0

NEWCASTLE NEONATAL SERVICE

ANNUAL REPORT

2016

1

FOREWORD

This is the twenty first Annual Report produced using the NPC database. Whilst much of the

format is as in previous years I hope the new additions give a ‘user’ feel to the data. There are

a plethora of outcome and ‘quality’ measures that we submit regionally and nationally (for

example NNAP, MBRRACE-UK, ICCQIP, Specialised Service Quality Dashboards). I have

not included them to avoid repetition of publicly available data: suffice to say that the

Newcastle Neonatal Service continues to provide high quality care.

The key issues for us continue to be around the sustained rise in workload and high cot

occupancy rates. We have directed considerable energy at maintaining appropriate levels of

both trainee medical staff and nurses with some success: we have re-opened all of our

intensive/high dependency care cots and a proportion of our closed low dependency cots in

2017.

The establishment and hosting of the regional neonatal transfer service at the RVI is the first

externally visible sign of network reconfiguration: significant expansion is still required to

enable us to reach our goal of providing high quality care to all babies and their families who

choose to book for their care with our service or who are referred specifically for the care we

provide.

As ever I am indebted to the clerical staff for ensuring records are kept up to date and missing

notes retrieved. Naveen Athiraman was responsible for the majority of primary data input.

Jenny Dixon compiled the developmental outcome data. Mark Green (Northern Neonatal

Network) kindly undertook the confidence interval analysis for the rolling survival data.

Alan Fenton

July 2017

2

Executive Summary

Activity & cot occupancy (pp 3-5, pp 31-33)

Numbers of births at the RVI fell by 4%. Despite this, demand for neonatal

intensive and high dependency (IC/HD) care at the RVI remained high.

We have become highly proactive at managing patient flow to ensure optimum cot

usage and maintain patient and overall service safety.

Staffing levels have enabled us to re-open cots in early 2017 that had been closed

long term. However, we remain in urgent need of additional IC/HD cots as

recommended by the RCPCH Network Review to achieve our goal of 80%

maximum IC/HD occupancy.

A regional neonatal transfer team (NNeTS) has been established, hosted at the

RVI.

Mortality (pp 6-12) & Morbidity (pp 13-)

Our survival in preterm infants remains high.

Congenital malformation contributes significantly to our mortality, particularly in

term and near-term infants. This has been reflected in MBRRACE-UK data.

Major neonatal morbidity (in particular infection rates) rates remain low,

reflecting our commitment to high quality care.

We have managed to obtain detailed follow up data on virtually all of our target

population. Aggregate outcomes remain in line with published national data.

Research and Nursing Initiatives (pp 14-15, pp 40-44)

The neonatal service continues to produce a significant research output, both

locally and by contributing to multi-centre (portfolio) studies.

Our approach to the care of mildly preterm and vulnerable infants in a transitional

care setting continues to reduce inappropriate separation of mothers and their

infants.

3

Workload

Table 1: RVI booked births and all Ward 35 admissions 1994 – 2016

NB: Total RVI births (1st column) include in utero admissions to Ward 35 (7

th column) and the small number of in utero transfers who were admitted to

the postnatal wards following delivery. “Resp support” in this table includes infants receiving CPAP alone.

4

Workload and Cot Occupancy

Throughout 2016 we continued to operate with 2 IC/HD and 6 LD cots closed with a

corresponding fall in our IC/HD workload (Figure 1) and total occupancy (Figure 2). The

disproportionate fall in LD workload probably reflects the large (and increasing) numbers of

referrals of less preterm infants and their mothers that have to be refused admission to or

transferred out of the RVI (Table 2).

Figure 1: RVI Ward 35 2004 - 16: Rolling Annualised IC/HD workload

Despite the cot closures IC/HD occupancy remains high and well above our aspirational goal

of 80% maximum occupancy. The Trust has recently permitted us to over-recruit to our

nursing establishment to stay abreast of retirements and long term leave, and this has

improved our staffing levels towards those recommended by BAPM.

