A quarter of extremely premature babies are born in the wrong hospital, report warns

Posted on October 02, 2018

Ambulance Transfer

Bliss has warned that more needs to be done to ensure that extremely premature babies are born at a hospital which is best equipped to properly care for them.

Bliss’ comments come in response to the latest National Neonatal Audit Programme (NNAP) 2018 report which found that one in four babies born at less than 27 weeks gestation was born at a hospital without an on-site neonatal intensive care unit (NICU). Further to this, only two of 15 neonatal networks are meeting their target of ensuring that 85 per cent of babies born before 27 weeks are delivered in centres with a NICU.

Caroline Lee-Davey, Chief Executive at Bliss said: “It is extremely disappointing that opportunities for transfer before birth in complicated pregnancies are being missed. Evidence shows that extremely premature babies born at hospitals with a NICU have the best possible chance of survival thanks to the specialist staff and equipment in place at these units. While it is not always possible for mothers in spontaneous labour to be transferred safely to a hospital with a NICU on-site, there is wide and unacceptable variation across the UK in how often this happens.

“Bliss echoes the recommendations of the report and calls upon neonatal and maternity services to work together as a matter of urgency to address this variation in practice, so that as many extremely premature babies as possible are born in a hospital which is fully equipped to care for them safely.”

The NNAP report also found that some babies admitted into neonatal care might be separated from their parents for longer than necessary. Term babies receiving a low level of specialist care spent an average of 3.2 days in the neonatal unit when separation from their mother was not necessary.

The report recommends that neonatal units with above average numbers of separation days for term, or late preterm babies should consider a revision of their admission or discharge criteria.

Caroline Lee-Davey said: “Babies have the best start in life when they are able to have their parents with them - for term or late preterm babies who need a little bit of extra help after birth, this means being cared for alongside their mother in a post-natal or transitional care ward, rather than being admitted into neonatal care and separated from their parents.

“Research has shown that parental involvement in a baby’s care supports brain development and cognition.[i] Other benefits for parents staying with their babies in hospital playing a hands-on role in their care include improved breastfeeding rates, earlier discharge from hospital, and reduced re-admission rates.[ii] [iii] It is therefore essential that avoidable separation of babies from their parents is closely scrutinised and that processes of admission into and discharge from neonatal care are reviewed.”

[i] Flacking R, Lehtonen L, Thomson G, Axelin A, Ahlqvist S, Hall Moran V, Ewald U, Dykes F. (2012) ‘Closeness and separation in neonatal intensive care,’ Acta Pædiatrica 101:1032–1037

[ii] Flacking et al. (2012) ‘Closeness and Separation’

[iii] O’Brien, K., Bracht, M., Macdonell, K., McBride, T., Robson, K., O’Leary, L., Christie, K., Dicky, T., Levin, A., Lee, S.K., (2013), A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit. BMC Pregnancy and Childbirth, 13(Suppl 1):S12