Neonatal care improving, but key measures show variation in care

HQIP
By: HQIP
Published:

Royal College calls on units to share best practice to further improve care of preterm babies

The latest National Neonatal Audit Programme report (NNAP), published today by the Royal College of Paediatrics and Child Health (RCPCH), shows improvements in care for preterm babies in England, Scotland and Wales, but also reveals variations in service delivery which means many babies are still not getting the care they need.

Commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and patient Outcomes Programme (NCAPOP), the NNAP report assesses whether babies requiring specialist neonatal care receive consistent high quality treatment. It is an annual audit which this year assessed the care given to nearly 100,000 babies, with 98% of neonatal units responding.

To download the full report click here

The report highlights progress on a number of audit measures including ensuring that babies’ eyes were screened to minimise the risk of premature visual loss, maintaining a baby’s temperature within the recommended range, and that parents received a timely consultation with a senior member of the neonatal unit team. Specifically:

• More babies born at less than 32 weeks, 4,868/8,044 (61%) in 2016 compared to 4,537/7,864 (58%) in 2015, have a temperature recorded on admission within the recommended range of 36.5 – 37.5 degrees C
• More babies are being screened on time for Retinopathy of Prematurity 8,597/9,131 (94%) in 2016 compared to 8,226/8,821 (93%) in 2015
• More parents are documented as having a consultation with a senior member of the neonatal team with 24 hours of their baby's admission, 54,442/60,148(90%) in 2016 compared to 51,300/58,077 (88%) in 2015

There are also several examples cited in the report of regional neonatal networks making significant improvements in the year since the last audit, including:

• In Wales, the number of babies born at less than 32 weeks whose temperature is recorded within an hour of admission within the recommended range of 36.5-37.5 degrees C has increased from 166/294 (56%) in 2015 year to 214/318 (67%) in 2016
• Also in Wales, reporting of health data from a 2 year follow up check for babies born at less than 30 weeks has risen from 46/147 (31%) in 2015 to 100/168 (60%) in 2016
• In the Shropshire, Staffordshire and Black Country neonatal network, ‘on time’ screening for Retinopathy of Prematurity improved from 279/319 (87%) in 2015 to 320/325 (98%) in 2016

Dr Sam Oddie, Consultant Neonatologist and the NNAP Clinical Lead, said:

“We’re seeing overall improvements in many areas of care for preterm babies which is obviously really encouraging. The number of units who have made significant improvements to particular aspects of care over a 12 month period is impressive. It shows that progress can be made – and the positive impact on the health of these babies can be huge. For example, admitting babies with a normal temperature seems to reduce the risks to babies in terms of reducing the severity of illness and is certainly one sign that the initial care of the baby went well.”

But despite clear signs of improvement, the audit also highlights a number of areas of neonatal care where there is variation:

• There remains significant variation between regional networks and units when it comes to the necessary support and care that is being given to preterm babies. For example, it is recommended that antenatal magnesium sulphate is given to mothers who are likely to deliver a preterm baby in order to reduce the risk that the baby will later develop cerebral palsy, but administration rates vary from 26% to 70% between neonatal networks
• The number of preterm babies discharged from hospital whilst receiving at least some of their own mother’s breastmilk varies enormously between regions, from 39% to 78%
• Complete two year follow-up of preterm babies remains a problem. Four out of every ten babies born more than ten weeks early had no two year follow up clinical information of any type reported to the NNAP

Dr Oddie added:

“There is no reason why many of these measures could not be achieved far more successfully - paying attention to the clinical processes and working with the whole involved team to improve them are the keys to improvement.

For example, we need a health care system where every baby born very early is followed up at 2 years. However, we know that 40% of babies don't have any clinical information at all recorded about their health and development at 2 years. It simply isn't good enough - babies born more than 10 weeks early do sometimes have important problems with their development, and knowing about this at an early stage helps babies, their families and the health service.

Clinicians sometimes say that their results for two year follow up and other NNAP measures are actually better than what they have recorded in the clinical information system from which the NNAP receives data for analysis. Close review of a units’ own data on NNAP Online will show this is by no means an adequate explanation for the variable performance that we see. Submitting complete data remains vitally important and we hope that audit users will use their own data, and the recommendations that the NNAP has made, as tools to improve their own services."

Dr Oddie concluded:

“Wherever a baby is born and in whichever hospital they are treated, our aim is for the care that they receive to be consistent and of the highest possible quality. There are some networks and units doing certain things exceptionally well and others could learn from them. We undoubtedly need to get better at working together with neighbouring hospitals and, by using the NNAP Online reporting tool, clinical teams are able to identify and contact other units who have demonstrated good practice and hopefully receive information from them which they can apply to their own unit in order to improve care for babies. The RCPCH will continue to work with the departments of health of the three nations to support their improvement plans for neonatal care.”