Audit drives improvements in neonatal care

Published: 02 Jul 2025

Data from the National Neonatal Audit Programme (NNAP), commissioned by the Healthcare Quality Improvement Partnership (HQIP), shows a significant improvement in the adoption of a life-saving intervention for preterm babies. The audit has played a vital role in identifying neonatal care providers with lower-than-national-average rates of Deferred Cord Clamping (DCC), a practice which is known to reduce mortality.

In 2023, 68.3% of babies born at less than 34 weeks’ gestation in England, Wales, Scotland and the Isle of Man received DCC. In 2022, the proportion was 60.4%, indicating a striking 7.9% improvement in one year. This demonstrates the vital role that clinical audit plays in saving lives, given that evidence shows that DCC may reduce the chance of mortality by around 32%*.

Clinical Lead for the NNAP, Dr Sam Oddie explains: “Deferring cord clamping in preterm babies, as opposed to clamping the umbilical cord immediately after birth is highly recommended, because it has been shown to reduce mortality by approximately a third.”

“The world stopped and nothing else mattered,” Nick and Gemma, parents of baby Allegra

Data from the NNAP shows that adoption of DCC in the UK has previously been very low, at less than 29% as recent as 2020. However, there has been a steady increase since, with the rate expected to be over 70% in 2024 (publication date October 2025). By identifying neonatal networks and units with lower than national average rates, the NNAP has played an important part in supporting this major change in clinical practice, assisting partner agencies and programmes to increase adoption of DCC. Importantly, it can also lead to even further improvements. Dr Oddie shares how: “While UK neonatal clinicians can – rightly – be proud of their evidence-informed change in practice, they should now reflect on occasions when DCC doesn’t seem appropriate. This will support the next stages in researching how it should be delivered, and help to achieve even better outcomes.”

Delivered by the Royal College of Paediatrics and Child Health (RCPCH), the NNAP assesses whether babies admitted to neonatal units receive consistent high-quality care, identifying variation and supporting improvement through evidence-informed change. In addition to neonatal care, the audit also reports on perinatal care, maternal breastmilk feeding, parental partnership, neonatal nurse staffing levels, and other important care processes. The NNAP’s data dashboard is a frequently updated resource for those involved in neonatal and perinatal care (details at the bottom of this article). It provides care providers with monthly-updated results, as well as benchmarking and data cleaning tools. As such, it gives an accurate and up-to-date picture of their performance, enabling early intervention where improvement initiatives are needed.

Evidence shows that DCC may reduce the chance of mortality by around 32%

The NNAP is one of more than 40 national clinical audits and programmes commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of the NHS and other bodies, as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). This unique programme – the largest of its kind in the UK – measures and reports on a variety of clinical disciplines, from asthma to vascular care, and helps to drive local, regional and national improvements in healthcare.

Chris Gush, HQIP’s CEO, commented: “As demonstrated by the NNAP, audit data highlights the changes that will have the greatest impact on patient outcomes. It is critical in ‘lighting the way’ for system leaders and clinicians alike, to understand where to target resources, particularly in these changing times when pressures have never been greater.”

The NNAP’s impact does not stop at improving the adoption rates of DCC. Other reported improvements include a 9.4% increase (between 2022 and 2023) in the national adherence to screening for retinopathy of prematurity (ROP), with 78.4% of eligible babies being screened according to the guideline. There was also 4.1% increase over that same time period of babies born at less than 34 weeks being admitted with a temperature within the recommended range. In addition, their work also focuses on parent partnership in care – reporting that breastmilk feeding at two days of life increased to 62% in 2023, an increase of 13% from 2022.

The importance of these improvements cannot be underestimated. Driven by national clinical audit, they represent not just newborn babies – whose lives have been saved and improved as a result – but also their loved ones. As such, the final word must go to one such family. Nick and Gemma, the parents of baby Allegra, who further underline the importance of improved neonatal care, when they describe the “feeling of how the world stopped and nothing else mattered” when their daughter was born at 31 weeks’ gestation.

* Fogarty, M. et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol. 2018 Jan;218(1):1-18. doi: 10.1016/j.ajog.2017.10.231. Available at: https://pubmed.ncbi.nlm.nih.gov/29097178/

Links to further information on this article

Case studies on DCC

Further information on HQIP

Healthcare Quality Improvement Partnership (HQIP)

Every patient deserves safe, high quality care, and national clinical audits and similar programmes (such as the NCAPOP and the National Joint Registry, both run by HQIP) help to make that happen, by measuring the quality of care across hospitals and services. These programmes collect and analyse data to show what is working well in healthcare, and where improvements are needed. HQIP is an independent, not-for-profit long-term partner of the NHS that is led by the Academy of Medical Royal Colleges and the Royal College of Nursing. More data and quality improvement resources from HQIP.

Further information on NNAP

National Neonatal Audit Programme (NNAP)

The NNAP supports professionals, families and commissioners to improve care provided by neonatal services who look after babies born too early, with a low birth weight or who have a medical condition requiring specialist treatment. For more information on the impact of the NNAP for 2024.

Reports: The NNAP publishes an annual summary, and extended analysis, reports on the previous year’s data. The summary report summarises key messages and national recommendations, based on NNAP data relating to babies discharged from neonatal care in England, Wales, Scotland and Isle of Man for that year. The extended analysis report provides in-depth results and a summary of findings by audit measure, along with next steps and resources. You can find these reports here.

Dashboard: NNAP has two publicly available dashboards:

1) NNAP Online: Report Data, which can be used to:

  • view an overall annual summary report for a chosen neonatal unit or network
  • view and compare the results for specific NNAP audit measures for different units, unit designations or networks
  • view, via the outlier analysis section, whether a result for a unit or network is outside the expected range.

2) Public Access Dashboard, which provides results for each of the 10 NNAP performance metrics as annual rolling averages. Results can be displayed for neonatal units, Integrated Care Systems and Health Boards (Wales and Scotland), and by neonatal network. These results are updated monthly. There is also a Restricted Access Dashboard, for unit and network users to view their NNAP data (access to this resource is limited to participating neonatal units and networks).

Resources for parents & carers: The NNAP also publishes a parent and carer guide to the audit, Your baby’s care. The guide covers the NNAP measures most relevant to parents and carers, as chosen by parents and carers of preterm babies, supported by neonatologists. It includes images and quotes from parents and carers of preterm babies who received neonatal care. We encourage neonatologists and paediatricians to share it with parents. You can find this report here.