Perinatal/Infant Health - Annual Report

 

Illinois’ priority for the Perinatal and Infant Health Domain is:

 

• Support healthy pregnancies to improve birth and infant outcomes (Priority #3).

 

Rates of adverse infant outcomes show mixed progress over the last several years. Rates of low birth weight (NOM #4) and preterm birth (NOM #5) have remained steady over the last 10 years, with no substantial changes in either direction. For both these outcomes, there are persistent inequities by race/ethnicity (Black infants more than twice as likely to experience the outcome), educational attainment, insurance status, and socioeconomic status.

 

In contrast, there were substantial drops in all measures of perinatal/infant mortality in Illinois during 2019. Perinatal mortality (NOM #8) decreased by 5% from 2018 to 2019. Overall infant mortality (NOM #9.1) decreased by 14% from 2018 to 2019, and this is the first time the overall Illinois rate has been below 6.0 per 1,000. Nearly all of this drop could be attributed to neonatal deaths (NOM #9.2: decreased by 17%) and little of it was due to changes in post-neonatal deaths (NOM #9.3: decreased by 5%). Additionally, both preterm-related infant mortality (NOM #9.4) and SUID mortality (NOM #9.5) decreased by 14% from 2018 to 2019. For various infant mortality outcomes, Illinois has improved its ranking among the 50 states; for example, the Illinois rate of infant mortality improved appreciably from 37th to 25th. Notably, all infant mortality indicators in Illinois have improved in rankings. The reasons for the particular drop in infant mortality during 2019 are not yet known. Preliminary data from 2020 and 2021 have shown similar lower rates so 2019 was not an outlier and there appear to be sustained improvements in infant mortality in Illinois. The MCH epidemiology team is planning to conduct an in-depth analysis of infant mortality during fall 2022 to better understand these trends and explore the underlying causes of infant deaths.

 

Despite overall improvements in infant mortality, inequities by race/ethnicity remain some of the largest in the nation. Compared to white infants, black infants are 2.7 times as likely to die during the first year of life. They are 2.4 times as likely to die during the neonatal period, 3.2 times as likely to die during the post-neonatal period, 3.2 times as likely to die from preterm-related causes, and 3.8 times as likely to die from Sudden Unexpected Infant Death (SUID). The in-depth analysis of infant mortality that will be conducted in fall 2022 will include an updated perinatal periods of risk analysis to assess the types of infant deaths most contributing to these disparities and to identify windows of opportunity for intervention. Previous PPOR analyses showed that maternal health/prematurity and post-neonatal deaths were the periods of risk that caused most of the black-white infant mortality disparity. This suggests that focusing on prematurity prevention, overall maternal health before and during pregnancy, social determinants of health, breastfeeding, and safe sleep promotion are the interventions that could most support achieving health equity for Illinois infants.

 

Illinois women are more likely than ever to deliver in a risk-appropriate care setting; nearly 86% of Illinois’ very low birth weight infants were born in a hospital with a level III NICU (NPM #3) during 2020. When Illinois first selected this national performance measure in 2010, the rate was only 77.6%. Success in this measure has come through persistent hard work of the administrative perinatal centers and coordination of our state’s regionalized perinatal system. Unlike most maternal and child health services and outcomes, risk-appropriate care rates are similar for non-Hispanic Black, White, and Hispanic women across Illinois. However, there are wide differences in receipt of risk-appropriate care by geographic area. The rate of receiving risk-appropriate care is over 90% for Chicago residents, but only 66% for residents of rural counties in Illinois. Illinois will continue to monitor this measure for the potential impact of obstetric hospital closures that have occurred in both urban and rural areas of Illinois and to implement strategies to improve care in maternity care desert areas.

 

There has also been substantial progress in breastfeeding in Illinois during recent years. The breastfeeding initiation rate (NPM #4A) increased from 71% in 2008 to nearly 85% in 2018, meeting the Healthy People 2020 objective. During the same time period, the rate of exclusive breastfeeding at six months doubled from approximately 12% to 25% (NPM #4B). However, breastfeeding rates remain lower for infants born to non-Hispanic Black mothers, young mothers, and residents of rural areas. Illinois has worked hard to improve the structures and supports to improve breastfeeding, as demonstrated through the increase in Baby-Friendly hospitals (ESM#4.1) over the last several years. In 2015, there were only 6 Baby-Friendly hospitals in Illinois, which served approximately 4% of the state’s births. By 2021, this increased to 29 Baby-Friendly hospitals, which served approximately 17% of the state’s births.

 

New this year -- Illinois added NPM #5 to our selection of national performance measures because of the need to better address sleep-related deaths in order to achieve racial equity in infant mortality. While most (85%) infants are placed on their back to sleep (NPM #5A), this is substantially lower among non-Hispanic Black infants (~60%) compared to non-Hispanic White infants (~92%), Hispanic infants (83%) and Asian infants (82%). Furthermore, only about half of infants are placed in a safe sleep environment without loose bedding (NPM #5C) and just over one third of infants are placed on a separate sleep surface (NPM #5B), with non-Hispanic Black infants having substantially lower rates of these sleep practices than non-Hispanic White infants. Illinois will analyze more data on sleep-related behaviors using a health equity lens and will support new strategies to improve infant safe sleep in FY22 and the years to come.

