Audit urges neonatal hospital partnerships following lack of care improvements

Published: 26 Sep 2016

Experts are urging neonatal units to form partnerships with neighbouring hospitals in a bid to reduce variation and drive up standards of care for very sick babies. The call comes as the latest National Neonatal Audit Programme report (NNAP), published today by the Royal College of Paediatrics and Child Health (RCPCH), found that very little or no improvement had been made over the last year in meeting several important care standards.

The NNAP report, which assesses whether babies requiring specialist neonatal care receive consistent high quality treatment, found that progress had stalled on some measures including ensuring that babies’ eyes were screened to minimise risk of premature visual loss, their temperature management and that parents received timely consultation with a senior member of staff.

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The NNAP report recommends that, by using the new NNAP online reporting tool, launched today alongside the report, neonatal units will be able to identify good practice and form links with other units, and be better equipped to learn from one another and adapt ways of working to improve the levels of care delivered to babies in their own unit.

Commissioned by the Healthcare Quality Improvement Partnership (HQIP), the report which assessed 95,325 admissions of babies across 179 neonatal units in England, Wales and for the first time this year, Scotland*, found that:

  • Hypothermia remains a common problem – 28% of babies (born at less than 32 weeks gestation) had a temperature below the recommended range of 36.5-37.5 degrees
  • The proportion of babies born at less than 29 weeks within the recommended temperature range was only marginally better than in  2014 (52% in 2015 vs 51% in 2014) and levels of admission within this temperature range vary from 11-91% showing huge variation across the country
  • 85% of mothers who gave birth to babies at 24 – 34 weeks gestation received antenatal steroids prior to birth which reduce the chance of breathing problems. This figure remains  unchanged from 2014
  • More than one in 20 babies (7%) did not receive retinopathy of prematurity screening (eye screening) at the recommended time – a figure unchanged from 2014
  • Five networks had on-time screening rates of <90% and were clearly below the average for all networks
  • 58% percent of babies delivered at less than 33 weeks gestation were being fed with their mother’s milk at the time of their discharge from neonatal care; this figure has remained stable since 2012
  • 12% of parents did not have a recorded consultation with a senior member of staff within 24 hours of their baby’s admission to the neonatal unit – adherence to this standard varies widely at unit level ranging from 54-100%.
  • 27% of units achieved a rate of 100% adherence of timely consultation

Dr Sam Oddie, clinical lead for NNAP said:

“Some units are doing remarkably well when it comes to meeting the care standards measured by the NNAP; however there are others that are simply not delivering on these yet. These units need to be looking at improving this.

“100% of babies should have their temperature taken within an hour of birth and the fact this isn’t happening is very concerning. If not monitored closely, low admission temperature can lead to hypothermia and severe illness, so getting this right is essential.

“Solutions to this problem can be remarkably simple. For example, many units use the combination of plastic bags, radiant warmers, hats and warm delivery rooms to maintain a newborn baby’s temperature, and do it very well. Good practice like this needs to be shared.”

Responding to the findings relating to a lack of consultation with parents, Dr Oddie said: “When a baby is admitted to a neonatal unit, it can be a daunting time for parents. Having a doctor speak to them early about what is happening and the support on offer to them is extremely important. 27% of units did this for all their families, showing that there is no excuse for not providing this key element of support for parents. This is something I hope to see improved very quickly.”

The NNAP also found that considerable improvements had been made relating to the recording of vital developmental checks at age two.

Some 60% of babies born at 30 weeks gestation had their two-year follow up appointment compared to 54% recorded in 2014, meaning doctors are better informed to identify any developmental delays and arrange appropriate treatment.

Dr Oddie concluded: “Babies born prematurely do not always reach key developmental milestones so these checks at age two provide a valuable opportunity to identify any potential issues early. This time last year, we were very concerned about the number of children who were not receiving these checks so it is extremely encouraging to see such an improvement in the last 12 months. However all children should be receiving this follow-up service so we must not be complacent – there is still a long way to go.”