Health. Rising Infant Mortality: HAS's Ten Recommendations to Reverse the Curve

In France, one in 250 children dies before their ^first birthday. In 2024, a quarter of these deaths occurred on the day of the child's birth. France ranks only ^22nd in Europe for infant mortality, with a rate higher than the European average.

And despite the recommendations and decisions of political authorities, perinatal health indicators are no longer improving.

Between 2011 and 2024, the infant mortality rate increased from 3.5‰ (per thousand births) to 4.1‰ in 2024. This increase is mainly explained by the increase in mortality from 1 to 27 days of life, which increased from 1.5‰ to 2.0‰ over this period. With multiple and sometimes poorly understood causes, it seems urgent to reform the care and management of mothers and newborns.

Following the Court of Auditors and the Senate's information mission on the future of perinatal health in 2024 , it is the turn of the High Authority for Health to address the issue. On Wednesday, May 21, it published a list of 10 recommendations based on a study of 328 serious adverse events associated with care (SAEs) that occurred specifically in newborns between ^March 1, 2017, and May 27, 2024.

As a reminder, since 2017, EIGS have been declared by health professionals, anonymized by the Regional Health Agencies (ARS) and transmitted to the High Authority for Health (HAS).

57% of these dramatic events were deemed avoidable

The main consequences of EIGS were death in 54% of reports, life-threatening in 31% of reports and probable permanent functional deficit (e.g. skin necrosis and neurological sequelae) in 15% of reports. Among the 179 EIGS resulting in death, 42 reports concerned stillborn children (8 cases of fetal death in utero and 34 cases of liveborn children with failure of resuscitation).

Reporters judged that 57% of these EIGS were avoidable or probably avoidable. Among the immediate causes, the HAS cites errors related to obstetric care (particularly lack of monitoring), errors related to care or the organization of care (particularly care-related infections), and medication errors.

"As for the root causes, these are mainly factors linked to the patients (in particular the state of health of the newborn and the mother); to the tasks to be accomplished (incomplete or even absent protocol, or even unknown to the professionals involved in the care); or to the team (lack of communication, difficulties linked to transmissions and alerts)”, adds the HAS.

10 recommendations

It makes 10 recommendations to ensure the safety of babies at birth.

1. systematically ensure the skills (technical and non-technical) of professionals working in gynecology-obstetrics and neonatal pediatrics.
2. ensure access for all healthcare professionals involved to all medical information necessary for the care of newborns and their mothers.
3. combat diagnostic errors (delayed, erroneous, missed or not communicated diagnosis to the patient).
4. better manage high-risk pregnancies and births.
5. improve the management of neonatal resuscitation in maternity wards.
6. better prevent the risks of falls and suffocation of newborns in the maternity ward.
7. systematically respect good practices for decision-making regarding in utero and perinatal transfers.
8. continue to secure drug management and the use of medical devices.
9. strengthen the safety of assisted home births and births in birthing centers.
10. develop the EIGS declaration form and improve the quality of declarations.

The HAS has also introduced new certification criteria for healthcare establishments: the prevention of major obstetric risks and teams to ensure safe care for newborns.