6377 Are we ready for statutory review of neonatal death certificates?

Objectives In April 2024 medical examiners will review all neonatal death certificates. There is no systematic training for doctors completing neonatal death certificates. Very few medical examiners have any neonatal expertise. How much detail was on our neonatal death certificates from the last four years? Would they be suitable for medical examiner scrutiny and has training prepared medical examiners for neonatal death certificates? Methods A newly trained medical examiner (SJC) reviewed 171 neonatal death certificate counterfoils (collated by GNB), for completeness, diagnostic groupings and considered if they would be accepted by the medical examiner service. Results Neonatal death certificates were only mentioned once in the core training package for new medical examiners. Of 171 certificates, over 4 years, 11 (6.4%) had a mode of death in (a) main diseases or conditions. All of these had causes of death in (b) other diseases or conditions. No certificate had all 5 sections completed. 95 (55%) had no maternal information in (c), (d) or (e). 26 (15.2%) only had part (a) filled in. Of which 18 (10.5%) were deemed insufficient, including two hypoxic ischaemic encephalopathy with no other information. Up to 5 diseases/conditions were listed in (a), giving 210 causes of death. 32.7% prematurity; 26% pulmonary; 11.7% congenital anomalies; 7.6% encephalopathic; 7% intracranial haemorrhages; 6.4% infection. Two causes should have been in maternal conditions (c) Up to 6 diseases/conditions were listed in (b), giving 240 other conditions. 30.1% prematurity; 14% pulmonary; 8.7% congenital anomalies; 6.4% intracranial bleeds. Four conditions should have been in (c). Up to 3 diseases/conditions were listed in (c) Main maternal diseases/conditions, giving 88 conditions. 20.4% premature labour; 17% maternal bleeding; 12.5% premature prolonged rupture of membranes; 9.1% twin; 5.6% maternal infection; 6.4% intracranial bleeds. 8 conditions should have been in neonatal conditions (a) or (b). Up to 3 diseases/conditions were listed in (d), giving 27 conditions. These were far more eclectic. 3 gestation, which should have been on (a) to (d). 3 twin; 2 maternal bleeds; 2 maternal infections; 2 premature prolonged rupture of membranes; 2 premature labour; 2 weights, which should have been (a) or (b). Conclusion Medical examiner training has not prepared for neonatal death certification. 37 (21.6%) certificates would have needed additional information or amending. However, this was clear to a neonatologist with medical examiner training. The increased scrutiny is not likely to improve death certification unless there is sufficient training for medical examiners.