NNAP publishes latest report on neonatal care across England and Wales

The National Neonatal Audit Programme (NNAP) has published its latest report on the delivery of care by neonatal services in England and Wales between January and December 2021.

The NNAP Summary report on 2021 data shows wide variation across individual units and networks in rates of key outcomes of neonatal care and neonatal nurse staffing levels.

Established in 2006, the NNAP is an ongoing audit that assesses whether babies requiring specialist neonatal care receive consistent high quality treatment. It is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and is delivered by RCPCH.

The NNAP annual report on 2021 data found that variation in rates of key outcomes of neonatal care remains wide and concerning across neonatal services, including mortality rates varying between 4% and 8% across networks. Among babies born between 24 and 27 weeks gestational age, this ranges from 7.8% to 19.3%. Additionally, the NNAP report published today shows that:

  • In 2021, 1% fewer babies were delivered in the most appropriate maternity unit compared to 2020, following a pattern of year-on-year improvement since the introduction of the related audit measure in 2017. 
  • Rates of breastmilk feeding at discharge from neonatal care remain static (60.6% in 2021; 60.1% in 2020). Breastmilk feeding rates at 14 days of age are higher (80.5%) than at discharge (60.6%), but this is still a 1.7% reduction compared to 82.2% in the first year of reporting in 2020.
  • Neonatal nurse staffing levels have deteriorated with 26.1% of nursing shifts not meeting recommended levels in 2021 compared to 21.4% in 2020. In Neonatal Intensive Care Units (NICUs), which provide the care for babies requiring the highest level of support, 42.3% of shifts did not meet recommended staffing levels. Wide unit and network level variation exists in the achievement of recommended nurse staffing levels. 
  • In 2021, 95.4% of eligible babies received on time screening for retinopathy of prematurity (ROP), a condition which affects the blood vessels at the back of the eyes and can lead to loss of vision.

The variation in rates of mortality is should be considered in light of the findings from the Child Mortality and Social Deprivation report published by National Child Mortality Database Programme last year. It found a clear association between the risk of child death and the level of deprivation. More specifically, it states that over a fifth of all child deaths might be avoided if children living in the most deprived areas had the same mortality risk as those living in the least deprived. 

RCPCH’s child health inequalities position statement states that health inequalities are the avoidable, unfair and systematic differences in health outcomes between different groups of babies, children and young people. Continuous evidence shows that the health impacts of growing up in poverty are significant and follow children across their life- and beginning from birth. Health inequalities are driven by the social, economic, and environmental factors in which individuals live.

The NNAP report indicates a need and opportunity to deliver significantly improved outcomes for babies if the poorest performing networks across each measure improved to the performance of the best performing. However, what is most clear is the role poverty and deprivation play in driving health equalities in babies, children, young people, and their families. Concerted effort is needed, now, to tackle this and can begin with the Government’s publication of the Health Disparities White Paper.

Professor Paul Dimitri, RCPCH Vice President for Science and Research, said:

“It is fantastic to see the NNAP report published today with its focus on driving improvements in the care of neonates. The report identifies clear opportunities for faster adoption of life saving clinical practices such as deferred cord clamping. RCPCH urges units and networks around the UK to use the NNAP data to support their efforts to enhance clinical care and reduce inequalities in health outcomes.

“The report also identifies marked regional variation in the delivery of care – including worrying differences in mortality. It is very concerning that rates of infant mortality are so much higher among the most deprived fifth of the UK compared to the most affluent. RCPCH recognise that prematurity is the main contributor to this difference in mortality and note with interest the renewed vigour with which quality improvement activity is targeting improvements in care for babies born preterm.

“Action to tackle the growing inequality that leads to poorer health outcomes for children from birth is imperative. The Health Disparities White Paper should be published without delay and Government must ensure it includes a specific focus on children and young people.”


Read the NNAP Summary report on 2021 data.