FRESH concerns about safeguards in maternity units have been raised as a new report reveals major differences in death rates among babies.
The perinatal death rate – for babies at or around the time of birth – is four times higher in some maternity units than in others, the first audit of all 20 public and private centres across the country has found.
At the same time, there is a worrying fall in the number of autopsies carried out on these babies, particularly newborns, to determine the cause of death and extent of disease.
An investigation is needed to find out if this pattern of higher baby deaths in some units continues in the coming years to determine if there are safety concerns, said Paul Corcoran, a senior researcher at the National Perinatal Epidemiology Centre in University College Cork, which carried out the study.
"The figures are small and you can have fluctuations from year to year in the one unit," he said.
"But we will be looking at whether the same units have high rates over a year or two years and why this is the case," Mr Corcoran added.
"While this level of variation is in line with statistical expectations, further investigation is needed to establish the extent to which it reflects differences in the risk profiles of mothers delivered in the units," said the report.
It found there were 491 of these deaths in 2011 with rates in hospitals varying from 1.9 per 1,000 births to 9.1 per 1,000 births.
When babies with fatal birth defects were excluded and only those who could possibly have survived are counted, the death rates again ranged from 1.5 per 1,000 births to 6.6 per 1,000 births.
Although the hospitals and units are not named, the higher rates were not confined to those centres with specialist departments that look after some of the country's sickest babies.
The national audit of deaths among babies of at least 24 weeks gestation or 500 grams in weight was set against a background of 74,265 births.
It follows the report by the patient safety watchdog, the Heath Information and Quality Authority, which raised questions over safety standards in maternity units due to a lack of information, including the failure by eight centres to produce an annual report.
The findings, based on information voluntarily given by the hospitals, revealed:
* The national rate is 6.1 per 1,000 births and this falls to 4.1 per 1,000 when babies with birth defects are excluded. This compares favourably with the UK and Europe.
* Stillbirths, deaths within the first seven days of life and within the first eight to 28 days accounted for most of the fatalities. Major birth defects were the main cause.
* There were 13pc of unexplained stillbirths, while 4pc of women had a previous perinatal death and 7pc had three or more miscarriages.
* Although women who had twins, triplets or other multiple births only made up 4pc, they experienced 13pc of the baby deaths.
* More than one in two of the stillbirths and 40pc of babies who died within seven days were below the normal range for birthweight. Some 6pc of the mothers were admitted to high dependency units and 2pc to intensive care.
There were 269 deaths that did not involve a post-mortem.
More research is needed to explain the decline in post-mortems in the case of neo-natal death.