National Neonatal Audit Programme report shows high variation in mortality rates across units

Posted on November 09, 2022

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The National Neonatal Audit Programme (NNAP) report has shown that access to high-quality neonatal care is not consistent across units and networks in the UK.

The 2022 report, published today, collects and analyses data relating to babies discharged from neonatal units between January and December 2021.

The audit shows that mortality rates remain high and that there are unacceptable variations between units across the country. It also highlights the importance of sharing learning, undertaking multi-disciplinary reviews and using quality improvement to improve all aspects of care.

In 2021:

  • 6.4% of very preterm babies (those born before 28 weeks of pregnancy) born between July 2018 and July 2021 died before discharge home, ranging from 4% to 8% between networks. In 2020, this was 6.3%.
  • Observed mortality varies two-fold, from 4% to 8%. Among babies born between 24 and 27 weeks gestational age, this ranges from 7.8% to 19.3%.
  • 78.9% of babies born at less than 27 weeks were born in a centre with a NICU on-site, ranging from 67.6% to 86.3% between networks. This was 70.6% in 2020.
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The report also recorded the proportion of ward rounds with parents present, the first time this data has been collected. While it is positive that in 85.8% of admissions a parent was present on a ward round at least once during their baby’s stay, the proportion of ward rounds with at least one parent present was only 44.1%. This shows that there is much more to do to embed parent attendance at ward rounds consistently.

At Bliss we know that babies have better outcomes and quality of life when their parents are caregivers on the unit, and that units must get back to pre-pandemic levels of parental involvement in their baby’s care. The audit has recommended that each ward round with a parent present is recorded to improve the delivery of care.

Caroline Lee-Davey, Chief Executive of Bliss, said:

“It is incredibly concerning that there continues to be such significant variation in outcomes for babies in neonatal care. Most notably, there is a serious variation in mortality rates, which echoes findings of other recent reports such as the MBRRACE Perinatal Mortality Report (Oct 2022).

"Combined with the report released today highlighting an increase in maternal mortality, this reinforces the need for an urgent re-commitment to the National Ambition to halve rates of maternal and neonatal mortality, as well as rates of stillbirth and brain injury at birth, to drive sustained improvement in care for both mothers and babies.

“Overall this report highlights clear opportunities to deliver significantly improved outcomes for babies. Bliss urgently calls on the government and the NHS to tackle this variation to ensure that all babies in neonatal units across the country receive the best quality care.”

You can read the full report here