A major unanticipated benefit of the reduction in cot numbers has been a sustained

improvement in efficiency of managing patient flows. Daily bed utilization meetings identify

potential patient discharges to make cots available, and our use of transitional care has

continued to lessen demand for low dependency cots. The recent establishment of the

Northern Neonatal Transport Service has further improved our (and other units’) ability to

relocate babies promptly to maximize cot capacity across the network. More recently (May

2017) we have re-opened our IC/HD and 2 of the LD cots. This combined with the agreement

5

from Specialist Commissioners to fund our long-awaited IC/HD expansion will facilitate our

efforts to provide care for all babies booked at or referred to the RVI.

Figure 2: RVI Ward 35 2004 - 16: Cot Occupancy (solid horizontal lines indicate

100% capacity)

Table 2: Ward 35 RVI 2009-16 – postnatal transfers out and referrals refused

due to over-capacity (* - IC/HD capacity only)

6

Outcomes

Outcomes for infants to 27 days by place of booking and delivery are shown by gestational

age (Table 3) and birthweight (Table 4).

Table 3: Ward 35 2016 - Outcome of all admissions to 27 days by gestational age

Table 4: Ward 35 2016 - Outcome of all admissions to 27 days by birthweight

7

Mortality - inborn population 1994-2016

Time specific mortality rates are presented in Table 5 and Figure 3, the latter demonstrating

the significant influence of stillbirth on perinatal morality.

Table 5: Mortality rates for booked RVI births 1994-2016

NB: Total births (column 2) include the antenatal transfers who were admitted to Ward 35 in addition

to the small number of antenatal transfers who were admitted to the postnatal wards following delivery.

All deaths refer to booked infants only.

8

Figure 3: Mortality rates for booked RVI births 1994-2016

Mortality - all admissions

37 infants are known to have died within 1 year of birth. The distribution of age at death

(divided into early and late neonatal and post-neonatal) and route of admission is shown in

Table 6 together with the number of deaths in each group attributable to lethal congenital

malformation. The latter constitutes a large proportion of overall mortality and has been noted

as part of MBRRACE-UK national reporting. Deaths >27 days include all known deaths up to

31st July 2017.

Table 6: Ward 35 2016 - Mortality by postnatal age & contribution of

malformation

9

Congenital malformation

Table 7 shows the contribution of major malformation to death in the selected mixed

population admitted to Ward 35 1994-2016.

Table 7: Ward 35 1994-2016 - Malformation and mortality by postnatal age

10

Ward 35 2016: Mortality by Clinico-Pathological Diagnosis (CPD)

(Hierarchical classification based on Wigglesworth’s pathological diagnoses)

Congenital Malformation (CPD 10-14)

Infant GA Bwt (g) Diagnosis Cause of death Age at death

13109 39 2490 Spinal Muscular Atrophy type I Respiratory failure 8 days

13137 37 2380 Rt CDHernia Pulmonary hypoplasia 2 days

13247 36 2440 Trisomy 21; AVSD; duodenal

obstruction

HIE - collapse during

cardiac catheterisation

53 days

13463 41 3090 Haemophagocytic lymphocytosis Hepatic failure 43 days

13515 27 780 Hydrops ?cause Multi-organ failure 1 day

13537 37 2400 Acyl carnitine deficiency Multi-organ failure 5 days

13538 38 2980 Lt CDHernia Pulmonary hypoplasia 6 days

13551 23 720 Hydrops ?cause Pulmonary hypoplasia 1 day

13589 37 2460 Complex CHD; Dandy-Walker;

unbalanced 9:10 translocation

S aureus sepsis/pneumonia 28 days

13590 31 2120 Congenital lymphangiectasia Multi-organ failure 9 days

13612 36 3240 Rt CDHernia Pulmonary hypoplasia 43 days

13673 34 1700 Exomphalos major Pulmonary hypoplasia 21 days

13766 38 3900 Multicystic dysplastic kidneys Pulmonary hypoplasia 22 hours

13771 36 2420 Congenital lymphangiectasia Respiratory & renal failure 6 days

13779 30 1600 Hydrops ?cause (maternal yellow

nail syndrome)

Cardiac failure 4 days

13784 35 1700 Acute hepatic failure ?cause Hepatic failure 96 days

13793 33 1600 Central nuclear myopathy Respiratory failure 2 days

13795 28 690 HLHS Perforated NEC 28 days

Peripartum Asphyxia (CPD 30-31)

Infant GA Bwt (g) Diagnosis Age at death Transfer

13116 37 2670 HIE 3; SGA 23 days Booked

13176 38 3060 HIE 3 1 day Booked

13350 36 3200 HIE 3; HRHS; exomphalos major 10 hours Antenatal transfer

13479 38 3270 HIE 3 6 days Postnatal transfer

13487 31 1740 HIE 3 2 days Postnatal transfer

Trauma (CPD 40)

There were no deaths attributable to trauma.

