Notes Data are presented as a pair of overlying bars, the outer, wider bar representing the period

1st Oct 2007 to 30th September 2008, and the inner, narrower bar the period 1st October

2008 to 30th June 2009.

Interpret network analyses with caution; neonatal units commenced participation at

different time and all units within a network have not necessarily contributed data for all

periods; the reports do not therefore reflect complete network activity, nor are all

networks represented in every analysis.

Data need to be interpreted as a guide to potential areas for further investigation and not

as evidence of quality of care. There are several reasons why a network may appear as an

outlier in the data; these include errors in the data entered, inconsistencies in the type of

data entered, missing data, incomplete network-wide participation and inadequate risk

adjustment.

© 2008 Imperial College London All Rights Reserved

The use of the information provided in this report is welcomed, on the

understanding that the Neonatal Data Analysis Unit is acknowledged.

The right of the authors and the Neonatal Data Analysis Unit to be identified

as the authors of this work has been asserted in accordance with the Copyright,

Designs and Patents Act 1988.

Figure 1 Birth weight by gestational age, all infants, all contributing units 1 October 2007 - 30 June 2009

Figure 2a Admissions by birth weight category, neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 2b Admissions by birth weight category, neonatal unit and networkLevel Two units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 2c Admissions by birth weight category, neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 3aAdmissions by gestational age category, neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 3bAdmissions by gestational age category, neonatal unit and networkLevel Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 3cAdmissions by gestational age category, neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 4aAdmissions by reason for admission, neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 4bAdmissions by reason for admission, neonatal unit and networkLevel Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 4cAdmissions by reason for admission, neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 4dReason for admission as a percentage of total admissions by network of admission 1 October 2007 - 30 September 2008 and 1 October 2008 – 30 June 2009

Figure 5aBabies receiving respiratory support by neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 5bBabies receiving respiratory support by neonatal unit and networkLevel Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 5cBabies receiving respiratory support by neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 6aCare days by neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 6bCare days by neonatal unit and networkLevel Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 6cCare days by neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 6dLevels of care as a percentage of total days of care provided, by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 7aAdmissions by discharge destination, neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 7bAdmissions by discharge destination, neonatal unit and networkLevel Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 7cAdmissions by discharge destination, neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 8aAdmission temperature, babies ≤ 32+6 weeks gestational age, by neonatal unit and network of first admissionLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009The top and bottom edges of the box represent the 75th and 25th centiles; the dots represent temperatures above the 75th centile orbelow the 25th centile; the centre horizontal line represents the median

Figure 8bAdmission temperature, babies ≤ 32+6 weeks gestational age, by neonatal unit and network of first admissionLevel Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009The top and bottom edges of the box represent the 75th and 25th centiles; the dots represent temperatures above the 75th centile or below the 25th centile; the centre horizontal line represents the median

Figure 8cAdmission temperature, babies ≤ 32+6 weeks gestational age, by neonatal unit and network of first admissionLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009The top and bottom edges of the box represent the 75th and 25th centiles; the dots represent temperatures above the 75th centile or below the 25th centile; the centre horizontal line represents the median

Figure 9aFeeding at discharge by neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 9bFeeding at discharge by neonatal unit and networkLevel Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 9cFeeding at discharge by neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 9dFeeding at discharge by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 10aAdmissions by Index of Multiple Deprivation (2007), by neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009The top and bottom edges of the box represent the 75th and 25th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values; the higher the index, the greater the deprivation

Figure 10bAdmissions by Index of Multiple Deprivation (2007), by neonatal unit and networkLevel Two Units 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009The top and bottom edges of the box represent the 75th and 25th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values; the higher the index, the greater the deprivation

Figure 10cAdmissions by Index of Multiple Deprivation (2007), by neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009The top and bottom edges of the box represent the 75th and 25th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values; the higher the index, the greater the deprivation

Figure 11aMultiple births by neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 11bMultiple births by neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 11cMultiple births by neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 11dMultiple births as a percentage of total admissions by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 to 30 June 2009

Figure 12aPost-menstrual age at discharge by neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009The top and bottom edges of the box represent the 75th and 25th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values

Figure 12bPost-menstrual age at discharge by neonatal unit and networkLevel Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009The top and bottom edges of the box represent the 75th and 25th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values

Figure 12cPost-menstrual age at discharge by neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009The top and bottom edges of the box represent the 75th and 25th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values

Figure 13aAdmissions by maternal ethnicity, neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 13bAdmissions by maternal ethnicity, neonatal unit and networkLevel Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 13cAdmissions by maternal ethnicity, neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 13dMaternal ethnicity by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 14aMajor morbidities by neonatal unit and networkLevel One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 14bMajor morbidities by neonatal unit and networkLevel Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 14cMajor morbidities by neonatal unit and networkLevel Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 14dMajor morbidities by network of booking1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 15Babies born out of network, by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 16Babies receiving some care outside booked network 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2010

