Neonatal audit: doctors express major concern crucial checks missed for premature babies

Published: 05 Nov 2015

Premature babies could be missing out on vital developmental health checks at age two, increasing the likelihood of significant disabilities being missed and specialist care being delayed, says the 2015 annual report of the National Neonatal Audit Programme (NNAP), published today.

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Doctors say the lack of two-year follow-up health data for 46% of premature babies leaving neonatal units in England and Wales raises “major concerns” that disabilities caused by impairments such as cerebral palsy, visual impairment and intellectual developmental delay could be missed, only to become apparent later in their childhood.

The clinical audit is commissioned by HQIP as part of NCAPOP and carried out by the Royal College of Paediatrics and Child Health (RCPCH).

Currently, all preterm babies born more than 10 weeks early should be followed up around two years after their due date, to ensure that they are developing normally. This audit shows that, in many instances, neonatal units may not be doing this or that they are failing to record the details of the two year follow up consultations, even when they have taken place.

The NNAP, which analysed data from over 86,000 newborns in England and Wales requiring neonatal care during 2014, also identified communication worries, with 11% of families not recorded as having a consultation with a senior member of clinical staff within 24 hours of their baby’s admission to the neonatal unit.

Dr Sam Oddie, clinical lead for the NNAP said: “When a baby is born very prematurely, they are born before they are physically ready for life outside the womb. This means they often have health problems, which can extend into childhood.

“To ensure they are developing as they should be, it is crucial that these babies are monitored closely from birth, at least for the first couple of years. So the fact 46% of babies had no developmental data entered at age two, is a major concern. Not only does this create added anxiety for parents about whether their child’s developmental milestones are being met, it also adds pressure to the health service as such children will need to begin a new pathway through the NHS.

“Another cause for concern in findings is the lack of recorded discussions with parents at some neonatal units.

“For a parent of a sick or premature baby, receiving a detailed explanation of their child’s illness and treatment is a much needed comfort in a sad, and often daunting, situation. So whilst the rate of timely consultation with parents has increased over the past two years (89% in 2014 vs 84% in 2013), our audit showed that one in ten families were not recorded as having a consultation with a senior member of the neonatal team within 24 hours of their baby’s admission. This has to change.”

NNAP helps to assess whether babies requiring specialist neonatal care receive a consistent and high level of treatment across hospitals in England and Wales. This year’s findings also highlighted a number of improvements including:

  • 93% of eligible babies were recorded as being screened in a timely way for Retinopathy of Prematurity (ROP) – a condition which if left untreated, can cause blindness – compared to 67% recorded as screened on time in 2012 and 87% in 2013. Whilst this represents a marked improvement in care processes and the recording of relevant data a rate of 100% should be achieved by all units
  • At a national level, 85% of the mothers of babies born between 24 and 34 weeks of gestation were recorded as being given one or more doses of antenatal steroids – needed to increase a premature baby’s chance of survival – rates of administration of antenatal steroids, and the recording of relevant data, have improved considerably since 2008 when the figure was 63%
  • 94% of all babies born at less than 29 weeks gestation were recorded as having had their temperature measured within an hour of birth – up from 78% in 2008
  • An important rise in the number of babies recorded as leaving units being breast fed – with 60% receiving their mother’s milk either exclusively or with another form of feeding, compared to 54% in 2011

In order to encourage improvements in neonatal service delivery and outcomes of care for babies, the NNAP has made a series of recommendations this year. These include:

  • Neonatal follow-up: Specialist Commissioners and Health Boards should ensure that their contractual arrangements with NHS units include adequate arrangements for neonatal follow up in line with current Neonatal Critical Care Service Specifications
  • Neonatal follow-up: Neonatal units should arrange appropriate follow up for babies discharged home two years from their due date, and make arrangements for data capture through (i) identification of eligible babies at discharge, (ii) a mechanism for tracking families through transfer for neonatal care or follow up and change of address, (iii) obtaining information on the reasons for non-attendance of follow up meetings
  • Consultation with parents: Neonatal units with low rates of timely consultation with parents should critically review their processes of both communicating with parents and how they record details of this. They should make contact with other units with better results in order to learn whether there are any particular practices that they might adopt. Units should make use of guidance on parent involvement in their baby’s care which is readily available in the Bliss Baby Charter Standards.
  • Consultation with parents: Neonatal networks should review the consultation rates of their units, and where these are low they should offer targeted support to facilitating and recording communication with parents