11

Lung Pathology (CPD 50-53)

Six infants died with respiratory problems associated with pulmonary immaturity or hyaline

membrane disease (HMD), none of whom had an associated pneumothorax.

Intracranial Haemorrhage (CPD 60-61)

No infant died as a result of intracranial haemorrhage.

Infection including NEC (CPD 70-74)

There were 5 deaths directly attributable to NEC and 2 directly attributable to sepsis.

Miscellaneous (CPD 80-84)

One infant was found to have died as a consequence of intra-abdominal haemorrhage.

Unexplained (CPD 90-99)

No infants were coded in this way.

Post mortem studies

Post mortem consent was obtained for 43% (16/37) of the infants who died, a significant

improvement from the previous year. Consent was not sought in only 3 infants, 2 of whom

died outwith Ward 35; the remaining infant was 22 weeks gestation. Clinical details of these

infants are shown in Table 8, and Table 9 details post mortem rates for infants admitted to

Ward 35 1994-2016.

Tabel 8: Ward 35 RVI 2016 – Details of infants where autopsy consent was not sought

(NS) or refused (R)

Infant GA Bwt (g) Diagnosis PM Place of death

13095 22 410 Extreme preterm NS Ward 35 RVI

13109 39 2490 SMA I R Home

13116 37 2670 IUGR; HIE 3 R Ward 35 RVI

13137 37 2380 Rt CDHernia; imperforate anus R Ward 35 RVI

13199 28 840 Pulmonary hypoplasia R Ward 35 RVI

13283 24 540 Fulminant NEC; E coli sepsis R Ward 35 RVI

13350 36 3200 HIE 3; HRHS; Exomphalos major R Ward 35 RVI

13421 24 730 GBS sepsis; multi-organ failure R Ward 35 RVI

13479 38 3270 HIE 3 R Ward 35 RVI

13487 31 1740 HIE 3 (mat splenic artery aneurysm rupture) NS Adult ITU RVI

13587 26 450 Severe IUGR; deln short arm Y chr p11.32 R Ward 35 RVI

12

13589 37 2460 Complex CHD; Dandy-Walker; unbalanced

9:10 translocn; S aureus sepsis/pneumonia

NS PICU FRH

13612 36 3240 Rt CDHernia; multi-organ failure R PICU GNCH

13651 26 800 Triplet; NEC; bilat extensive cystic PVL R Ward 35 RVI

13673 34 1700 Massive exomphalos; pulmonary hypoplasia R Ward 35 RVI

13674 30 2200 Beckwith Wiedemann syndrome; Dandy

Walker variant; S aureus sepsis

R Ward 35 RVI

13707 25 935 PPROM; pulmonary hypoplasia R Ward 35 RVI

13784 35 1700 Acute hepatic failure ?cause R Sunderland RI

13795 28 690 HLHS; NEC R Ward 35 RVI

13824 25 785 Fulminant NEC R Ward 35 RVI

13825 25 860 Fulminant NEC R Ward 35 RVI

Table 9: Autopsy rate Ward 35 1994-2016

13

General

Fetal Medicine Referrals

A total of 146 infants (15 deaths, 131 survivors) were admitted following antenatal referral to

the Fetal Medicine Unit at the RVI. 75 of these (3 deaths) were originally booked at the RVI.

As in previous years the majority were referred with congenital malformation (106 infants,

most of whom were transferred for surgical treatment). Infants from 6 pairs of twins were

admitted with a diagnosis of twin-twin transfusion syndrome.

Postnatal Wards

78 infants were admitted from the postnatal wards, a significant reduction from previous

years (109 and 92 infants admitted in 2014 and 2015 respectively). It is also of note that this

number of admissions is lower than the equivalent figure from 2001, despite an increase in

RVI births of almost 50%.

