National Neonatal Audit Programme Annual Report on 2020 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 and Wales in 2020.
"Olive was born at 29 weeks 3 days by caesarean. This picture was taken post treatment. This was an important milestone for us as Olive finally came off low flow oxygen." Ben Turner, father
Last modified
8 July 2022

Key messages

  • Adverse outcomes (BPD, NEC and infection) vary importantly across neonatal units and networks. For example, the proportion of babies with BPD varies by 11 percentage points between neonatal networks. Adjustment for background variables does not account for geographical variation in rates of bronchopulmonary dysplasia. This likely represents unwarranted variation and an opportunity to change care to improve outcomes.
  • Mortality in very preterm babies varies substantially (from one in 25 babies to one in 12 across neonatal networks) depending on where they are cared for, even when baseline risks are taken into account. This is unexplained.
  • Despite the significant impact of COVID-19 on aspects of healthcare delivery in the period after March 2020, neonatal services have achieved high, and improved, rates of perinatal health promoting strategies such as antenatal steroid administration, antenatal magnesium sulphate administration, normal temperature on admission and birth of extremely preterm babies in a centre with a neonatal intensive care unit. However, variation persists between neonatal units and networks, demonstrating opportunity for further improvement.
  • Deferred cord clamping is an important intervention known to reduce mortality in babies born preterm. Implementation of deferred cord clamping varies greatly between neonatal units and networks – ranging from 7.3% to 60.6% among networks. Implementation also varies by type of neonatal unit, with higher levels of deferred cord clamping in neonatal intensive care units. This is the first year of reporting this audit measure in the NNAP and rates of missing data are significant as well as data varying greatly between services.
  • There has been no significant change in of the proportion of babies receiving breast milk, either at 14 days of age or at discharge from neonatal care in recent years. However, nationally, rates of breastmilk feeding appear to have been maintained despite the COVID-19 pandemic. Low rates of breastmilk feeding, variation by geography in use of breastmilk, and variation within unit types has persisted over time.
  • Restrictions on parents’ access to the neonatal unit imposed in response to the COVID-19 pandemic from March 2020 onwards may have impacted on parental consultation within 24 hours of admission and parents' attendance on ward rounds. The rate of parental consultation has reduced by 1.2 percentage points compared to 2019, and the rate of improvement in parent’s attendance on ward rounds has slowed. However, variation in performance varies widely between neonatal units, and some units have been able to maintain high performance in these measures.
  • Compliance with nurse staffing ratios set out in the service specification for neonatal critical care is improving, both in terms of the total nurse’s element and the qualified in specialty (QIS) element of the specification. However, neonatal networks vary widely in the proportion of shifts staffed according to specification and fall far short of full compliance in both elements. Given the clear link between higher nurse staffing ratios and improved outcomes, nurse staffing remains a serious challenge for neonatal services.
  • The rate of improvement in the delivery of medical follow-up at two years of age has been slow, with a reduction seen in 2020 which may be due to the impact of the COVID-19 pandemic. Wide geographical variation remains in its delivery.

You can download the full report 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. The updated guide to the annual report on 2020 data  is available in both English and Welsh and can be found here

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're developing a slide deck to help neonatal units present their NNAP results to other audiences in an accessible way. This will contain information on NNAP recommendations and further resources.

The NNAP recommendations checklist will enable 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 2020's NNAP measures.

Both resources can be downloaded below.