Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009–2014

Hopkins Leisher, Susannah, Teoh, Zheyi, Reinebrant, Hanna, Allanson, Emma, Blencowe, Hannah, Erwich, Jan Jaap, Frøen, J. Frederik, Gardosi, Jason, Gordijn, Sanne, Gülmezoglu, A. Metin, Heazell, Alexander E. P., Korteweg, Fleurisca, Lawn, Joy, McClure, Elizabeth M., Pattinson, Robert, Smith, Gordon C. S., Tunçalp, Ӧzge, Wojcieszek, Aleena M. and Flenady, Vicki (2016) Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009–2014. BMC Pregnancy and Childbirth, 16 . doi:10.1186/s12884-016-1071-0

Author Hopkins Leisher, Susannah
Teoh, Zheyi
Reinebrant, Hanna
Allanson, Emma
Blencowe, Hannah
Erwich, Jan Jaap
Frøen, J. Frederik
Gardosi, Jason
Gordijn, Sanne
Gülmezoglu, A. Metin
Heazell, Alexander E. P.
Korteweg, Fleurisca
Lawn, Joy
McClure, Elizabeth M.
Pattinson, Robert
Smith, Gordon C. S.
Tunçalp, Ӧzge
Wojcieszek, Aleena M.
Flenady, Vicki
Title Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009–2014
Journal name BMC Pregnancy and Childbirth   Check publisher's open access policy
ISSN 1471-2393
Publication date 2016-10-05
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/s12884-016-1071-0
Open Access Status DOI
Volume 16
Total pages 17
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2017
Language eng
Formatted abstract
Each year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization’s development of a new global approach to classifying perinatal deaths.

A systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region.

Eighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35–.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible.

The plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system.
Keyword Stillbirth
Neonatal death
Perinatal death
Classification system
Cause of death
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Article number 295

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Mater Research Institute-UQ (MRI-UQ)
UQ Centre for Clinical Research Publications
HERDC Pre-Audit
Admin Only - School of Medicine
School of Medicine Publications
Admin Only - UQCCR
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 5 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 5 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Fri, 28 Oct 2016, 20:16:42 EST by Ms Hanna Reinebrant on behalf of UQ Centre for Clinical Research