The commonest presenting problems were respiratory (29) and significant abdominal

concerns (10 – mostly bile-stained vomiting or abdominal distension). The respiratory issues

are discussed further below, but it is of note that the rise in the number of these admissions is

proportionally greater than the rise in births. No infants were admitted for low temperature

per se, reflecting the effect of initiatives to improve our NNAP performance. The postnatal

liaison team’s input can be seen in the absence of admissions for feeding issues. Postnatal

ward admissions are shown in Figures 8 & 9 by gestation and birthweight respectively.

Table 10 shows the numbers of and reasons for admissions of infants from postnatal wards

2001-2016, with trends highlighted.

Figure 8: Ward 35 2016 – Admissions from postnatal

wards by GA

Figure 9: Ward 35 2016 – Admissions from postnatal

wards by BW

14

Table 10: Ward 35 RVI – Admissions from postnatal wards 2001-2016

Year

2001 2003 2005 2007 2009 2011 2013 2015

Births (1000) 4.6 4.8 4.9 4.9 5.2 5.7 6.2 6.4 6.8 7.0 7.0 7.3 7.7 7.4 7.0 6.7

Admissions 86 69 71 88 74 69 98 103 88 78 99 111 83 113 95 78

Infants 82 66 69 85 74 62 97 99 82 77 94 104 82 109 93 78

Hypogly. 16 16 17 20 17 5 16 21 26 8 11 7 11 9 9 4

IUGR 12 14 7 13 14 5 8 11 10 7 5 1 8 7 6 9

Feeding 19 18 7 19 10 11 23 17 14 18 25 2 1 9 2 0

Low temp 6 14 11 9 3 3 1 2 1 3 6 3 4 3 3 0

Respiratory 12 3 12 12 14 18 18 22 16 34 31 19 23 32 32 29

NAS 2 6 3 5 4 8 8 4 4 3 2 4 5 3 5 1

Unexpected term admissions

There is considerable interest nationally in reducing avoidable separation of mothers and

infants. Around 3% of inborn, non-malformed term infants are admitted to Ward 35 each year

(Table 10a), with approximately two thirds of these being admitted directly from delivery

suite or the Newcastle Birthing Centre. The rate of term admission varies with gestational

age. The majority of these have respiratory distress, mostly requiring non-invasive pressure

support: this may be a consequence of obstetric management and will be examined

prospectively in more detail next year. The relationship between gestation and unexpected

term admission with respiratory distress 2013-16 is shown in Figure 10.

Figure 10: Ward 35 RVI – Unexpected term admissions with respiratory distress

by gestational age 2013 – 16

15

Table 10a: Ward RVI 2016 - % Non-malformed term infants admitted

Social Admissions

From Included Excluded

Delivery suite/NBC 2.09% 1.96%

Postnatal 0.89% 0.82%

All 2.97% 2.78%

Postnatal Workload – ‘Transitional’ Care

In addition to our efforts to minimise separation of term infants from their mothers we

continue to look after late preterm and vulnerable infants with their mothers on the postnatal

wards, in turn reducing the effects of the continuing cot closures on Ward 35. This continues

to require considerable input from the postnatal liaison team as well as the medical staff. The

data presented in Table 11 excludes baby checks and IV antibiotics given to infants on the

postnatal wards.

Table 11: Ward 35 RVI 2006 - 2016 – ‘Transitional Care’ on postnatal wards

Year 2006 2008 2010 2012 2014 2016

Thermal

support &/or

nasogastric

feeding

559 654 1302 1139 1694 2072 2935 3317 3683 3864 3602

SBR/glucose

monitoring

08.00 – 16.00

831 536 578 403 280 121 67 140 216 264 247

Transitional

care days * * * * 2581† 2915 3509 2972 3206 4268 4374

Maternal

methadone * * * * * * *

173 52 24 33

† - data Apr-Dec

Multiple Births

Admissions of infants from multiple births and survival rates for infants from twin

pregnancies 1996-2016 are shown in Table 12. The proportion of Ward 35 admissions that

twins and higher order births constituted has risen compared to last year. Table 13 shows the

mortality related to twin delivery where one or both infants required admission to Ward 35.