 

Title V utilized the following strategies to address the Infant and Perinatal Health Domain priority:

 

3-A. Maintain a strong system of regionalized perinatal care by supporting perinatal network administrators and outreach/education coordinators and identifying opportunities for improving the state system.

 

Illinois has two perinatal nurses (one in the northern region of the state and one in the southern region) to cover the approximately 101 hospitals in Illinois that have perinatal units. The perinatal nurses work in conjunction with the 10 administrative perinatal centers. Each administrative perinatal center has a perinatal nurse administrator, a neonatal nurse educator, an obstetric nurse educator, a maternal fetal medicine co-director, and a neonatology co-director. The administrative perinatal centers and the perinatal nurses conduct site visits at each perinatal hospital in Illinois to assess the hospital’s compliance with the Illinois Perinatal Code 640.

 

The IDPH perinatal nurses are fully funded by Title V and function as nursing consultants in maternal and child health issues by doing the following:

• Providing nursing expertise and leadership in the development, interpretation, and enforcement of regulations and program contract specifications related to programs impacting women throughout the reproductive cycle and infants working with other divisions at IDPH and external stakeholders, such as the CDC and U.S. Food and Drug Administration (FDA), to provide expertise and support for perinatal related needs.
• Coordinating and monitoring assigned maternal and child health program activities.
• Attending various state and local committee meetings (e.g., Perinatal Advisory Committee) to identify opportunities for collaboration and alignment between programs.
• Supporting hospitals statewide with education and technical assistance.

 

3-A.I.  Conduct a study of very preterm infants (<32 weeks) delivered outside Level III facilities to identify reasons for no maternal or neonatal transport and barriers to risk-appropriate care.

 

Illinois has implemented a special data collection process to gather information on very preterm (VPT) infants born outside Level III hospitals. Since 2015, OWHFS has implemented a data collection tool with six major sections: infant characteristics, maternal characteristics, information about the hospital admission and stay, reasons why mother was not transported to a Level III before delivery, outcome of the infant, and reasons why infant was not transported to a Level III after delivery. All Illinois hospitals that are not Level III facilities are required to complete the form for every instance of a live birth at 22-31 weeks gestation and to submit the form through the ePeriNet data system. These forms are linked to vital records files, enabling detailed analysis of patient characteristics and infant outcomes that are related to a lack of risk-appropriate care. Analysis of the VPT review forms will continue even though the COIIN has ended. Specifically, Illinois will continue to collect the VPT review form for all infants 22-31 weeks gestation born in non-Level III hospitals through the 2020 birth cohort. Data collection occurs through the ePeriNet online system. Due to competing priorities and training of new epidemiology staff members in FY21, the Title V epidemiology team was not able to analyze the collected data. The team anticipates that work on this project will resume in FY23.

 

3-A.II.  Update state Obstetric Hemorrhage Toolkit based on information in the ACOG patient safety bundle and distribute updated materials to all Illinois hospitals.

 

The update of the hemorrhage toolkit was completed in FY18. The regionalized perinatal program continues to disseminate the toolkit and other related training materials to birthing hospitals throughout Illinois with the support of I PROMOTE-IL and ILPQC. Hospitals continue to be encouraged to provide annual training on obstetric hemorrhage to all hospital staff that interact with pregnant/postpartum women.

 

3-A.III.  Designate and maintain perinatal levels of care and support administrative perinatal centers.

 

Illinois Perinatal Code 640 requires hospitals to undergo a site visit every three years. These visits include one perinatal nurse, one representative from the Perinatal Advisory Committee, and the administrative perinatal center team, which includes one perinatal nurse administrator, one neonatal nurse educator, one obstetric nurse educator, one maternal fetal medicine director, and one neonatology director. The purpose for the perinatal site visit is to assess if a perinatal hospital is following the State’s Perinatal Code 640 according to the hospital’s designated level of care. Standards for perinatal care and resource requirements are reviewed for each hospital as related to the hospital’s perinatal level. The levels are I, II, II with Extended Neonatal Capabilities (II-E), and III.

 

The IDPH perinatal nurses attend morbidity and mortality reviews at hospitals to keep abreast of emerging best practices and trends in the field. Quality improvement technical assistance site visits are also provided as requested. In FY21, the northern perinatal nurse attended 26 perinatal site visits (due to COVID-19, 24 visits were hybrid of in-person to observe compliance of the units and virtual for discussion of compliance with the Perinatal Code). Two visits were with Administrative Perinatal Centers. Multiple quality assurance and technical assistance was provided virtually, via phone, and onsite as needed for cases, including temporary and/or permanent OB closures due to COVID-19 census in hospitals. The southern perinatal nurse attended 18 perinatal site visits, four morbidity and mortality reviews at delivery hospitals, and 16 quality improvement/assurance or technical assistance visits. Three of those quality improvement visits lasted for one week and were in person due to the visits being with teams from other offices at IDPH. The other visits were virtual.

 

Illinois has a regionalized perinatal health care program that provides the infrastructure and support for Illinois’ birthing and non-birthing hospitals. Ten highly resourced hospitals are contracted as administrative perinatal centers (APCs) and charged with engaging and supporting a network of hospitals. Each birthing hospital has a perinatal level of care designation based on its resources and ability to care for neonates. The goal of the program is to improve birth outcomes through training, technical assistance, consultation on cases with complex health issues, and providing transportation to a higher level of care when appropriate. Title V provides grants to the 10 APCs annually.

