Safety of maternity services

We examine rates of full-term babies being admitted to neonatal units and unplanned maternal readmissions.

Indicator

Last updated: 29/01/2020

Safety
Primary and community care Hospital care

Background

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 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.

Unplanned maternal readmissions may also be due to failures in care provided at different stages of the maternity pathway, although not all admissions can be prevented and some may be due to unavoidable or unrelated causes. Common causes of readmission include infection, wound breakdown, pain, anaemia and venous thromboembolism. Emergency readmissions within six weeks of birth also separate new families and can have emotional and social consequences.


How does the rate of babies admitted to a neonatal unit soon after birth vary over time in England? 29/01/2020

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This graph captures the number of full-term babies (gestation greater than 36 weeks) admitted to a neonatal unit in England, expressed as a percentage of all full-term births. The rate increased from 5.1 in 2010 to 6.1 in 2012, however variation in the number of trusts submitting data may affect comparability. Data after 2012 is unavailable, as NHS Digital stopped publishing updates on this indicator because the methodology requires review.

In 2016/17, the National Maternity and Perinatal Audit (NMPA) began publishing data on the rate of full-term babies admitted to a neonatal unit. In 2016/17, the rate was 5.7. Note that data from the NMPA is not directly comparable due to differences in data collection for the number of full-term births. 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.


How has the percentage of unplanned maternal readmissions changed over time? 29/01/2020

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The National Maternity and Perinatal Audit (NMPA) records the percentage of mothers who have an unplanned, overnight readmission to hospital within 42 days of giving birth, as this represents a deviation from the normal course of postnatal recovery. Between 2015/16 and 2016/17, the percentage of unplanned maternal readmissions in England increased from 2.4% to 3.3%. In Scotland, the percentage was higher in 2015/16 (2.9%), but also increased to 3.3% in 2016/17. The rate of unplanned maternal readmissions varies by method of delivery. In England, the rate is higher for caesarean births at 4.4% in 2016/17 (data not shown).


About this data

NHS Digital data:

The rate of babies admitted to a neonatal unit is calculated as the number of full-term babies (gestation greater than 36 weeks) admitted within 28 days of birth to a neonatal unit, divided by the number of all full-term births. The NHS Digital data notes say that for this indicator 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 that submit data for babies who receive neonatal care within a neonatal unit of an NHS trust, and units that submit 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 a possibility that an infant (especially a full-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.

This data is no longer being published because the methodology for the indicator requires review, which is not being actively progressed at this time.

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

National Maternity and Perinatal Audit data:

The rate of admissions to neonatal units is calculated as the proportion of live-born, singleton babies born between 37+0 and 42+6 weeks of gestation who are admitted to a neonatal unit. It excludes babies who are admitted to neonatal transitional care settings, which provide additional care beyond what would be provided on a postnatal ward, allowing babies to stay with their mothers.

The rate of unplanned maternal readmissions is calculated as the number of women giving birth to a singleton baby between 37+0 and 42+6 weeks of gestation who were readmitted to hospital within 42 days. It excludes those who died before discharge or were not discharged within 42 days of delivery, as well as planned readmissions or transfers, readmissions of less than one day and those accompanying an unwell baby.

For more information, please see the NMPA Measures – Technical Specification.

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