Child Death, Near Death and Stillbirth Commission
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     Beginning in the mid 1990’s, Delaware’s infant mortality rate was increasing while the national trend was decreasing annually.  This trend prompted Governor Minner to convene an Infant Mortality Task Force (IMTF) in June 2004.  In the Task Force’s Report of May 2005, implementation of “a comprehensive review of every fetal and infant death in Delaware” was the first recommendation. 

     The overall goal of fetal and infant mortality review is to enhance the health and well-being of women, infants and their families by improving community resources and service delivery systems available to them.  The FIMR process brings together key members of the community (comprising the case review team/CRT) to review information from individual cases of fetal and infant death in order to identify the factors associated with those deaths, determine if they represent system problems that require change, develop recommendations for change and assist in the implementation of change.  All case information is de-identified and reviews remain confidential.

     The purpose of these reviews is to understand how a wide array of local social, economic, public health, educational, environmental and safety issues relate to the tragedy of infant loss. 

     Key steps in the FIMR process include:

  • Information about the fetal/infant death is collected through public health data and medical records.  They are reviewed by a Registered Nurse.
  • An interview is conducted with the mother who suffered the loss by a Senior Medical Social Worker.  Referrals for bereavement support and community resources are offered.
  • The CRT comprised of health professionals, social service professionals and other experts from the community review the case summary and interview, identify issues and make recommendations for community change if necessary.
  • The Community Action Team (CAT) is a diverse group of community leaders review the CRT recommendations and implement interventions to improve service systems and resources. 

      FIMR exists under the authority of the Child Death, Near Death and Stillbirth Commission (CDNDSC) in Delaware and is charged with reviewing all deaths of children up to the age of 18 years.  In recent years, the statute was revised and expanded to include fetal and infant deaths occurring as early as 20 weeks gestation.  The FIMR staff includes the RN FIMR Program Coordinator, the Senior Medical Social Worker and an Administrative Specialist who report directly to the Executive Director of the CDNDSC. 

     The FIMR process is action oriented, a community coalition, a voice for families in Delaware and is supported by the American College of Obstetricians and Gynecologists (ACOG), the March of Dimes Birth Defects Foundation and the federal Maternal and Child Health Bureau. 

2007 Goals

  • Establish a baseline rate of fetal and infant deaths for use in subsequent FIMR operations
  • Hire and train three full time staff
  • Initiate development of the FIMR database
  • Create case review teams and community actions teams state-wide
  • Develop formal relationships with key stakeholders in Delaware and nationally

2007 Accomplishments

  • Identified a total of 110 infant and fetal deaths
  • Reviewed 7 cases between April and June.
  • Conducted five maternal interviews (20 women declined participation)
  • Fully staffed FIMR
  • Identified and secured a database program, BASINET, to track FIMR data
  • Recruited volunteers for two case review teams
  • Identified Community Action Teams within the Delaware Healthy Mother Infant Consortium and the Child Death, Near Death and Stillbirth Commission (CDNDSC)

Unique features

  • Assessment of medical records, birth certificates, and death certificates
  • Interviews with mothers and their families

Next steps for FY 08

  • Expand the budget and monitor it through CDNDSC
  • Monitor full implementation through CDNDSC
  • Collect FIMR data on a fiscal-year basis
  • Identify core issues/themes discussed at the Case Review Teams
  • Action on these identified issues by the Community Action Team
CDNDSC address graphic