 

3-A.IV.  Develop, designate, and maintain maternal levels of care.

 

In FY21, the Perinatal Advisory Committee (PAC) began the extensive process of developing regulations to create a Maternal Levels of Care designation system authorized under PA 101-0447. It is anticipated that this system will complement the existing Illinois perinatal designations; but focus on a hospital’s abilities and resources to care for the mother or birthing person. PAC has determined that the levels of care will be based on the levels developed by the American College of Obstetricians and Gynecologists (ACOG). Once these regulations are in place, a birthing hospital will have both a maternal and perinatal designation based on their staffing, resources, and capabilities. IDPH and PAC will employ a thoughtful and transparent process in creating these designations. This process will include ample time for stakeholder review and feedback. Key partners, such as the staff of the Illinois Hospital Association (IHA) will play a role in the process. IHA’s active engagement will help to ensure that the designation process considers the regional differences of the state.

 

3-A.V.  Highlights of the APCs’ key activities.

 

1. University of Chicago Perinatal Network

• Held 41 morbidity and mortality (M&M) conferences reviewing 190 cases and 25 severe maternal morbidities for opportunities for improvement or best practices.
• Assisted network hospitals with a quality initiative to ensure that newborn caregivers provided a safe sleep environment. This initiative also reinforced safe sleep practices through role modeling and follow-up instructions prior to discharge. Network hospitals continue to work on safe sleep certification through Cribs for Kids. Six hospitals have obtained the certification.
• Hosted 92 education programs attended by more than 1,100 staff and providers (courses, simulations and virtual education).
• Transported 170 maternity patients and 150 neonatal patients for a higher level of care.
• Kept network hospitals up to date on care and provided a warm handoff to primary provider at discharge.
• Completed 216 maternal and fetal medicine (MFM) consults.

 

2. Stroger Hospital’s Perinatal Network

• Held quarterly M&M conferences at each of the network hospitals to audit and review specific pre-identified cases as required in the 640 Code. Reviews included all maternal and neonatal transfers; all maternal, neonatal, intrauterine fetal deaths (IUFD) and neonatal deaths; severe maternal morbidity (SMM) reviews; severe hypertension cases; very preterm deliveries; selected cesarean sections: and added cases per request of the individual hospital.
• Continued to participate in the Severe Hypertension (HTN) Initiative collaborative that has seen network hospitals introduce global changes within their facilities. These changes include improvement of documentation in the electronic medical records capturing time to treatment and other interventions with patients experiencing severe HTN or hemorrhage episodes, development of massive transfusion policies or guidelines, locating emergency hemorrhage kits/box on the clinical floor, and including the emergency departments and laboratories/blood banks in discussions regarding changes and expectations.

3. Northwestern Perinatal Network:

• Reviewed 43 hospital-level SMM cases and discussed ways to improve the hospital-level SMM reviews with their network hospitals on an ongoing basis. Due to the ongoing COVID-19 pandemic, monthly and quarterly M&M meetings were held virtually. The APC saw an increase in attendance for M&M meetings due to the easier accessibility of virtual meetings.
• Through focused education, training, and recommendations from the SMM Review Sub-committee, the Northwestern APC and network hospitals have been able to decrease the rate of preventable SMM cases related to hemorrhage or hypertension/pre-eclampsia/eclampsia.
• Educated more than 650 learners on such topics as basic, intermediate, and advanced fetal monitoring; STABLE (sugar, temperature, airway, blood pressure, lab work and emotional support); perinatal loss; and Registered Nurse Certification (RNC) prep courses.

4. University of Illinois at Chicago Perinatal Network

• Implemented a monthly Fundamentals of Fetal Monitoring class using a curriculum created by the Perinatal Outreach Educators of Illinois (POEI). Classes were offered to novice nurses in labor and delivery, antepartum, and office setting. Approximately 300 nurses received this education. UIC and Rush Perinatal Center also offered this course to an additional 40 nurses.
• Held a conference entitled, “The State-of-the-Art Perinatal Care During the COVID-19 Pandemic.” The conference focused on the impact of COVID-19 on morbidity and mortality in mothers and newborns.
• Held a second conference entitled, “Stress, Burnout and Safety in the NICU.” This conference focused on the impact that provider burnout has on newborns in the NICU.
• A third conference was offered on perinatal bereavement. This conference allowed nursing champions to understand the impact of loss on patients and how providers could effectively provide appropriate compassionate care to their patients.
• Featured Illinois Doc Assist at a network meeting in March 2021 to present on care of perinatal patients with mental health disorders.
• Held nine lunch and learns focused on various topics including OB hemorrhage, adoption, maternal and newborn equity, and maternal mortality.

5. Loyola University Medical Center (LUMC) Perinatal Network:

• Achieved 100% network participation in a minimum of one ILPQC led quality initiatives.
• The Administrative Perinatal Center disseminated vital information and resources through quarterly Regional Quality Council and Nurse Council attended by every perinatal network hospital.
• To work toward the common goal of improving the care and outcomes of the maternal and neonatal population, the MCH Title V action plan was applied on a local level by the LUMC APC to deliver guidance, resources, and education to birthing and non-birthing staff on site at the perinatal network hospital.
• Provided 28 education programs attended by 569 nurses, facilitated 147 perinatal network hospital case reviews.