Figure 17Babies ≥36 weeks gestational age with recorded convulsions by network of admission 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

Figure 18aStandardised mortality ratio, unadjusted for case-mix, for babies born ≤32+6 weeks gestational age by neonatal network of booking (1 January 2008 to 31 December 2008)

Figure 18bStandardised mortality ratio (adjusted for gestational age at birth, birth weight, gender, antenatal steroids, and multiple birth) for babies born ≤32+6 weeks gestational age by Network of Booking (1 January 2008 to 31 December 2008)

Mortality by NetworkTwo plots of estimated mortality ratios (observed deaths/expected deaths) for networks are reported. For the unadjusted outcome the expected number of deathsis the number of deaths that would have occurred in the network if its overall death rate had been the same as the overall rate in the other networks. The adjustedexpected number of deaths is that which would be expected if the unit had the same death rates as the other networks combined, based on the gestational age atbirth, birth weight, sex, antenatal steroid use and multiplicity of pregnancy of the infants. A value for the ratio greater than 1 indicates an observed number of deaths greater than the expected and a value of less than 1 indicates an observed number of deaths less than the expected number. The mortality ratios are shown on funnel plots with the ratio plotted against the expected number of deaths. On the plots 95% and 99.8% confidence intervals are drawn for reference. These linesfall approximately two and three standard deviations respectively from the average and can be used to assess the statistical significance of any extreme observations.

Final OutcomeGestational Age (weeks)

22 23 24 25 26 27 28 29 30 31 32 33 34Died 01/10/2007-31/09/2008

8 62 72 53 45 40 31 13 16 12 12 4 1901/10/2008-30/06/2009

2 39 56 50 32 36 24 17 8 9 10 10 11Total

10 101 128 103 77 76 55 30 24 21 22 14 30Home 01/10/2007-31/09/2008

. 25 115 162 236 319 385 492 668 771 1071 1508 196801/10/2008-30/06/2009

. 15 59 96 152 224 297 404 462 650 868 1120 1540Total

. 40 174 258 388 543 682 896 1130 1421 1939 2628 3508Unknown 01/10/2007-31/09/2008

. 6 10 13 15 22 19 16 17 15 11 19 3601/10/2008-30/06/2009

2 6 31 29 28 37 24 20 22 21 24 24 31Total 2 12 41 42 43 59 43 36 39 36 35 43 67

Ward 01/10/2007-31/09/20081 3 8 7 8 10 6 11 13 10 22 94 392

01/10/2008-30/06/2009. 3 7 5 11 11 13 6 12 5 21 80 299

Total 1 6 15 12 19 21 19 17 25 15 43 174 691All

recorded

outcomes

01/10/2007-31/09/20089 96 205 235 304 391 441 532 714 808 1116 1625 2415

4 63 153 180 223 308 358 447 504 685 923 1234 1881Total

13 159 358 415 527 699 799 979 1218 1493 2039 2859 4296

Table 1 - Final outcome by gestational age - 1 October 2007 - 30 June 2009

Final OutcomeGestational Age (weeks)

Total35 36 37 38 39 40 41 42 43 44 45Died 01/10/2007-31/09/2008

10 15 17 26 25 21 24 2 . . . 52701/10/2008-30/06/2009

8 13 15 24 16 25 12 1 . . . 418Total 18 28 32 50 41 46 36 3 . . . 945

Home 01/10/2007-31/09/20081448 1377 1214 1514 1536 1922 1298 221 8 1 . 18259

01/10/2008-30/06/20091073 1127 971 1159 1219 1516 1050 211 5 . . 14218

Total2521 2504 2185 2673 2755 3438 2348 432 13 1 . 32477

Unknown 01/10/2007-31/09/200831 50 66 139 96 117 72 14 . . . 784

01/10/2008-30/06/200933 32 64 89 92 108 48 11 . . . 776

Total 64 82 130 228 188 225 120 25 . . . 1560Ward 01/10/2007-31/09/2008

591 765 866 1203 1203 1759 1142 227 11 . . 835201/10/2008-30/06/2009

509 628 764 1024 1064 1416 892 187 11 1 1 6970Total

1100 1393 1630 2227 2267 3175 2034 414 22 1 1 15322All recorded outcomes 01/10/2007-31/09/2008

2080 2207 2163 2882 2860 3819 2536 464 19 1 . 2792201/10/2008-30/06/2009

1623 1800 1814 2296 2391 3065 2002 410 16 1 1 22382Total

3703 4007 3977 5178 5251 6884 4538 874 35 2 1 50304