16

Table 12: Ward 35 RVI - Admissions from multiple pregnancies 1996-2016

Year

Twins

(n)

Survival

(%)

Higher order

births (n)

Total

admissions

% Total

admissions

1996 144 55 9

583

26.2%

1997 118 91 14

645

20.5%

1998 61 93 7

605

11.2%

1999 107 77 11

534

22.1%

2000 77 90 8

580

14.7%

2001 61 97 19

518

15.4%

2002 102 93 2

524

19.8%

2003 87 91 12

525

18.9%

2004 70 96 7

573

13.4%

2005 93 88 0

539

17.3%

2006 91 95 6

553

17.5%

2007 103 94 0

563

18.3%

2008 114 89 3

613

19.1%

2009 103 95 9

563

19.9%

2010 116 94 7

638

19.3%

2011 131 95 3

712

18.8%

2012 125 92 17

741

19.2%

2013 98 95 13

724

15.3%

2014 98 95 6

742

14.0%

2015 84 94 11

673

14.1%

2016 102 96 16

709

16.6%

Table 13: Ward 35 RVI 2016 - Mortality related to twin delivery

Admitted to Ward 35

Live Dead Survival (%)

First born 51 2 96

Second born 47 2 96

Totals 98 4 96

Hypoxic ischaemic encephalopathy

14 infants (5 deaths) were coded as having suffered a severe perinatal insult sufficient to

warrant therapeutic hypothermia. 10 infants (2 deaths) delivered at the RVI.

Fits

Clinically recognisable fits were recorded in 11 infants (5 deaths, 6 survivors), of whom 7 (3

deaths) were booked deliveries. In 5 infants the fits could be reasonably attributed to a

hypoxic ischaemic insult. Only 3 infants were preterm.

17

Post-Haemorrhagic Hydrocephalus

One preterm infant with multiple congenital malformations underwent VP shunt insertion for

severe ventriculomegaly associated with aqueduct stenosis. Two other preterm infants

(initially treated outside the RVI) developed post haemorrhagic hydrocephalus requiring

shunt insertion.

Retinopathy of prematurity

16 infants (all <27 weeks gestation, no deaths) who received the majority of their neonatal

care at the RVI developed retinopathy which reached current treatment threshold. 5 of these

infants received treatment with anti-VGEF therapy. All infants identified with significant

ROP were within current screening guidelines. All infants who fulfilled criteria for ROP

screening whilst on Ward 35 were screened.

Infection

We continue to see infants transferred for on-going management of sepsis and infants with

positive blood cultures associated with abdominal surgery (7 infants).

1) Positive blood cultures

24 infants (5 deaths) had organisms isolated in blood cultures that were felt to be significant.

The commonest organism isolated was Group B Streptococcus (GBS) (5 infants) followed

by S. epidermidis and E. coli (4 infants each). 2 infants developed S. aureus infection. We

continue to have had no systemic Candida infections in inborn infants since the introduction

of Fluconazole prophylaxis. No infant developed MRSA sepsis.

2) Pneumonia

11 infants (no deaths) were coded as having a significant respiratory infection, most of whom

had significant changes on chest X-ray but no organism isolated.

3) Meningitis

One preterm infant was transferred in for management of Ureaplasma urealyticum isolated

from CSF. One term infant with a persistent pyrexia had an associated raised CSF white cell

count and ventriculitis on cranial ultrasound but negative CSF cultures. Parechovirus was

isolated from CSF in one term infant.

18

Patent ductus arteriosus

29 infants (4 deaths) developed clinical and ultrasound signs consistent with left to right

shunting through a patent ductus. All except 4 were <28 weeks gestation and received

respiratory support for HMD. 18 infants were treated solely with ibuprofen. 11 infants

underwent surgical ligation. The incidence and management of symptomatic PDA 1994-2016

is shown in Figure 11 and the proportion of infants undergoing surgical ligation in Figure 12.

Figure 11: Ward 35 RVI 1994-2016 – Symptomatic PDA

Figure 12: Ward 35 RVI 1994-2016 – Proportion of infants undergoing PDA ligation

19

Necrotising Enterocolitis

19 infants (7 deaths) had signs and symptoms suggestive of NEC. As previously a

considerable proportion of cases (11 infants of whom 2 died) were specifically transferred

from other hospitals for surgical management with NEC as a diagnosis. Overall, 3 infants

were coded as “suspicious”, 9 received a full “medical” course of treatment for a clinical

picture supported by radiological findings and 7 underwent laparotomy. Details of infants

with NEC admitted to Ward 35 1994-2016 are shown in Figure 13.

