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Audit finds neonatal care 'improving but inconsistencies remain'

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A record number of neonatal units are meeting national care standards, but there remain variations in service provision across the country, the latest national audit has shown.

It found improvements in temperature taking and steroid treatment for premature babies, but also noted continuing concerns about hypothermia and geographical variations in breastfeeding.

The Royal College of Paediatrics and Child Health looked at data on 80,000 babies treated in all 179 neonatal units that were open in England and Wales during 2013.

“There is still work to be done though to ensure that each and every baby who is admitted to a neonatal unit receives the same high standard of care regardless of postcode”

Sam Oddie

It found that in 84% of cases, a documented consultation between parents or a carer and senior member of the neonatal team occurred within 24 hours of admission, a large increase from 56% in a similar audit in 2008.

Meanwhile, 93% of babies born at less than 29 weeks had their temperature measured within an hour of birth – increasing from 89% in 2012.

However, the audit report said hypothermia “remains depressingly common”. It said 12% of babies had a temperature below 36°C, which demonstrated only a small improvement from 16% in 2012, and 41% of babies had a temperature below 36.5°C, compared to 43% in 2012.

The audit report – titled The National Neonatal Audit Programme 2013 – also found a further 5% rise in the number of babies being breastfed when discharged from hospital, up from 54% in 2011 to 59% in 2013.

However, a “striking geographical variation” was identified relating to this type of care.

The report found babies born prematurely in the south of England were more likely to go home breastfeeding than those born early in the north of England. It warned that this increased the chance of those babies born in the north of infection and disease.

Dr Sam Oddie, report author and clinical lead of the RCPCH, said it was encouraging to see a steady rise in the number of premature babies going home breastfeeding.

RCPCH

Sam Oddie

Despite this, he said it was concerning to see the north-south divide in the number of premature babies being breastfed at discharge, and urged all healthcare professionals to support mothers to breastfeed.

“Expressing milk for and then breastfeeding an early baby is hard work for mums, but the benefits it carries, for mum and baby alike, are worth the persistence,” he said.

“We need all healthcare professionals to support mothers to breastfeed. Doing this will not only drive up national breastfeeding rates but more importantly, bridge that gap,” said Dr Oddie.

The audit also showed 87% of eligible babies were screened on time for Retinopathy of Prematurity, a condition that can cause blindness if left untreated.

However, as with 2012, a “significant” number were screened at the wrong time, the report added. It said the data indicated smaller, more mature babies were not always screened.

Dr Oddie added that he was “delighted” at the “rapid improvements” in care shown by the latest audit results, which he said demonstrated that “very nearly all babies” were now getting care that met its audit standards.

“There is still work to be done though to ensure that each and every baby who is admitted to a neonatal unit receives the same high standard of care regardless of postcode,” he said.

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