According to bmj.com, neonatal services in the UK have improved significantly since new guidelines have been introduced in 2003 that were aimed to help increase the percentage of premature babies born in a specialist care unit, which is linked to better outcomes, and decrease the numbers of acute postnatal transfers between hospitals within 24 hours of birth, which is associated with adverse outcomes.

An examination of maternity units in England, Wales and Northern Ireland between 1998 and 2000 and maternity units in England between 2009 and 2010 by researchers from the Imperial College London revealed a partial success of the guidelines.

They discovered that even though the percentage of babies delivered at gestation week 27/28 had risen, half of the deliveries are still carried out in non-specialist units, which indicates that the coordination between maternity and neonatal services is not appropriate.

The researchers also established that the percentage of newborns that were transferred within 24 hours of their birth has increased and that one third of multiple birth newborns are still treated in separate units, which demonstrates an ongoing inadequacy in cot capacity.

Overall, between the first and second time frames (1998-2000 and 2009-2010) the percentage of infants delivered at specialist care centers rose from 18 to 49%, yet the percentage of acute transfers in England also increased from 7 to 12%, whilst the percentage for late transfers rose from 18 to 22%. The researchers note that the survival of premature babies also improved by 5% between the two time frames, rising from 88% to 93%.

The researchers conclude that two goals of the guidelines have been achieved, namely that a higher percentage of infants are being born in specialist care units, who are transferred back to neonatal units closer to home when highly specialized care is no longer necessary.

The researchers do highlight the fact though that co-ordination between both neonatal services and maternity units is still poor and that “future analysis of the wider population” will allow more insight into the organization of specialist newborn care.

Bliss Head of Programs, Jane Abbott declared:

“Bliss welcomes these findings which show that the introduction of managed clinical networks has brought about improvements in the delivery of neonatal care. It is very encouraging to see that more babies requiring specialist treatment are being born in units that can provide the right level of care.

This reinforces the importance of managed clinical networks and their contribution to improving outcomes for babies born sick or premature. However, it is clear that investment into neonatal care and better coordination between maternity and neonatal services needs to be made a priority to ensure the best outcomes for all babies and their families.”

Dr Ciaran Phibbs from Stanford University School of Medicine writes in a linked article that regardless of England having achieved “a good start on improving the regionalization of neonatal care”, Phibbs believes that efforts must be expanded to include obstetric services in order to regionalize all high-risk deliveries. According to Phibbs, England still has a “long way to go” before achieving the best possible outcomes for high-risk deliveries.

Written by Petra Rattue