Record low for Scottish infants' deaths

Published on Monday 24 January 2011 17:25

THE number of babies dying in the first year of life has hit a record low in Scotland, new figures have shown.

Statistics seen by The Scotsman reveal that in 2009, there were 235 infant deaths, down from 253 the year before and 272 in 2007. Advances in the treatment of sick and premature babies are thought to be behind the falling death rate.

But there has been no such progress in cutting the number of stillbirths, which has changed little in two decades and is at a higher rate than in many other European countries.

The figures showed 317 stillbirths were recorded in Scotland in 2009, compared with 325 the previous year.

Experts and charities called for more action to be taken so the improvements in infant mortality could be matched with a drop in the stillbirth rate.

The figures, published in the Scottish Perinatal and Infant Mortality and Morbidity Report 2009, reveal the rate of infant deaths in Scotland fell to four per 1,000 live births in 2009.

This compares with 4.7 per 1,000 two years earlier and 5.1 in 2003. NHS Quality Improvement Scotland (NHS QIS), which published the figures, said the rate of four per 1,000 births was the lowest ever recorded.

Leslie Marr, reproductive health programme co-ordinator at NHS QIS, said the drop was thought to be down to improvements in neonatal care.

"The numbers each year are comparatively small and we are always a bit wary of looking at a year in isolation, but the trends seem to be suggesting that deaths are decreasing, which is a very positive thing," she said.

Recent medical advances have helped sick and premature babies, who would have died in the past, survive. Developments include the wider use of steroids in mothers likely to give birth early, which helps development of the foetus, as well as improvements in ventilation and temperature control in neonatal units.

But more progress is needed to find out the causes of stillbirths. The figures revealed the rate dropped slightly in Scotland, from 5.4 per 1,000 births in 2008 to 5.3 in 2009.

The most recent figures for England and Wales, for 2008, show a rate of 5.1, while Northern Ireland, it was 4.5.

Comparisons with other countries in Europe are difficult, because of differences in the definition of stillbirth depending on the length of the pregnancy.

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But a report in 2009, examining European figures for 2004, suggested Scotland had higher stillbirth rates than countries including Germany, the Czech Republic, Denmark, Estonia, Finland, Sweden and Spain.

The reasons for the higher rates in Scotland are not clear, but campaigners are working with the Scottish Government to try to reduce stillbirths.

Ms Marr said it was still unclear why stillbirth rates had not changed significantly in more than 20 years. Possible reasons include women having children later and rising levels of obesity.

"If you give birth over the age of 40, you are twice as likely to have a stillbirth than if you are aged 25-35," Ms Marr said.

"People who are obese are more likely to have a stillbirth and we know nationally that obesity is increasing.

"You are also more likely to have a stillbirth if you live in a poorer socio-demographic area."

Ms Marr said officials were changing how they collect data on stillbirths to include information on age, weight and deprivation to try to understand more about the causes.

Neal Long, chief executive of stillbirth charity Sands, said it was "an ongoing tragedy" that almost every day in Scotland, a baby was stillborn.

"The stillbirth rate in Scotland remains stubbornly consistent, having not changed significantly in the past 20 years," he said.

"Scottish stillbirth rates are higher than several other European countries and as yet it is unclear exactly why this is.

"What we do know is that, despite the fact that Scotland has relatively good levels of maternity funding, good pathology services and better data collection following the death of a baby than much of Europe, the stillbirth rates are still very high."

Mr Long said by working with the Scottish Government through the newly formed Scottish Stillbirth Working Group, which will meet for the first time next month, they hoped to begin to answer some of these questions.

The report revealed a small rise in post-mortem examinations in stillbirth cases, from 55 per cent to 59 per cent in 2009.

But it expressed concern the placenta was examined in only 77 per cent of cases, despite lots of information being available from such tests. The report calls for more to be done to explain the benefits of post-mortems to parents.

It also said all placentas should be examined.

Margaret Evans, a paediatric pathologist based at Edinburgh Royal Infirmary, said the placenta had a lot to offer to improve knowledge of stillbirths.

But she said there were still many cases in Scotland where it was not sent away for testing because staff did not think to do so.

"Obviously, the gold standard would be to have a post-mortem because we might find information from that that is pertinent.

"But in the absence of that, we must look at the placenta because it has a great deal of information to offer," she said.

Examples of how the placenta may offer information on a stillbirth include looking at how the cord is coiled. Research has shown that not having enough coils in the cord can make it more likely to be compressed by pressure from the baby's body, stopping blood flow.

It may also show if the mother has a clotting disorder, which could have significant effects on future pregnancies, as well as disorders such as lupus. "That can be something you can treat in the next pregnancy, so the effects of that disease do not lead to a stillbirth the next time," she said.

As well as helping to manage future pregnancies, she said it was important to give women a reason for what had happened.

"For a mother to have as stillbirth where there is no explanation must be very frightening," Dr Evans said. "It happens in quite a significant number, but it has been shown that the number of unexplained cases falls if the placenta is looked at."Dr Alexander Heazell, from baby charity Tommy's, said: "There has been no significant change in the stillbirth rate, as there is a lack of sufficiently sensitive tests to identify pregnancies at risk of stillbirth. As we can't predict stillbirth accurately, we don't know which women to deliver and not to deliver.

"The majority of stillbirths are due to the placenta not working properly, and not enough is known yet about what goes wrong with the placenta in stillbirth and how we can detect any problems. If we had a better understanding of this, we might have a better understanding of stillbirth and which pregnancies we can intervene on."