Safety of maternity services

While babies may be admitted to neonatal care for many different reasons and not all admissions are avoidable, many admissions could be due to failures in care provided at the different stages of the maternity pathway (i.e. antenatal care, care during and after labour). This measure is included in domain five of the NHS Outcomes Framework (treating and caring for people in a safe environment and protecting them from avoidable harm), with the aim of stimulating reductions in the number of avoidable admissions of full-term babies to neonatal care, and of improving the safety of maternity services overall.

How does the rate of babies admitted to a neonatal unit soon after birth vary over time in England?

The graph captures the number of full-term babies (gestation greater than 36 weeks) admitted within 28 days of birth to a neonatal unit in England, expressed as a percentage of all full-term births. The rate has increased slightly from 6 admissions per 100 full term births in 2011 to 6.1 in 2012. While both these figures represent a substantial increase compared with the rate of 5.1 per 100 full term briths in 2010, that number was calculated based only on the 135 trusts that submitted data in 2010 - as opposed to 161 trusts submitting data in 2012 - so many not be directly comparable. It is also important to note that some babies may be admitted to the paediatric unit rather than the neonatal unit, so these figures could be underestimating the true admission rate.

Updated March 2017.

About this data

This indicator is a rate. Risk adjustment is not necessary at a national level.

In 2010, 135 trusts submitted data for a full calendar year, compared to 159 in 2011 and 161 in 2012. There are neonatal units submitting data for babies who receive neonatal care within a neonatal unit of an NHS trust and units submitting data for babies who receive neonatal care within the neonatal unit and outside the neonatal unit (but still within the same NHS trust). Users are asked to consider these data quality issues when making comparisons between years.

There is approximately a two-year time lag for this indicator, with data for a calendar year typically published in November two years later. This is because the Office for National Statistics (ONS) uses a specially linked dataset known as the NHS Numbers for Babies (NN4B). This links birth notifications to birth registrations and subsequent infant deaths. This is necessary because certain variables, such as gestation (required to identify full-term births) are only available on birth notifications, not registrations. ONS requires Section 251 permission from the Care Quality Commission to access birth notifications data. Permission to access birth notifications data was granted to study infant mortality, specifically for the output Gestation-specific Infant Mortality in England and Wales. ONS cannot send out the births data until after the Gestation-specific Infant Mortality bulletin has been published. This complex situation, over which HSCIC has no control, is responsible for the long time lag.

There is a possibility an infant (especially a term infant) will be admitted to a paediatric ward rather than a neonatal unit and may only receive care there, thus never entering the National Neonatal Research Database. Some neo-natal admissions may not be avoidable or as the result of inappropriate care provided by the NHS. Only neonatal admissions that could be linked to a Primary Care Trust (PCT) are included in the numerator. This is for historical reasons and will be reviewed before 2013 data is released.

For more information see: Indicator Quality Statement: NHS Outcomes Framework 5.5 -Admission of full-term babies to neonatal care. 

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