Has the incidence of hypoxic ischaemic encephalopathy in Queensland been reduced with improved education in fetal surveillance monitoring?

Background: Hypoxic ischaemic encephalopathy (HIE) is secondary to intrapartum asphyxia and the fifth largest cause of death of children under five. Incorrect use and interpretation of intrapartum cardiotocographs has been identified as a contributing factor to the development of HIE. Therefore, RANZCOG introduced the Fetal Surveillance Education Program (FSEP) to improve education and practice of intrapartum care. Aim: To investigate the incidence of HIE throughout Queensland between 2003 and 2011 during the introduction and implementation of RANZCOG FSEP. Methods: The incidence of HIE admissions at each hospital in Queensland (2003-2011) was collated from Queensland Health Statistics Centre. RANZCOG FSEP provided data regarding course attendees throughout Queensland (20062011). Hospitals were grouped into four regions. Statistical analysis was conducted using Stata (TM) (version 12.0) - data appeared to follow a damped harmonic model. Results: The posteducation (2006-2011) HIE rate was significantly lower (P = 0.02) than the pre-education (20032005) rate. The final model predicted a stabilisation of HIE occurrence rate at approximately 160 events/100 000 live births by 2012. This rate was stable if the level of education was maintained but rose back to the initial rate of 250 events/100 000 live births if the education participation was discontinued. Conclusions: This study identified a significant reduction in the incidence of HIE - a potentially life-threatening newborn condition - between 2003 and 2011, during and following FSEP implementation. Notwithstanding the inevitable limitations of state-based data collection, these results are encouraging. For such improvements to be sustained, education must reach all staff engaged in intrapartum care and be regularly repeated.