Survival of very preterm infants admitted to neonatal care in England 2008–2014: time trends and regional variation
Open accessAbstract
Objective: To analyse survival trends and regional variation for very preterm infants admitted to neonatal care. Setting: All neonatal units in England. Patients: Infants born at 22 +0 –31 +6 weeks +days gestational age (GA) over 2008–2014 and admitted to neonatal care; published data for admitted infants 22 +0 –25 +6 weeks +days GA in 1995 and 2006, and for live births at 22 +0 –31 +6 weeks +days GA in 2013. Methods: We obtained data from the National Neonatal Research Database. We used logistic regression to model survival probability with birth weight, GA, sex, antenatal steroid exposure and multiple birth included in the risk adjustment model and calculated annualpercentage change (APC) for trends using joinpoint regression. We evaluated survival over a 20-year period for infants <26 weeks’ GA using additional published data from the EPICure studies. Results: We identified 50 112 eligible infants. There was an increase in survival over 2008–2014 (2008: 88.0%; 2014: 91.3%; adjusted APC 0.46% (95% CI 0.30 to 0.62) p<0.001). The greatest improvement was at 22 +0 –23 +6 weeks (APC 6.03% (95% CI 2.47 to 3.53) p=0.002). Improvement largely occurred in London and South of England (APC: London 1.26% (95% CI 0.60 to 1.96); South of England 1.09% (95% CI 0.36 to 1.82); Midlands and East of England 0.15% (95% CI −0.56 to 0.86); and North of England 0.26% (95% CI −0.54 to 1.07)). Survival at the earliest gestations improved at a similar rate over 1995–2014 (22 +0 –25 +6 weeks, APC 2.73% (95% CI 2.35 to 3.12), p value for change=0.25). Conclusions: Continued national improvement in the survival of very preterm admissions masks important regional variation. Timely assessment of preterm survival is feasible using electronic records.
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With an increase in live births at 22+0 to 23+6 weeks of gestation receiving neonatal care and surviving to be taken home by their parents and also increases in babies registered as 'live born' before 22 weeks of gestation in the UK in recent years, use of the word 'miscarriage' to describe the death of any baby before 24 weeks of gestation in the UK is problematic.
“With an increase in live births at 22+0 to 23+6 weeks of gestation receiving neonatal care and surviving to be taken home by their parents14, 15 and also increases in babies registered as ‘live born’ before 22 weeks of gestation in the UK in recent years (https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/datasets/birthcharacteristicsinenglandandwales; accessed”
From Parents’ experiences of care following the loss of a baby at the margins between miscarriage, stillbirth and neonatal death: a UK qualitative study (2020) · cites this paper as [15]
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- Authors
- Santhakumaran, S., Statnikov, Y., Gray, D., Battersby, C., Ashby, D., & Modi, N.
- Affiliations
- Imperial College London (GB)
- Corresponding author
- Modi, Neena
- ORCID
- Venue
- Archives of Disease in Childhood - Fetal and Neonatal Edition
- Publisher
- BMJ
- Published
- 2017-09-07
- Volume
- 103
- Issue
- 3
- Pages
- F208-F215
- ISSN
- 1359-2998 (ISSN-L)
- 1468-2052
- PMC
- PMC5916099
- OpenAlex
- W2752811233
- Cited by
- 189
- References
- 15
- Citations by year
- 2026: 8 · 2025: 20 · 2024: 16 · 2023: 20 · 2022: 22 · 2021: 27 · 2020: 47 · 2019: 18 · 2018: 8 · 2017: 2 · 2014: 1
- FWCI
- 22.38
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Archives of Disease in Childhood Fetal & Neonatal (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Funders
- Programme Grants for Applied Research
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- very preterm infants, neonatal survival, survival trends, regional variation, gestational age, birth weight, antenatal corticosteroids, multiple births, neonatal care, EPICURE, England, neonatal unit, risk adjustment, annual percent change, southern England, Northern England
- MeSH terms
- Birth Weight, England, Female, Gestational Age, Humans, Infant, Infant Mortality, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Infant, Small for Gestational Age, Male, Survival Rate, Logistic Models, Databases, Factual, Infant, Very Low Birth Weight
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