Figure 13: Ward 35 RVI 1994-2016 - NEC

20

Mechanical Ventilation

Population

411 infants received respiratory support (including 184 who received CPAP alone), of whom

382 (93%) survived to 27 days. The distribution of infants requiring any respiratory support

by gestation and birthweight is shown in Tables 14 & 15. The numbers of infants requiring

formal ventilation compared to CPAP alone are shown in Tables 16 & 17 (by gestation) and

Tables 18 & 19 (by birthweight).

Table 14: Ward 35 RVI 2016 - Outcome of all infants receiving any respiratory

support to 27 days by gestational age

Transfers

Gestation Booked Antenatal Postnatal Total

(weeks) Tot L D Tot L D Tot L D L D+L

%

Survival

<24 2 1 1 3 1 2 4 4 0 6 9 67%

24-25 9 8 1 6 3 3 6 6 0 17 21 81%

26-27 10 10 0 17 15 2 10 10 0 35 37 95%

28-29 11 9 2 14 14 0 7 6 1 29 32 91%

30-31 36 35 1 11 8 3 7 6 1 49 54 91%

32-33 33 33 0 7 7 0 8 7 1 47 48 98%

34-36 54 54 0 16 13 3 6 6 0 73 76 96%

>36 103 99 4 13 10 3 18 17 1 126 134 94%

Totals 258 249 9 87 71 16 66 62 4 382 411 93%

Table 15: Ward 35 RVI 2016 - Outcome of all infants receiving any respiratory

support to 27 days by birthweight

Transfers

Birthweight Booked Antenatal Postnatal Total

(g) Tot L D Tot L D Tot L D L D+L

%

Survival

<500 1 0 1 1 0 1 0 0 0 0 2 0%

500-749 11 10 1 14 10 4 9 9 0 29 34 85%

750-999 15 12 3 13 11 2 7 6 1 29 35 83%

1000-1249 7 7 0 12 12 0 7 7 0 26 26 100%

1250-1499 26 26 0 7 7 0 10 10 0 43 43 100%

1500-1999 39 39 0 8 6 2 11 9 2 54 58 93%

2000-2499 36 34 2 15 11 4 3 3 0 48 54 89%

>2499 123 121 2 17 14 3 19 18 1 153 159 96%

Totals 258 249 9 87 71 16 66 62 4 382 411 93%

21

Mechanical Ventilation (cont)

Table 16: Ward 35 RVI 2016 - Outcome of all infants receiving CPAP alone to

27 days by gestational age

Transfers

Gestation Booked Antenatal Postnatal Total

(weeks) Tot L D Tot L D Tot L D L D+L

%

Survival

<24 0 0 0 0 0 0 0 0 0 0 0 0%

24-25 0 0 0 0 0 0 0 0 0 0 0 0%

26-27 3 3 0 0 0 0 1 1 0 4 4 100%

28-29 1 1 0 6 6 0 2 2 0 9 9 100%

30-31 24 24 0 3 3 0 3 3 0 30 30 100%

32-33 25 25 0 6 6 0 1 1 0 32 32 100%

34-36 35 35 0 6 6 0 1 1 0 42 42 100%

>36 62 62 0 4 4 0 1 1 0 67 67 100%

Totals 150 150 0 25 25 0 9 9 0 184 184 100%

Table 17: Ward 35 RVI 2016 - Outcome of all ventilated infants to 27 days by

gestational age

Transfers

Gestation Booked Antenatal Postnatal Total

(weeks) Tot L D Tot L D Tot L D L D+L

%

Survival

<24 2 1 1 3 1 2 4 4 0 6 9 67%

24-25 9 8 1 6 3 3 6 6 0 17 21 81%

26-27 7 7 0 17 15 2 9 9 0 31 33 94%

28-29 10 8 2 8 8 0 5 4 1 20 23 87%

30-31 12 11 1 8 5 3 4 3 1 19 24 79%

32-33 8 8 0 1 1 0 7 6 1 15 16 94%

34-36 19 19 0 10 7 3 5 5 0 31 34 91%

>36 41 37 4 9 6 3 17 16 1 59 67 88%

Totals 108 99 9 62 46 16 57 53 4 198 227 87%

22

Mechanical Ventilation (cont)