6. Rush University Medical Center (RUMC) Perinatal Network:

• Purchased simulation supplies for individual hospitals to utilize in training and education of staff in situ as well as providing educational opportunities in a more formal setting. These supplies included newborn task trainers that allowed for procedural training and fetal monitoring, and STABLE textbooks. Additional maternal pelvic models were purchased to assist in hemorrhage training for all the network hospitals.
• Provided continuous quality improvement (CQI) support for both network and ILPQC projects that promote healthy pregnancies and better maternal and newborn outcomes.
• Provided support and guidance to all network hospitals during M&M reviews, incorporating updated research materials, educational programs, and supporting hospitals through the pandemic by moving education and meetings to a virtual platform.

7. Javon Bea Hospital Perinatal Network:

• Conducted 30 M&M meetings. Cases included: 38 SMMs, 37 neonatal/fetal demise cases, and six newborn cases requiring whole body cooling therapy.
• Conducted OB hemorrhage and maternal hypertension management educational offerings for the providers and staff in the region. The restrictions associated with COVID-19 was a barrier to scheduling these educational sessions. Nevertheless, the APC was able to offer 10 educational sessions that reached a total of 163 attendees (24 MDs/Residents, 128 RNs, and 11 ‘others’).
• Facilitated a total of 255 neonatal consults, 315 maternal consults, 143 neonatal transport referrals, and 123 maternal transport referrals.

8. OSF St. Francis Medical Center Perinatal Network:

• Conducted 28 virtual M&M meetings with a total of 518 multi-disciplinary attendees. Case narratives included discussions regarding potential implicit bias and identified social determinants of health.
• Facilitated intermediate and advanced fetal monitoring courses. The advanced AWHONN fetal monitoring courses were offered virtually while the intermediate courses were face-to-face programs.
• A one-day program entitled Teaming Up for Perinatal Care was held in April 2021, with 150 participants from throughout the state. This program was devoted to the following topics: Marijuana Use and its Impact on Young Adults, Marijuana Use in Pregnant Women and its impact on the Fetus/Neonate, Sepsis in Pregnancy, and Obstetrical Emergencies.
• A virtual grand rounds presentation was offered to physicians and mid-level providers on the topic of Maternal Mortality and Morbidity in the State of Illinois. The grand rounds presentation was viewed by 132 physicians and mid-level providers.

9. South Central Illinois/St. John’s Children’s Hospital Perinatal Network:

• Offered 13 educational programs to network hospitals, emergency medical services (EMS), and fire departments. Reached a total of 500 participants through these programs. Course topics included OB hemorrhage, electronic fetal heart monitoring, and CQI oversight.
• Continued support for neonatal participation in ILPQC quality improvement initiatives. The hypertension project has been beneficial in central Illinois.

10. Cardinal Glennon Perinatal Network:

• Disseminated current perinatal literature to hospitals in the southern Illinois network and conducted multiple educational sessions. Educational sessions offered included 13 “Fetal Monitoring” courses (fundamentals and advanced), a level set course on maternal hemorrhage and hypertension for all birthing hospital managers, educators, and emergency department leadership, eight “Preparing for the Unexpected:  An Emergency Childbirth Workshop” for emergency department staff and providers, including EMS partners at hospitals without OB services. Included hands-on simulation and a perinatal support visit with a review of equipment and supplies, and six “A Course in Intrapartum Nursing” classes designed to provide core curriculum education to perinatal nurses, including neonatal and maternal complications and emergencies.
• Organized and hosted a Maternal and Neonatal SIPN Conference on September 22, 2021.
• Conducted 17 Morbidity and Mortality Reviews with the birthing hospitals (including 5 redesignation site visits). Cases reviewed during M&Ms were specifically chosen to highlight the maternal hemorrhage, hypertension, and MNO projects.

 

3-B. Implement surveillance systems to assess the impact of COVID-19 on pregnant women and neonates, including use of CDC’s Surveillance of Emerging Threats to Mothers and Newborns (SET-NET) system and development of system to track universal testing of pregnant women admitted for labor and delivery.

 

In FY21, Title V monitored the impact of the COVID-19 pandemic on MCH services and outcomes. Specifically, the Title V epidemiology team participated in the CDC’s Surveillance of Emerging Threats to Mothers and Newborns (SET-NET) surveillance system for COVID-19. In the first year of the pandemic, more than 13,000 pregnant persons had confirmed positive specimens for COVID-19. Of all live births during the first year of the pandemic, 5.6% were confirmed maternal prenatal COVID-19 cases. The groups of birthing persons with the highest prevalence of maternal prenatal cases were: Hispanic, younger than 25 years old, Medicaid recipients, and residents of Chicago. Title V will continue to analyze these data to understand the effects of COVID-19 during pregnancy on maternal and birth outcomes.

 

3-C. Support the Fetal and Infant Mortality Review (FIMR) program to identify factors that contribute to fetal and neonatal loss and subsequent adverse pregnancy outcomes and develop recommendations to improve quality care as well as address social determinants of health.

