Infant death rate in isles highest in Scotland by a wide margin

By JOHN ROBERTSON

Shetland babies have been dying during their first year at a rate more than two-and-a-half times that of the rest of Scotland, according to government statistics.

Shetland’s infant death rate has been much higher on average than the Scottish rate since 2003, rising last year to a potentially alarming level with seven baby deaths, giving Shetland an infant mortality rate of 25.2 per 1,000 live births – exactly six times the Scottish average of 4.2.

In contrast, no infants from Orkney or the Western Isles died last year. Indeed, Orkney’s infant death rate has been below the national average over the same six-year period and less than one-third of Shetland’s average rate of 12.3 infant deaths per 1,000 live births. Infant deaths are those which occur in the first year of life.

Shetland’s director of public health Sarah Taylor said this week she believed there was no pattern to the infant deaths and voiced caution about drawing conclusions from statistics based on very small numbers. Responding to concerns about the figures, she said: “Is there something overall going on that is suspicious? My professional opinion is I don’t think so.”

Asked if she could re-assure the community, she said: “I would want everybody to be re-assured that there is nothing in particular going on in Shetland.”

For bigger health boards down south it is possible to discern odd trends more easily due to the greater numbers, helping pinpoint potential problems relating to such causes of death as sudden infant death (cot death), premature birth, particular congenital problems, problems at birth or perhaps those who have suffered child abuse or the effects of heroin or alcohol abuse. But for Shetland the figures are small and can therefore zig-zag up and down from year to year.

Dr Taylor said if there were four infant deaths in a year they would be from different causes. “What I know is that there is not a single cause that happens in Shetland in anything other than in odd single figures. Our approach to it is to look at individual cases and try and understand whether something could have been prevented or changed in that case.

“The only way we can really understand it is to understand each death and understand whether there is anything in particular about individual deaths. Whereas if we had large numbers [like Glasgow or Edinburgh], we would be looking at the proportion that die of different causes.”

Regarding the stark figures for 2008, she said so far nothing had come to light to give cause for alarm and it could be a statistical blip. “This is likely to be the sort of variation that you see with small numbers. I would want people to be re-assured around this because obviously we would be vigilant if we thought there was anything that caused concern.”

There are obvious dangers in highlighting statistics which suggest a problem if they are not actually significant, but the information is publicly available and Shetland’s high figures for infant deaths jump out at the reader, naturally prompting questions.

The 2008 figures show that 278 babies were born alive last year and seven died during their first year, three of them within the first week. The figures are still provisional and may change once the data has been checked to ensure there have been no mistakes, such as attributing a birth to a mother who was not actually living in Shetland.

Dr Taylor said it was hard to say what the 2008 figures mean at this stage because the board does not have full details of the causes of death yet. A number of local babies are born in hospitals outwith the islands rather than under Shetland Health Board’s jurisdiction. Women with complicated pregnancies go to Aberdeen or elsewhere and babies which are found to have problems at birth or in their early days may be sent south for intensive care or to a neo-natal unit.

The preliminary data available to her for 2008 does show no cases last year of cot death, nor cases of meningitis or more than the usual number of pneumonia or respiratory illness cases which could kill a baby.

She said the most common cause of infant death is congenital problems (abnormalities which have developed during pregnancy) or problems to do with the birth. There were “half a dozen” of these last year but she said the exact nature of the problems was not known at this stage. They could involve an increase of one or two very premature babies, an additional baby with congenital problems or a whole set of different issues which she does not know about in detail yet.

There is a national audit system for studying the deaths of babies occurring before, during or in the days after birth with the aim of learning lessons from the findings but Dr Taylor said it took a year to 18 months to get the annual report on Shetland baby deaths.

“What we do is we say: ‘Is there something going on behind these seven [deaths] that is a systematic problem that we should be doing something about? But when we’ve looked back over previous years there is nothing systematic going on.”

The high levels seen for infant deaths do not extend to stillbirths, of which Shetland had none last year and, over the six-year period, experienced a rate lower than the Scottish average and less than that of the two other island groups. Dr Taylor said Shetland had a high percentage of mothers who make full use of ante-natal care where potential problems can be picked up.

All the figures in this story are publicly available on the internet site of the General Register Office for Scotland which records data on many aspects of Scotland’s population, including life expectancy, causes of death and rates of hospital-acquired infections such as MRSA.