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National Neonatal Audit Programme Annual Report 2019 - on 2018 data

Clinical Standards and Quality Improvement team
This report highlights the key findings and recommendations from the analysis of the data provided by neonatal units on the admissions of babies for neonatal care in England, Scotland and Wales in 2018.
NNAP 2019 Annual report on 2018 data | RCPCH audits | HQIP | "This photo was taken for last year's World Prematurity Day. It is a picture of Henry in his pre-school uniform at two years old holding a picture of himself on the unit. I love this picture because it really demonstrates how far he has come." - Nicki Cooper, mother

Key messages

Several key messages emerged from the National Neonatal Audit Programme's (NNAP's) dataset in 2018, including:

  • Rates of mortality in very preterm babies (less than 32 weeks' gestational age) until discharge home or 44 weeks' post menstrual age, whichever occurs sooner, vary widely by network of care from 4.9% to 9.8% adjusted rate. Adjusting for background characteristics does not explain the variation.
  • Processes such as administration of antenatal magnesium, screening for retinopathy of prematurity and measures of parental partnership in care show widely divergent practices between different neonatal units and networks.
  • Neonatal outcomes such as bronchopulmonary dysplasia, necrotising enterocolitis and late onset neonatal infection vary between neonatal units, in a way that is unlikely to be explained by differing patient characteristics.
  • Nurse staffing levels on neonatal units are below national recommendations. Overall, 64% of shifts (80,642 of 126,240) are numerically staffed according to national guidelines. 44% (37,935 of 86,139) of shifts have sufficient staff qualified in speciality. Only 21 of 53 NICUs had half or more of their shifts with sufficient staff qualified in speciality.
  • Outcomes for very preterm babies are improved when they are cared for in a NICU from birth. 74.3% of babies born at less than 27 weeks' gestational age were born in a NICU. This is a slight improvement on 2017, when the rate was 73.9%. 3 of the 15 neonatal networks achieved the developmental standard of 85%

The NNAP annual report, appendices and line of sight document are available to download below.

Your baby's care

Your Baby's Care is a guide for parents and carers to the NNAP 2019 Report on 2018 data. A Welsh language edition is available.

NNAP Online

NNAP Online is the audit's interactive reporting tool. It can be used to compare performance at a unit, network and national level; supporting neonatal units and networks to share best practice and stimulate quality improvement activities.

NNAP slide deck and recommendations checklist

The NNAP slide deck has been created to help neonatal units to present their NNAP results to other audiences in an accessible way. It contains information on NNAP recommendations, further resources and new measures due to be introduced in 2020.  

The NNAP recommendations checklist enables perinatal teams, neonatal networks, neonatal units and maternity systems to examine their practice to identify areas of good practice and areas that require improvement and begin action planning for quality improvement, relative to their performance against 2018's NNAP measures.

Both resources are available to download below.

NNAP quality improvement case studies

Four examples of quality improvement work against different NNAP measures are available to download below.

Additional data files

As part of our commitment to open data, we have made available our data files on specific measures from the audit.