 

FIMR continues to examine and to identify the significant health, social, economic, cultural, safety, and education systems factors (non-medical) that are associated with fetal and infant mortality through review of individual cases. FIMR identifies fetal deaths (infants born dead after the 20th week of gestation) and neonatal deaths (any live born infant regardless of gestational age and weight) who die within the first 28 days of life. Through interviews with families who recently experienced a fetal loss, several challenges were identified, including inconsistent medical advice regarding inter-conceptual care and community changes impacting health (increase in community violence, gentrification in some communities, decreased rates of employment opportunities, and closing of local schools).

 

University of Chicago FIMR

 

The University of Chicago is responsible for administering the FIMR program and reviews deaths occurring within the city of Chicago. In FY20, the University of Chicago and IDPH successfully applied for the CDC and Harvard T.H. Chan School of Public Health (HSPH) Program Evaluation Practicum to do a process evaluation. Students in the practicum provided insight on how to standardize the collection of FIMR data to facilitate its synthesis into action item, to create a Community Action Team (CAT) able to interact with services in need of improvement or facilitate creation of services needed, and to develop ways to identify the impact of community actions. The University of Chicago developed an action plan to recommence reviews in FY21. This plan included collaborating with other FIMR agencies; securing Institutional Review Board (IRB) approval; hiring a full-time community action manager to develop, to plan, and to oversee the FIMR CAT; recruiting members to serve on the CAT; updating and revising program forms; creating outreach and marketing materials; and establishing a calendar for meetings.

 

University of Chicago developed an IRB approved FIMR program guided by the National Center for Fatality Review and Prevention that helps provide the community perspective on needs and supports that could make a difference in the health of communities. The data captured by this program helps identify interventions, needed programs and policy advocacy avenues that pinpoint opportunities for health improvement strategies.

 

During FY21, the FIMR team created a Community Action Team that serves as a space to inform community members of updates on the FIMR program as well as share available supports and resources. An executed agreement with the National Center for Fatality Review Prevention and the Michigan Public Health Institute to help house FIMR data also occurred. A case review system that allows for the capture of data variables that present themselves within Chicago but may not have been captured previously by the FIMR database. The team is using what they learn from families to identify new variables to assess trends over time. This is done with consensus from the review team. In FY21, the University of Chicago FIMR reviewed a total of 20 cases.

 

Southern Illinois Healthcare Foundation FIMR

 

A second FIMR team was established in southern Illinois by the Southern Illinois Healthcare Foundation (SIHF). SIHF implemented the first FIMR program in St. Clair County, identified local factors that associated with fetal loss and infant deaths and developed recommendations to address factors, distributed face masks to pregnant/postpartum and parenting women (COVID-19 prevention), participated in and collaborated with the Illinois Task Force on Infant and Maternal Mortality Among African Americans, participated in and collaborated with I-Promote to develop statewide maternal health strategies, and, in collaboration with local health departments, developed a five-year action plan to reduce infant mortality. During FY21, SIHF FIMR held two case review meetings and examined a total of three cases. The team was also able to develop a Community Action Plan for Safe Sleep, facilitated infant safety and safe sleep environment education, conducted Safe Sleep Champion Training for health care providers, and conducted a Safe Sleep Education Workshop for parents and care givers, case managers, and home visitors. 

 

3-D. Support the Illinois Perinatal Quality Collaborative (ILPQC) in its implementation of obstetric and neonatal quality improvement initiatives in birthing hospitals.

 

Babies Antibiotic Stewardship Improvement Collaborative Initiative

 

ILPQC launched Babies Antibiotic Stewardship Improvement Collaborative (BASIC) initiative to work with hospital teams to implement system changes for Early Onset Sepsis (EOS) risk assessment, identification, and response, and clinical culture change using neonatal/pediatric provider and nursing education, clinical debriefs of newborns receiving antibiotics to improve care, and regular data review to improve care for all newborns at risk for EOS. ILPQC recruited 82 birthing hospitals/children’s hospitals to participate in the BASIC initiative and officially launched in December 2020 with 200 participants attending the first meeting. ILPQC held monthly BASIC team calls and webinars focused on hospitals implementing systems to improve newborn antibiotic stewardship and achieving the two main aims: (1) reduction of babies receiving any antibiotics in the first 72 hours of life and (2) reduction of babies who receive antibiotics for longer than 48 hours with a negative blood culture.

 

ILPQC also worked with hospital teams regarding data collection strategies, data definitions, and QI tools to support work. They also developed a variety of provider and patient education quality improvement tools and resources to help hospital teams implement systems and clinical culture change to improve care for newborns receiving antibiotics including:

• Family education video about antibiotics with accompanying handouts (in English and Spanish).
• Communication tools to help facilitate transfer of information between OB and neonatal units regarding maternal risk for infection and between nursing and physicians on the newborn units regarding infant risk for sepsis and antibiotics.
• Blood culture collection and communication workflows.

 

ILPQC is sharing these strategies and resources with hospital teams to help reduce bias through implementation of standardized processes to provide optimal clinical care to all newborns who receive antibiotics and to equitably engage all parents/families. ILPQC also reorganized the BASIC toolkit to support team efforts to locate key resources for implementation of strategies. Resources and updates can be viewed on ILPQC’s BASIC webpage: https://ilpqc.org/basic2021/.   

