About the National Neonatal Audit Programme (NNAP)

The NNAP supports professionals, families and commissioners to improve care provided by neonatal services who look after babies born too early, with a low birth weight or who have a medical condition requiring specialist treatment.

About

Established in 2006, the National Neonatal Audit Programme (NNAP) is commissioned by the Healthcare Quality Improvement Partnership (HQIP). The NNAP is funded by NHS England, the Scottish Government and the Welsh Government, and is delivered by the RCPCH. We are currently contracted to deliver the NNAP to the end of March 2025.

The NNAP assesses whether babies admitted to neonatal units in England, Scotland and Wales receive consistent high-quality care. We identify areas for quality improvement in relation to the delivery and outcomes of care.

Privacy statement

The NNAP has section 251 approval to collect patient identifiable data without explicit patient consent. This data is processed and reported by the NNAP team at RCPCH, with HQIP (Healthcare Quality Improvement Partnership) and NHS England as the joint data controllers.

HQIP may approve the sharing of pseudonymised NNAP data for the purpose of academic research if stringent data protection policies and arrangements can be demonstrated by requestees and the aims of the research are approved.

Further information about how data collected for the audit is used and the NNAP privacy notice, can be found on the National Neonatal Audit Programme privacy notice - Your baby's information page

What we measure

The audit reports on key measures of the process and outcomes of neonatal care and supports professionals, families and commissioners to improve the care provided to babies requiring specialist treatment. In particular, we report outcomes of neonatal care, measures of optimal perinatal care, maternal breastmilk feeding, measures of parental partnership, neonatal nurse staffing, and other important care processes.

The NNAP Project Board conducts a regular review of the NNAP dataset and audit measures in close consultation with the wider neonatal community, taking note of the publication or amendment of any relevant professional guidance and/or standards.

 The NNAP project team notifies participating neonatal networks and units of any changes to the audit dataset, prior to those changes being implemented.

The full NNAP data dictionary can be downloaded below.

2022 audit measures

We have made a number of changes to the audit measures to be reported for 2022 data, summarised below. We’ve made these changes to align as closely as possible with other measurement programmes, and in particular MatNeoSIP, and in line with current guidance and guidelines. We have also changed the cohort of babies included for some of the measures to improve the timeliness and frequency of reporting.

Key changes for the 2022 data year:

  • The new measure of antenatal steroid administration looks at whether eligible mothers receive a full course of antenatal corticosteroids within 1 week prior to delivery.

  • The measure of birth in a maternity service on the same site as a NICU has been expanded to include babies born at less than 800 grams or born as a multiple at less than 28 weeks as well as all babies born at less than 27 weeks gestational age.

  • The upper gestational age cut-off for the measure of deferred cord clamping has been increased from less than 32 weeks to less than 34 weeks gestational age.

  • A new measure of type and duration of respiratory support has been introduced, answering the question ‘What proportion of babies born at less than 32 weeks gestation only receive non-invasive respiratory support* during the first week of life? ‘

  • The measure of on time ROP screening has been updated in line with the new screening guideline published in March 2022.

  • A single measure relating to nurse staffing will be reported, as follows: ‘What proportion of nursing shifts are numerically staffed according to guidelines and service specification?'

  • A new measure of breastmilk feeding will be introduced, to align as closely as possible with the MatNeoSIP intended measure of breastmilk feeding in the first 24 hours of life, taking into account the constraints of available data. We will continue to report rates of breastmilk feeding at 14 days and at discharge, but the gestational age cut-off will be increased from less than 32 weeks to less than 34 weeks.

  • The inclusion criteria for the following measures has changed from babies discharged within the calendar year to babies first admitted during the calendar year; antenatal steroids, antenatal magnesium sulphate, birth in a centre with a NICU, deferred cord clamping, temperature on admission, type and duration of respiratory support (new measure), parental consultation within 24 hours of admission, breastmilk feeding within 2 days (new measure).

For more information about these changes, and all other measures within the 2022 data year, download the guide to the 2022 audit measures below.

Audit measures from previous years

You can download guides to the audit measures from 2014 to 2021 below.

Data flow

A diagram describing the flow of English and Welsh data in the NNAP can be downloaded below.

Outlier management policy

The NNAP manages outliers according to the NNAP: Detection and management of outlier status for 2020 data policy and in line with HQIP guidance for the detection and management of outliers in England and Wales. The NNAP outlier management policy for 2020 data is available to download below.

Trust quality account information

The National Neonatal Audit Programme is included in the NHS England Quality Accounts list, which is available from the Healthcare Quality Improvement Partnership (HQIP) website.

HQIP also publishes the National Clinical Audit and Enquiries Directory which should answer most of your questions relating to the NNAP.

All neonatal units in England, Wales and Scotland are eligible to participate in the NNAP. The audit expects 100% case ascertainment from participating units. To find the list of participating units for the latest published year of results, please see Appendix A NNAP 2020 data results and methods.

The table below summarises NNAP data collection periods and expected report publication dates.

Data collection period

Expected annual report publication date 

1 January 2021 to 31 December 2021

November 2022

1 January 2022 to 31 December 2022

November 2023

1 January 2023 to 31 December 2023

November 2024