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Changes in admissions, care processes and outcomes for very and extremely preterm infants in England and Wales: an
Mohammad Chehrazi1,2, Kayleigh Ougham1, Chris Gale1,2
1Section of Neonatal Medicine, School of Public Health, Imperial College London, London, UK.
Insights
Preterm birth rates in England and Wales remain unchanged over a decade, with persistent ethnic disparities. While some care processes improved, clinical outcomes for extremely preterm (EPT) and very preterm (VPT) infants saw only modest gains.
Area of Science:
- Neonatal care
- Public health
- Perinatal epidemiology
Background:
- Preterm birth presents significant public health challenges with long-term consequences.
- National policies in England and Wales aim to reduce mortality, enhance outcomes, and address health disparities.
Purpose of the Study:
- To analyze trends in admissions, care processes, and clinical outcomes for extremely preterm (EPT) and very preterm (VPT) infants.
- To investigate these trends in relation to maternal ethnicity over a decade.
Main Methods:
- Retrospective, population-based cohort study utilizing the National Neonatal Research Database and Office for National Statistics data (2013-2023).
- Analysis of temporal trends in care processes and clinical outcomes using modified Poisson regression, adjusted for gestational age, sex, multiplicity, and birth weight z-score.
Main Results:
- No significant change in overall EPT and VPT admission rates, though admissions for infants born before 24 weeks gestation nearly doubled.
- Mothers of Black ethnicity consistently showed the highest EPT and VPT admission rates.
- Decreased rates of delivery room intubation, respiratory support, and patent ductus arteriosus closure; increased emergency cesarean sections.
- In EPT infants, maternal milk use at discharge increased, while late-onset bloodstream infection, early postnatal transfers, and mortality decreased.
- In VPT infants, severe necrotizing enterocolitis decreased, but survival without major morbidity also decreased.
Conclusions:
- EPT and VPT admission rates in England and Wales have remained stable over the past decade, with persistent ethnic disparities.
- Improvements were observed in some evidence-based care processes, but clinical outcomes demonstrated only marginal advancements.
Introduction:
Preterm birth is a major public health concern with lifelong consequences. National policies in England and Wales aim to reduce deaths, improve outcomes and address disparities. We examined changes in admissions, care processes and outcomes among extremely (EPT) and very preterm (VPT) infants overall and by maternal ethnicity.
Methods:
We conducted a retrospective, population-based cohort study using the National Neonatal Research Database and Office for National Statistics data, covering all National Health Service neonatal units from 2013 to 2023. Temporal trends in care processes and clinical outcomes were estimated using modified Poisson regression. Models were adjusted for gestational age, sex, multiplicity and birth weight z-score. Results are presented as adjusted risk ratios with 95% CIs.
Results:
There were 26 132 EPT and 55 789 VPT admissions, with no significant change in overall admission rates. Admissions of babies born below 24 weeks gestation almost doubled. Mothers of black ethnicity consistently had the highest rates of EPT and VPT admissions. Deliveries by emergency caesarean section increased (EPT: 1.04, 1.03 to 1.04; VPT: 1.02, 1.01 to 1.02). Delivery room intubation (EPT: 0.96, 0.96 to 0.97; VPT: 0.93, 0.93 to 0.93), intubated respiratory support (EPT: 0.99, 0.99 to 0.99; VPT: 0.96, 0.96 to 0.97), and surgical or device closure of patent ductus arteriosus closure (EPT: 0.82, 0.80 to 0.84; VPT: 0.86, 0.81 to 0.92) decreased. In EPT infants, maternal milk uses at discharge (1.01, 1.01 to 1.02) and late-onset bloodstream infection increased (1.03, 1.02 to 1.04) and early postnatal transfers (0.98, 0.97 to 0.99) and mortality decreased (0.98, 0.97 to 0.99). In VPT infants, severe necrotising enterocolitis (0.96, 0.94 to 0.98) and survival without major morbidity decreased (0.99, 0.99 to 0.99).
Conclusions:
Over the last decade, EPT and VPT admission rates in England and Wales have not changed and ethnic disparities remain evident. Delivery of some evidence-based care processes improved, but clinical outcomes showed only modest gains.
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