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Published on: December 31, 2015
Optimising neonatal service provision for preterm babies born between 27 and 31 weeks gestation in England
Thillagavathie Pillay1,2, Neena Modi3, Oliver Rivero-Arias4
1Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK tilly.pillay@nhs.net.
Insights
This study investigates if neonatal intensive care units (NICUs) improve survival for babies born at 27-31 weeks gestation compared to local neonatal units (LNUs). Findings will guide care recommendations for this vulnerable preterm infant group.
Area of Science:
- Neonatal Medicine
- Perinatal Health Services Research
- Health Economics
Background:
- Evidence supports neonatal intensive care units (NICUs) for extremely preterm infants (23-26 weeks gestation), but optimal care location for moderately preterm infants (27-31 weeks gestation) is unclear.
- This moderately preterm group (12% of English preterm births) accounts for significant neonatal unit resource utilization, including over one-third of all care days.
- Current care for 27-31 week gestation infants is distributed across 45 NICUs and 84 local neonatal units (LNUs) in England, lacking evidence-based guidance on optimal placement.
Purpose of the Study:
- To determine if care in an NICU versus an LNU impacts survival and key morbidities up to age 1 year for babies born at 27-31 weeks gestation.
- To assess if care differences, not just unit designation, drive outcomes, evaluate cost-effectiveness, and understand parent/clinician perspectives on care location.
- To develop evidence-based recommendations for clinical practice, commissioning, and policy regarding the optimal location of care for moderately preterm infants.
Main Methods:
- A mixed-methods study analyzing routinely recorded data from January 2014 to December 2018.
- Data sources include the National Neonatal Research Database, Hospital Episode Statistics, and Office for National Statistics.
- Secondary objectives involve qualitative data on parent and clinician perspectives and cost-effectiveness analysis.
Main Results:
- Analysis of routinely collected data from 2014-2018 is ongoing.
- The study will compare outcomes (survival, morbidity) for infants born at 27-31 weeks gestation based on NICU vs LNU care.
- Parent and clinician perspectives will be gathered to inform the interpretation of quantitative findings.
Conclusions:
- Findings will inform national guidelines on the optimal location of neonatal care for moderately preterm infants (27-31 weeks gestation).
- Recommendations will aim to improve survival and reduce morbidity for this vulnerable population.
- The study seeks to optimize resource allocation and clinical decision-making in neonatal services.
Introduction:
In England, for babies born at 23-26 weeks gestation, care in a neonatal intensive care unit (NICU) as opposed to a local neonatal unit (LNU) improves survival to discharge. This evidence is shaping neonatal health services. In contrast, there is no evidence to guide location of care for the next most vulnerable group (born at 27-31 weeks gestation) whose care is currently spread between 45 NICU and 84 LNU in England. This group represents 12% of preterm births in England and over onr-third of all neonatal unit care days. Compared with those born at 23-26 weeks gestation, they account for four times more admissions and twice as many National Health Service bed days/year.
Methods:
In this mixed-methods study, our primary objective is to assess, for babies born at 27-31 weeks gestation and admitted to a neonatal unit in England, whether care in an NICU vs an LNU impacts on survival and key morbidities (up to age 1 year), at each gestational age in weeks. Routinely recorded data extracted from real-time, point-of-care patient management systems held in the National Neonatal Research Database, Hospital Episode Statistics and Office for National Statistics, for January 2014 to December 2018, will be analysed. Secondary objectives are to assess (1) whether differences in care provided, rather than a focus on LNU/NICU designation, drives gestation-specific outcomes, (2) where care is most cost-effective and (3) what parents' and clinicians' perspectives are on place of care, and how these could guide clinical decision-making. Our findings will be used to develop recommendations, in collaboration with national bodies, to inform clinical practice, commissioning and policy-making. The project is supported by a parent advisory panel and a study steering committee.
Ethics And Dissemination:
Research ethics approval has been obtained (IRAS 212304). Dissemination will be through publication of findings and development of recommendations for care.
Trial Registration Number:
NCT02994849 and ISRCTN74230187.
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