 

See Women’s/Maternal Health Domain strategy 2-I narrative for additional activities.

 

3-E. Collaborate with partners to support statewide efforts to improve breastfeeding outcomes and reduce disparities.

 

The OWHFS continues to participate on a collaborative project known as the Illinois State Physical Activity and Nutrition Program (ISPAN) that began in early 2019. This project aims to build on the accomplishments made already in physical activity and nutrition policy, systems, and environmental change. The purpose of this collaborative program is to reduce chronic disease and to increase the health and well-being of Illinoisans by reducing disparities. This work focuses on equitable and just opportunities for people to practice healthy eating habits and to be physically active. Specific to OWHFS is the work that aims to increase the number of places (e.g., pediatric/ family practices, WIC sites) that implement supportive breastfeeding interventions. In partnership with DHS, a learning collaborative was convened utilizing seven regional breastfeeding task forces across the state. In addition, DHS provided scholarships for WIC staff to become certified lactation consultants or specialists. DHS, through the U.S. Department of Agriculture Operational Adjustment grant, offered scholarship opportunities for community partners to attend these WIC breastfeeding trainings, with the goal of increasing access to lactation support professionals (CLC/CLS/IBCLC) with similar lived experiences among rural, Black/African American, and Latina women.

 

In addition, Title V collaborated with the Illinois Public Health Institute (IPHI) to create the Enhancing and Expanding Breastfeeding – Illinois (EEB) program. This program launched in July 2021. The program seeks to promote the positive state trends of increasing breastfeeding initiation and exclusive breastfeeding at six months rate. The specific objectives of the EEB program include improving the continuity of care and support for breastfeeding throughout Illinois, enhancing workforce development through training and the creation of tools for health care professionals who provide services to pregnant individuals, and developing and implementing programs that promote health equity in lactation support.

 

The Maternal Infant and Early Childhood Home Visiting (MIECHV) program which is housed in DHS’s Division of Early Childhood (IDHS-DEC), also partners with IPHI on various breastfeeding initiatives. In FY21, MIECHV and IPHI collaborated on a survey of home visitors to identify training needs and preferences. Over 500 home visitors across the state participated in the survey. Results of the survey indicated that the majority of home visitors need additional follow-up trainings on breastfeeding, including guidance on becoming Certified Lactation Counselors or Specialists.

 

3-F.  Partner with the Illinois Department of Corrections (DOC) and two state women’s correctional centers to support ongoing health promotion activities for incarcerated women and staff training, and to ensure women and babies receive Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services while residing in DOC facilities.

 

See Women’s/Maternal Health Domain strategy 1-B narrative for details.

 

3-G. Support and collaborate with the Illinois Task Force on Infant and Maternal Mortality Among African Americans to assess the impact of overt and covert racism on pregnancy related outcomes, identify best practices and effective interventions, address social determinants of health, and develop an annual report with recommendations to improve outcomes for African American women and infants.

 

See Women’s/Maternal Health Domain strategy 2-D narrative for details.

 

3-H. Provide support to pregnant women at risk for poor birth outcomes through an array of case management and home visiting programs by the Illinois Department of Human Services (DHS) Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, and ensure these DHS programs align with Title V priorities.

 

Home Visiting

 

During FY21, IL Title V supported home visiting through multiple activities. One activity consisted of the Title V director serving on the Illinois Home Visiting Task Force of the Illinois Early Learning Council, which was co-chaired by Start Early (formerly known as the Ounce of Prevention Fund). This task force consisted of individuals representing state agencies and private sector health, early childhood, and child welfare organizations, as well as providers, researchers, and advocates. The task force worked with the Governor’s Office of Early Childhood Development to continue to advance the quality, quantity, and coordination of home visiting services across the funding streams and relevant departments and served as the strategic advisory body for the MIECHV grant.

 

Title V continues to connect MIECHV and home visiting programs to other partners for collaboration and support (e.g., Task Force on Infant and Maternal Mortality Among African Americans). While the CDPH Nursing and Support Services under the mini-Title V grant are largely focused on maternal and infant health, CDPH’s home visiting nurses provide support, guidance, and referrals for families who need assistance and services for older children. Examples include referrals for day care and pre-K programs, pediatricians, early intervention, and benefit programs like Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP).

 

Specific Title V and MIECHV Activities:

 

While Title V does not provide any direct funding to MIECHV, the two programs attempt to align common strategies and participate in each other’s initiatives. For example, MIECHV’s project director is a member of the CDPH Family Connects Chicago community advisory board, which supports planning and expansion of this universal newborn service model. MIECHV funds Family Connects in two other at-risk communities (See strategy 3-I for more detail on Family Connects). In addition, DHS disseminated the Healthy Choices, Healthy Futures perinatal education toolkit to the MIECHV home visiting programs. The Healthy Choices, Healthy Futures is an EverThrive Illinois project supported by Title V (See strategy 1-A for more detail on the toolkit).

