Regional neonatal units celebrate highest delayed cord clamping rates in England and Wales for second year in a row

Regional neonatal units celebrate highest delayed cord clamping rates in England and Wales for second year in a row

Maternity and neonatal (MatNeo) units across the South West are celebrating achieving the highest rate of delayed cord clamping in England and Wales for the second year in a row, as measured by the 2021 National Neonatal Audit Programme (NNAP).

Rates of parental presence at one or more consultant rounds (for admissions lasting more than 24 hours) were also at their highest across England and Wales in the South West (at 91.4% against an England average of 85.8%).

On average, units across the South West also achieved the second highest rates of maternal early breast milk, the second lowest rates of necrotising enterocolitis (NEC) and the third lowest rates of mortality to discharge for babies born at less than 28 weeks across England.

The NNAP assesses whether babies admitted to neonatal units in England, Scotland and Wales receive consistent high-quality care, and identify areas for quality improvement. The NNAP’s 2021 audit shows delayed cord clamping (DCC) was at its highest level in units in the South West at 68.1% – against a national average of 43%. Five of the top 20 DCC performing units were from the South West. Evidence shows that DCC reduces death in preterm babies by nearly a third.

In the South West, Royal Devon University Healthcare NHS Foundation Trust were the highest performing local neonatal unit in the country for optimal cord management.

Congratulations go to local neonatal units at Royal Cornwall Hospitals NHS Trust, Musgrove Park Hospital in Taunton, and Derriford Hospital in Plymouth for achieving fifth, eighth and 17th places respectively for optimal cord management.

Torbay and South Devon NHS Foundation Trust and North Devon District Hospital achieved joint first place for the normothermia PERIPrem bundle element, with 100% of babies arriving warm to the special care baby unit.

These results follow intensive activity across the region to drive adoption and spread of a range of perinatal interventions through a unique care bundle known as PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth).

Implementing PERIPrem

Launched in April 2020, PERIPrem is a perinatal bundle designed to improve the outcomes for babies born before 34 weeks. The South West Academic Health Science Network (South West AHSN) is delivering PERIPrem in partnership with the West of England Academic Health Science Network and South West Neonatal Network. The bundle consists of eleven interventions that demonstrate a significant impact on brain injury and mortality rates amongst babies born prematurely.

The bundle was the first of its kind, and co-created by clinicians, MatNeo teams and parents. Since April 2021 PERIPrem has continued to be delivered across the region as part of the Maternal and Neonatal Safety Improvement Programme (MatNeoSIP). A number of NHS Trusts across England are now implementing care bundles based on the PERIPrem model with the project’s Clinical Leads frequently attending conferences and panels to share local learning nationally.

In August 2022, an independent evaluation conducted by the South West AHSN was published in the British Medical Journal Open Quality. It indicated 26% more mothers and babies born prematurely across the South West of England received the care interventions they were eligible for between July 2020 and June 2021, compared to before PERIPrem started. Explore a summary graphic of our PERIPrem evaluation.

Achieving results

By providing frequent share and learn webinars, 360 simulation videos, toolkits and quality improvement coaching to facilitate the spread of knowledge and best practice, PERIPrem increased confidence in implementing the 11 bundle elements. This includes DCC when babies are extremely premature, require resuscitation at delivery or are part of a twin delivery. Free delayed cord clamping resources can be accessed on the West of England AHSN PERIPrem webpages. The 2021 NNAP summary report (page 8) also recommends PERIPrem maternal early breast milk resources.

The NNAP explains that necrotising enterocolitis (NEC) “is a devastating illness which can follow preterm birth. Bowel inflammation prevents milk feeding and surgery may be needed. Babies who develop NEC typically stay in hospital for a long time. Rates of mortality in babies with NEC are high, at over 20%. Babies who survive NEC can have developmental as well as long-term feeding and bowel problems”. Rates of NEC (at its second lowest rate nationally in the South West) are directly influenced by uptake of two PERIPrem bundle elements: probiotics and maternal early breast milk.

Continuous improvement

Despite the challenges of the pandemic, geographic spread and staffing, with continuous improvement as a core driver of the PERIPrem programme, the proportion of births below 27 weeks gestation in a centre with a Neonatal Intensive Care Unit (NICU) across the South West have steadily improved each year since 2019. This indicator, known as Place of Birth, is a key focus of the MatNeoSIP.

Karen Luyt, Consultant Neonatologist, University Hospitals Bristol and Weston and PERIPrem Strategic Lead said:

In 2017-2018 the South West had the second highest brain injury rate in England. This was a key motivator in developing PERIPrem, alongside broader regional improvement work to try and reduce severe grade Intraventricular Haemorrhage (IVH). Thanks to this shared vision and focus on creating sustainable teams, rates of severe IVH or death in the South West now rank the second lowest in England.”

Sarah Bates, Consultant Paediatrician & Neonatologist at Great Western Hospitals NHS Foundation Trust and PERIPrem Neonatal Operational Clinical Lead said:

“The improvements seen across the South West in metrics such as deferred cord clamping and early maternal breast milk are reflective of true perinatal team working, sharing responsibility for achieving the best outcomes for preterm babies.  It is also highlights the impact of supporting and investing in the teams in every single unit across our region, in our SCUs, LNUs and NICUs”.

Dr Tracey Kay, Consultant Obstetrician and Gynaecologist at Royal Devon University Healthcare NHS Foundation Trust and PERIPrem Lead, said:  

I am so proud of  how we have worked collaboratively as a perinatal team over the last couple of years to improve outcomes for our smallest and most vulnerable babies. Our recent NNAP results have been really positive, particularly our optimal cord management rates with 96% of our preterm babies receiving >60 seconds.

In April 2022, PERIPrem featured as a case study in the latest NHS GIRFT Neonatology report with teams being encouraged to access our resources. PERIPrem case studies were also published by NHS Confederation (April 2022) and the National Child Mortality Database thematic report (August 2022), as well as this official PERIPrem resources have received Neonatal Nurses Association endorsement.

At the 2021 HSJ Patient Safety Awards, PERIPrem was highly commended in the category of Patient Safety Pilot of the Year. In September 2022 PERIPrem was awarded Best National/Regional Project at the British Association of Perinatal Medicine Gopi Menon Awards.

Read more about PERIPrem on our webpage.

Access the summary 2021 NNAP report and summary of data.

*This article was originally published on the West of England AHSN website on November 14, 2022. 

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