New reports find concerning variation in rates of neonatal mortality and inconsistent approaches to reviewing perinatal mortality

Posted on December 10, 2020

Bliss responds to the latest MBRRACE-UK Perinatal Mortality Surveillance Report.

The latest MBRRACE-UK Perinatal Mortality Surveillance Report examining perinatal deaths from 2018 has found that while the rate of neonatal mortality has fallen by 11% since 2013, there is still significant work to do to reduce this rate to match the best in the world, including to meet the Government’s National Ambition of achieving a 20% reduction in neonatal death by 2020 and a 50% reduction by 2025 in England.

Key to achieving these targets is to ensure that the widespread and unwarranted variation in neonatal mortality is addressed as a matter of urgency. Findings from the report show:

  • Women living in the most deprived areas had an 80% higher risk of stillbirth and neonatal death compared to women living in the least deprived areas, and that this had not reduced significantly between 2016 and 2018.
  • Asian and Asian British babies had a 59% increased risk of neonatal mortality compared to white babies.
  • Black and Black British Babies had a 45% increased risk of neonatal mortality compared to white babies.
  • Nearly half of all neonatal deaths in 2018 were of babies born extremely premature (before 28 weeks of pregnancy)
  • There is wide variation in the rates of neonatal mortality at Trusts and Health Boards with a Neonatal Intensive Care Unit, with only 17% of Trusts and Health Boards having a neonatal mortality rate within 5% of their comparator group – even when rates had been stabilised, adjusted and deaths due to congenital mortality excluded.

Caroline Lee-Davey, Bliss Chief Executive said ‘’While it is positive to see further reductions in neonatal mortality rates, today’s report highlight just how much more there is to do to meet the National Ambition of halving neonatal deaths in England by 2025.

“The sustained higher risk of neonatal mortality among babies born in the most deprived areas, as well as babies in certain ethnic minority groups, is deeply concerning, and points to ongoing health inequalities which must be addressed as a matter of urgency. We are also concerned at the high levels of variation between Trusts, and we would urge providers to do more intensive work locally to understand why current interventions aren’t working – and what needs to change. “

Today also marks the second publication of findings from the National Perinatal Mortality Review Tool which supports services across the UK to better understand how babies die, to provide answers to families and to share learning to reduce incidences of perinatal death over time. Learning from reviews is vital to understand how to reduce variation and the rate of neonatal mortality, but today’s report has found:

  • Too often, too few staff are involved in the review process, with 17% of neonatal deaths being undertaken by only one or two people rather than a multidisciplinary group.
  • Only 1% of neonatal deaths were reviewed by a group meeting the minimum recommended size
  • While just over 90% of deaths reviewed identified at least one issue with care, only 2% of neonatal death reviews said different care would have likely made a difference to the outcome, representing a significant disparity between the self-assessed PMRT reviews and the confidential enquiries conducted by MBRRACE which found changes in care could have changed the outcome in 78% of intrapartum stillbirths and neonatal deaths. While the MBRRACE enquiries have focused on a narrow population, today’s report states ’this wide disparity is unlikely to be entirely due to the fact that the confidential enquiries reviewed only deaths at term’’

Caroline Lee-Davey added: ‘’Bliss is also disappointed to see so many neonatal death reviews continue to lack the full involvement of neonatal health professionals. Understanding the impact of care a baby receives throughout the whole of their life is critical for driving quality improvement, and preventing more of these tragedies from occurring.

“Today also marks the release of the sobering first report from the Ockenden Review. It is more important than ever that services show their commitment to undertaking objective, thorough, multi-disciplinary reviews to improve their own practice, and to improve the practice of the whole community.”

We're here for you, if you feel affected by the content of this news item please visit our support section. You're not alone.