 

Illinois MIECHV also collaborates with the Illinois’ HRSA-funded State Maternal Health Innovation Grant, I PROMOTE-IL, led by the University of Illinois at Chicago. Leadership participated on the project’s Maternal Health Task Force and contributed to the development of its strategic plan which called for examining and expanding maternal health training for home visitors. MIECHV also collaborated with the I PROMOTE-IL team to conducted key informant interviews with select MIECHV sites. These interviews provided insight into home visitors’ past training on maternal health and helped to identify additional training needs. It was determined that home visitors wanted more training on maternal health warning signs and chronic conditions that affect maternal health. During FY21, I PROMOTE-IL developed the training outline with input from MIECHV and contracted with Start Early to create the training as part of the state’s home visiting professional development system. In addition, I PROMOTE-IL worked with MIECHV and its data partners to confirm the evaluation plan and data exchange for the training. The training curriculum is near completion.

 

Another Title V initiative that benefits from the participation of MIECHV is the Task Force on Infant and Maternal Mortality Amongst African Americans (IMMT) (See strategy 2-E for more detail on IMMT). MIECHV’s MCH nurse consultant serves as a co-lead for the IMMT Systems subcommittee and the MIECHV Strategic Planning Administrator is an active member of the Programs and Best Practices subcommittee.

 

Illinois - Early Childhood Comprehensive Services (IL-ECCS) grant

 

DHS has received an Early Childhood Comprehensive Services (ECCS) grant from HRSA. The purpose of the grant is to build integrated maternal and early childhood systems of care that are equitable, sustainable, comprehensive, and inclusive of the health system, and that promote early developmental health and family well-being and increase family-centered access to care and engagement of the prenatal-to-3 years old (P–3) population.

 

DHS and its partners seek to:

1. Enhance the P-3 statewide maternal and early childhood system of care by establishing a Universal Newborn Supports System (UNSS) that better connects moms and babies to programs and services.
2. Work across state agencies to establish a clearly aligned and sustainable infrastructure to support a stronger and more efficient and effective P-3 system.
3. Align policy, data, and financing mechanisms to support and to sustain a coordinated comprehensive P-3 system.

 

IL Title V supported the development of the grant and has representation on the IL-ECCS Cross Sector Advisory Committee/Care Coordination Committee. This committee will provide advice on the project and recommend strategic directions, policy, and financing changes.

 

Other DHS perinatal/infant activities supporting Title V

 

Better Birth Outcomes. DHS contracts with local health departments, community-based agencies, and FQHCs to provide intensive prenatal case management services, known as the Better Birth Outcomes (BBO) program, to high-risk pregnant women in defined geographic areas of the state with higher-than-average Medicaid costs associated with poor birth outcomes and higher than average numbers of women delivering premature infants.

 

During FY19, 85% of women who participated in the BBO program began prenatal care in their first trimester and 94% of the women were active in the Medicaid program. Approximately, 68% of the BBO participants received adequate prenatal care per the Kotelchuck Index and 66% received counseling on reproductive life planning. It is estimated that 60% of the participants in BBO received contacts monthly during their pregnancies and 44% received a home visit in each trimester. Thirty-eight percent (38%) of women in BBO initiated breastfeeding. Staff reassessed birth data to ensure the program is continuing to be offered in the areas of highest need. Title V funding for this program ended in FY19.

 

Family Case Management. Family Case Management (FCM) is a statewide program administered by DHS that provides comprehensive service coordination to improve the health, social, educational, and developmental needs of pregnant women, and infants (0–12 months) from low-income families in the communities of Illinois. Assistance in obtaining health and human services which promote healthy growth and development are provided to low-income families and high-risk infants as mandated in the Illinois Family Case Management Act and Maternal and Child Health Services Code. Agencies contracted with DHS to perform FCM activities perform assessments of client needs, provide linkage with Medicaid and primary medical care, refer clients for assistance with identified social needs, and coordinate care through face-to-face contacts and home visits at regular intervals throughout pregnancy and the infant’s first year of life.

 

DHS High-Risk Infant Follow-up Program. The High-Risk Infant Follow-up Program is a case management program administered by DHS. Based on eligibility established by the Adverse Pregnancy Outcome Reporting System (APORS), the Illinois birth defect registry housed in IDPH’s Division of Epidemiologic Studies, public health nurses in local health departments provide follow-up home visiting services. There is a direct connection between high-risk follow-up and numerous programs, such as WIC, Primary Care, Early Intervention, Perinatal Follow-up, and others depending on the needs of the family. Infants are followed until 24 months of age unless a complete assessment and the professional judgment of the nurse case manager indicate that services are no longer needed. In FY20, there were a total of 680 clients active in the High-Risk Infant Follow-up Program aged 24 months or younger.

 

3-I. Support the Chicago Department of Public Health (CDPH) in implementation of Family Connects Chicago to ensure nurse home visits for all babies and parents immediately following birth and linkage to a network of community supports to assist with longer term, family identified needs.

 

Title V has continued to support universal home visiting. Initially, a pilot for universal newborn home visiting (Universal Newborn Support System Pilot) was coordinated by the Ounce of Prevention Fund (now known as Start Early) and was championed by former Illinois first lady Diana Rauner, who co-chaired the home visiting committee of the Early Learning Council (ELC). The pilot included two working pilot sites in Illinois where every woman receives a home visit to assess maternal and child health and well-being after a baby is born. One site was in Stephenson County and the other was in Peoria. This pilot morphed into the Illinois Family Connects program.

