Neonatal deaths probe seeks doctor from 'outside Scotland'

The review, which has been commissioned by the Scottish Government, is expected to get underway in December.

It is tasked with examining why more newborns than expected died between April 2021 and the end of March this year.

The alarm was raised following two particularly unusual spikes in September 2021 and March 2022, when 21 and 18 babies died.

The expected number, based on pre-pandemic averages, would have been nine and eight.

Neonatal death rates exceeded the upper warning threshold (red dotted line) in September 2021 and March 2022, and was consistently higher than expected (blue dots) for most of 2021 (Source: Public Health Scotland) (Image: PHS)

It was the first time since monthly monitoring began in 2017 that the mortality rate had breached an upper warning threshold, known as the control limit, signalling a potential problem.

Since May this year, the rate has been below average.

The candidate is expected to commit around four to eight hours a month to the investigation, and have experience of perinatal mortality reviews in NHS maternity and neonatal units.

The job advert states: "This Review will hold its first meeting in December 2022 and is expected to conclude within six to nine months. All meetings will be virtual.

"The candidate should be a consultant neonatologist of a least 10 years' standing who is currently working in a NICU outside of Scotland and who is not the subject of an outstanding investigation."

READ MORE: Covid vaccines ruled out as cause of neonatal death spikes - but mothers' vaccination status was never checked 

Covid infections in pregnancy are known to increase the risk of complications such as pre-term birth, which is associated with neonatal mortality.

However, a preliminary investigation into the spikes by Public Health Scotland found "no direct link" to Covid infections in either the mothers or infants, and "no clear increase in occurrence of prematurity".

Chance variation is considered unlikely "given the magnitude and consistency" of the changes.

Internal reports have pointed to issues including Covid-related staff absences as a potential factor, but PHS has come under fire from antivaxxers who have accused the agency of a "cover up" after it emerged that it chose not to check whether any of the mothers whose babies died had been vaccinated against Covid during pregnancy.

The decision was disclosed as a result of a freedom of information request by the Herald on Sunday.

PHS said there was no public health reason to do so given that population surveillance studies show that the vaccines are safe.

It added that “the outcomes of such analysis, whilst being uninformative for public health decision making, had the potential to be used to harm vaccine confidence at this critical time”.

READ MORE: Neonatal deaths investigated at health board facing Fatal Accident Inquiry

Dr Viki Male, an expert in reproductive immunology at Imperial College London, said she understood the position taken by PHS.

She said: "I know from personal experience that grieving families are often targeted by those with an anti-vax agenda, or their stories are used without their permission to push that agenda."

Speaking during a meeting of Independent SAGE - a panel of non-government scientists who advise on Covid - Dr Male said there is no evidence that vaccination in pregnancy is linked to an increased risk of complications.

Dr Viki Male (Imperial College London) (Image: ICL)

She said: "Among 330,000 people vaccinated in pregnancy across eight countries there was no increased risk of any pregnancy problem associated with Covid vaccination.

"We've now followed up enough people who were vaccinated in the first trimester of pregnancy to be confident that there is no increased risk of miscarriage or congenital abnormalities associated with vaccination, as well as no increased risk of things like stillbirth or pre-term birth that we might be worried about later on."

Dr Teresa Kelly, a Scottish consultant obstetrician based in Manchester, said her NHS Trust had had to give high doses of the steroid, prednisone, to expectant mothers who became seriously ill with Covid prior to the vaccine rollout.

"Nearly everybody we gave prednisone to needed treatment for diabetes because it affected their blood sugar," said Dr Kelly.

READ MORE: When even the experts turn antivaxxers, we have a problem

She added that there had been "a lot of disquiet" among medical staff when pregnant women in the UK were initially excluded from the vaccine rollout at a time when it was being given to mothers-to-be in the US and Israel.

UK authorities eventually approved it for use in all pregnant women from April 2021.

Dr Kelly said: "By that time Delta hit and in July 2021 there was a big peak of people getting sick.

"In our own trust we had about six pregnant or recently delivered women in ICU across our three sites and what was upsetting was that some of those women had been eligible for vaccination but weren't vaccinated, and we knew that a lot of people died in that way who could have been protected because they were scared.

"As time went on, everyone I met who had a complication from Covid - a pulmonary embolism or something - said 'I thought I could wait until after I'd had the baby'."