Our new @JAMANetworkOpen paper https://ja.ma/3qDEO4tAssociation explores impact of unexpected newborn deaths on subsequent obstetric and neonatal care. w/ fave collaborator @maggiemcconnell + superb @handan_lkyspp and @akhadka49. @HarvardChanSPH (1/N)

>7000 full-term infants die each year in US, many in first week of birth. Much of this is SIDS and congenital, but some newborn deaths are preventable with high quality care during childbirth and early neonatal period (2/N)

Unanticipated death of full-term neonate after low-risk pregnancy is an adverse event that should trigger quality/safety review. We use vital stats data and event study analysis exploiting timing of these deaths to see whether provider practice is influenced by these deaths.(3/N)

C-section rates increase (at least initially) following unexpected newborn death, with larger impacts in matched samples and other models. No impact on induction, augmentation, or forceps/vacuum delivery. (4/N)

Newborn assisted ventilation, antibiotics for suspected sepsis and NICU admission increase. (5/N)

Providers responsive to unexpected newborn deaths, increasing C-Section and activities to address newborn complications. Many unknowns...are these events leading to valuable learning about quality gaps? Are they leading to risk-aversion? Concerns about legal action? (6/N)

Most important: can't say whether these changes in provider practice are leading to improvements in patient safety and outcomes. Different data needed for that. But highlights that recent adverse events may be important drivers of provider practice and quality. End