 

Family Connects is a community-based, universal program for parents of newborns, regardless of income or socioeconomic status. The support provided by the program includes physical assessments of the birthing person and the baby as well as screening for social determinants of health to help identify and to connect with supportive resources from which any new family may benefit. As part of its mini grant from Title V, CDPH developed and implemented a Family Connects pilot program in FY19. Activities included designing the community alignment function of Family Connects, building relationships with partner hospitals, training a nursing team on the model, and engaging an evaluation team to measure impact and to conduct an implementation study to inform plans to bring the pilot to scale. Families that participated were linked to care and provided parenting support, support for a safe home, and education, tools, and resources about maternal and infant health.

 

During FY21, CDPH continued to implement its Family Connect program. It used NowPow to provide the public facing search tool for resources and services on the Healthy Chicago Babies website (now OneChiFam), participated on EverThrive Illinois’ Contraceptive Justice Coalition to assist and support the development of improved polices for birth control access, and continued to educate women participating in the nursing and support services program on birth control options. CDPH also worked with nursing schools to offer rotations through the Family Connects program which allowed students to shadow and work with public health nurses.

 

During FY21, CDPH also launched three of the six Community Alignment Boards (CAB) for Family Connects (FC) that reflect the unique needs of the communities they serve. Continued work with the Citywide Advisory Council that acts as an advisory board for our Family Connects pilot and expansion.

Family Connects nurses screen birthing people for postpartum depression and substance abuse. When a need is identified, they are referred to services in the community for support. Family Connects also worked with CABS to identify relevant services and/or where gaps continue to exist. Data was monitored from visits to identify where families are referred and if they are connecting to those services.

In addition to Family Connects, CDPH continues to update and support OneChiFam and the resource page. The website is tailored to both providers and Chicago residents.

 

Another noteworthy strategy to address the Infant and Perinatal Health Domain priority:

 

IDPH’s Newborn Screening section ensures population-based metabolic and hearing screening for Illinois newborns

 

Universal newborn blood spot screening is offered through the IDPH Newborn Screening Laboratory and Follow-up Sections (NBS).  All Core RUSP conditions are included in the Illinois newborn screening panel. This includes mucopolysaccharidosis type II (MPS 2). In CY2021, there were 128,894 live births in Illinois and 129,189 babies screened. When including duplicate samples for babies requiring repeat screens and follow-up, a total of 154,396 newborn blood spot screening specimens were processed for 2021 births. Of the 154,396 screenings, 6,775 (5.24%) babies had a presumptive positive screening for at least one of the Core RUSP conditions and those babies were referred for further testing. Of those referred for testing, 298 (4.40%) were confirmed as having at least one Core RUSP condition and those babies were referred for treatment. Newborns diagnosed through newborn screening are followed annually through fifteen years of age with staff of the Newborn Screening Program contacting the pediatric sub-specialist to verify compliance with treatment and to monitor growth and developmental milestones. If needed, cases are referred to a local public health nurse to provide family assistance.

 

Currently, no screening data or reports of diagnosed cases of newborns with a critical congenital heart defect are reported to the Newborn Screening Program, however families of all newborns with such a diagnosis are reported to the Adverse Pregnancy Outcomes Reporting System (state birth defects registry), which provides periodic follow-up by a public health nurse through two years of age.

 

The IDPH Early Hearing Detection and Intervention (EHDI) Program provides tracking, monitoring, and referrals for Universal Newborn Hearing Screening for infants born in Illinois. During 2021, 127,197 out of 128,894 (98.68%) infants reported to the EHDI program received inpatient hearing screening prior to hospital discharge, 486 (0.38%) died prior to testing, and 1699 (1.32%) were not screened prior to discharge. Of those screened, 4,532 (3.58%) referred for further testing. Of all infants tested and reported, 347 (incidence of 2.7/1000) were documented as having a permanent congenital atypical hearing status. All newborns identified with atypical hearing are referred to Part C/ Early Intervention services and to the state Children with Special Health Care Needs Program (through UIC-DSCC) that offers ongoing follow-up services.

 

Other notable works of the Newborn Screening Section includes:

• The EHDI program dropped the lost to follow-up at time of diagnosis rate from 27% in 2020 to 19% in 2021.
• Submitted updated Administrative Rules for the Newborn Screening Program
• Submitted updated Early Hearing Detection and Intervention Act Rules to JCAR Administrative Rules for Public Act 099-0834.
• EHDI executed a business agreement collaboration with Illinois Hands and Voices, Guide By Your Side. This will allow the program to infuse the voice of parents into program and system development.
• EHDI completed the first annual report highlighting program activities:
• The EHDI Program began work with the National Center for Hearing Assessment and Management to update the Newborn Hearing Screening Training Curriculum online screener training to match the 2019 Joint Committee on Infant Hearing Statement. It also began work with the National Center for Hearing Assessment and Management to create the Virtual Site Visit Program, which was supported by CARES Act funding, to complete online and virtual meeting site visits that supports policies and procedures for newborn hearing screening.
• The EHDI Program translated parent materials into the top ten languages in Illinois
• The EHDI Program began a quantitative analysis of screening, diagnosis, and intervention data to identify potential disparate populations.