National Neonatal Audit Programme Annual Report on 2019 data

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, Wales and the Isle of Man in 2019.
There is a baby in an incubator receiving phototherapy and the title: 'NNAP 2020 Annual Report on 2019 data'
Last modified
25 March 2022

Update In March 2022, we published our NNAP annual report on 2020 data.

Key messages

Several key messages emerged from our dataset in 2019:

  • Rates of mortality in very preterm babies (less than 32 weeks’ gestational age) vary widely among the 14 networks, from 4.5% to 9.0%. Variations in case mix do not explain differences in mortality.
  • This audit shows that outcomes, such as bronchopulmonary dysplasia (BPD), necrotising enterocolitis (NEC) and late onset neonatal infection, vary strikingly between neonatal units and networks in a way that is unlikely to be explained by patient characteristics.
  • Improvements in care processes, such as thermoregulation (cold babies experience more complications) and administration of intravenous magnesium sulphate (which improves neurodevelopmental outcomes in the least mature babies) demonstrate the ability of perinatal teams to alter their care in light of published quality improvement objectives. However, unwarranted variation in these and other measures of care persists among neonatal units and networks, which identifies further opportunities for improvement of care. Nurse staffing, in particular,  remains well below nationally agreed desired levels.
  • The proportion of very preterm infants fed with some of their mother’s own milk at the time of discharge has remained persistently low over 5 years, with marked geographical variation.

Update, April 2021

Version 2 of the NNAP 2020 Annual Report on 2019 data was published in April 2021. This version corrects two analytical errors:

The first relates to antenatal steroids, magnesium sulphate, normal temperature on admission, and bronchopulmonary dysplasia results for two hospitals, and was caused by the incorrect assignation of a maternity location. There is no impact on the overall result for these measures.

The second applies a minor analytical revision made to the measure normal temperature on admission, which treats unrecordable temperatures as low, as intended in the NNAP methodology. This affects the results for 21 hospitals, and has a minimal impact on the overall result for this measure.

These corrections do not affect the conclusions or the recommendations made in this report.

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

For parents and carers

Your baby's care is a guide for parents and carers to this report. It covers the NNAP measures most relevant to parents and carers, as chosen by parents and carers of preterm babies, supported by neonatologists. 

Your baby's care also contains images and quotes from parents and carers of preterm babies, who received neonatal care.

We encourage neonatologists and paediatricians to share this booklet with parents.

Find out more and download this guide

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.

Using NNAP online, you can see and download unit and network level data in the form of different charts and posters.

Go to NNAP Online

Slide deck and recommendations checklist

We've again created a slide deck to help neonatal units present their NNAP results to other audiences in an accessible way. This contains information on NNAP recommendations and further resources. 

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 2019's NNAP measures.

Both resources 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.