MBRRACE-UK Perinatal Mortality Surveillance Report and APPG Safe Staffing reports highlight the impact of ethnicity and deprivation on neonatal outcomes

Additionally, with the neonatal death rate falling more slowly overall compared to stillbirth, the pace at which the rates are falling must “be increased significantly” if the National Ambition to halve mortality by 2025 is to be achieved.

The report also found that the neonatal death rate for twins increased between 2016 and 2020, widening the gap between singleton and twin neonatal mortality rates – with the risk of twin neonatal death almost 3.5 times higher in 2020 than for singletons.

Findings from the report show:

• There is significant variation in neonatal mortality rates at Trusts and Health Boards with a Level 3 Neonatal Intensive Care Unit (NICU)

• The largest reduction in neonatal mortality was among babies born between 24 and 27 weeks. There was a slight increase in the mortality rate among babies born between 28 and31 weeks (29.0 to 30.6 per 1,000 live births).

• Neonatal death and stillbirth rates increased with deprivation across all ethnic groups.

• Neonatal mortality rates were over 3 per 1,000 live births for babies of Pakistani and Black African ethnicity from the most deprived areas.

• In terms of socio-economic characteristics, the largest difference in twin and singleton neonatal mortality rates is for the youngest mothers, with the twin neonatal mortality rates as high as 11.4 per 1,000 live births for mothers aged under 20.

• Similarly to singletons, the neonatal mortality rate among twins increases with increasing levels of deprivation.

“Today’s report highlights that the overall reduction in neonatal mortality rates masks unacceptable variation and inequity in outcomes. This is particularly stark when considering the combined impact of ethnicity and deprivation, and the widening gap between the singleton and twin neonatal mortality rates.

“Compared with other ethnicities, babies of Black African, Black Caribbean, Pakistani and Bangladeshi ethnicity are nearly twice as likely to be from deprived areas and therefore much more affected by the higher rates of neonatal death associated with deprivation.

“Given the significant disparities outlined in this report, it is even more concerning that the long-awaited White Paper on health disparities has been dropped.

"There is an urgent need for the Government to refocus on achieving the aims of the National Ambition – and to include analysis of ethnicity, deprivation and other demographic factors to close the inequity in outcomes gap.”

Today also marks the publication of the Baby Loss and Maternity All Party Parliamentary report on the impact of staffing shortages in maternity and neonatal care.

The report shows serious staffing challenges at every stage of the care pathway – from antenatal care through to neonatal care – and that this is having a significant negative impact on the care received by women and babies, as well as the staff caring for them. The findings show:

• Neonatal services are described as stretched, with testimony from staff highlighting instances of doctors and nurses working beyond their hours and in inappropriate roles to manage shortages.

• Staffing shortages can cause delays in incident reporting and can make it difficult for staff to attend learning sessions or read learning resources.

• Families using services are not receiving the support and information they need due to the ongoing pressures caused by the staffing crisis, across the whole pathway.

• Professionals of all levels of experience are experiencing a decline in morale, with many reporting feeling physically and mentally exhausted – and, where wellbeing initiatives and services exist to provide support, these are often inadequate.

The inquiry is based on 102 responses to a call for written evidence. Most of the respondents were staff, followed by service users and organisations.

Caroline Lee-Davey added “Today’s report is deeply concerning with staff burnout posing a real threat to the quality and safety of care provision.

"Respondents reported that a lack of staff means there is a lack of adequate support with breastfeeding and failure to undertake routine observations which are leading to increased readmissions for infection.

‘’Again, we are seeing these issues having a disproportionate impact on babies and mothers from racially minoritised communities.

‘’We fully support the report’s recommendations to ensure maternity and neonatal services have a multi-year fully funded settlement and for funding to be available for the training and development of neonatal staff.’’