in PPPD in the groups receiving extra care. Also the mean rate of PPPD 1983-87 when compared to the five years before intervention showed: a reduction of 60.6% in Gosport; 32.2% in Portsmouth (including Gosport); against 12.2% in England and Wales; and only 5.4% in Wessex Region (not including Portsmouth). The study validated findings that patterns of age, sex, season, time, illnesses, overheating, smoking and infant feeding in PPPD are similar to typical patterns found in studies of SIDs only. The computerised scoring system, patterns of intervention and changes in practice of health care, have been acceptable not only to professionals but also to parents, who have generally welcomed the extra support given to them and the extra attention given to their infants.

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