Table 18: Ward 35 RVI 2016 - Outcome of all infants receiving CPAP alone to

27 days by birthweight

Transfers

Birthweight Booked Antenatal Postnatal Total

(g) Tot L D Tot L D Tot L D L D+L

%

Survival

<500 0 0 0 0 0 0 0 0 0 0 0 0%

500-749 3 3 0 0 0 0 0 0 0 3 3 100%

750-999 1 1 0 1 1 0 1 1 0 3 3 100%

1000-1249 4 4 0 5 5 0 1 1 0 10 10 100%

1250-1499 18 18 0 5 5 0 4 4 0 27 27 100%

1500-1999 25 25 0 2 2 0 1 1 0 28 28 100%

2000-2499 23 23 0 6 6 0 1 1 0 30 30 100%

>2499 76 76 0 6 6 0 1 1 0 83 83 100%

Totals 150 150 0 25 25 0 9 9 0 184 184 100%

Table 19: Ward 35 RVI 2016 - Outcome of all ventilated infants to 27 days by

birthweight

Transfers

Birthweight Booked Antenatal Postnatal Total

(g) Tot L D Tot L D Tot L D L D+L

%

Survival

<500 1 0 1 1 0 1 0 0 0 0 2 0%

500-749 8 7 1 14 10 4 9 9 0 26 31 84%

750-999 14 11 3 12 10 2 6 5 1 26 32 81%

1000-1249 3 3 0 7 7 0 6 6 0 16 16 100%

1250-1499 8 8 0 2 2 0 6 6 0 16 16 100%

1500-1999 14 14 0 6 4 2 10 8 2 26 30 87%

2000-2499 13 11 2 9 5 4 2 2 0 18 24 75%

>2499 47 45 2 11 8 3 18 17 1 70 76 92%

Totals 108 99 9 62 46 16 57 53 4 198 227 87%

23

Mechanical Ventilation (cont)

Time on ventilator

15 infants were ventilated >27 days whilst on Ward 35, of whom 1 died.

High Frequency Oscillation

38 infants (18 deaths, 20 survivors) were treated with high frequency oscillation, of whom 18

(8 deaths, 10 survivors) had respiratory distress syndrome. Oscillation continues to be used

selectively for the sickest infants (HIFOV is considered when an infant reaches an

oxygenation index of 15), hence the high apparent mortality.

Surfactant Therapy

130 infants who received their initial respiratory care at the RVI were treated with surfactant.

76 (58%) were <32 weeks gestation. All of the infants both <25 and between 25 and 29

weeks who were ventilated from birth received surfactant. 70 ventilated infants >29 weeks

received at least one dose of surfactant.

Inhaled Nitric Oxide

46 infants (16 deaths) received inhaled nitric oxide (iNO) as part of treatment for suspected

pulmonary hypertension, 21 of whom were <32 weeks gestation (13 survivors). The sustained

large rise in infants treated with iNO is partly due to our increased use in the preterm

population and an increase in the number of infants delivered with pulmonary hypertension

secondary to pulmonary hypoplasia. 8 infants with congenital diaphragmatic hernia received

iNO: 5 survived. Our current threshold for considering iNO therapy is an oxygenation index

of 20.

Pneumothorax

16 infants developed pneumothoraces (4 deaths), 1 whilst on nasal CPAP. 9 infants did not

have associated hyaline membrane disease. The pneumothorax rate in ventilated HMD

remains at 6%.

Tracheostomy

One term infant with Pierre Robin sequence and one preterm infant with multiple congenital

anomalies including a laryngeal cleft required a tracheostomy.

24

Mechanical Ventilation (cont)

Chronic Lung Disease

91 infants (88 survivors, 3 deaths) who remained on the ward were still in supplemental

oxygen at 28 days of age. 39 of these (1 death) were booked deliveries of whom 26 were still

in supplemental oxygen at a corrected gestation of 36 weeks. 20 of these were discharged on

home oxygen.

Trends in respiratory support and morbidity are shown in Table 20.

Table 20: Ward 35 - Respiratory support and morbidity 1994-2016

Surfactant HIFOV Pneumothorax Oxygen Dependency (n) at:

Year n

% <

32/40 n Died n Died

rate/ventilated

HMD (%)

28 days

(all)

36/40

(booked) Home

1994 90 87 n/a n/a 33 18 23 38 13 6

1995 114 81 35 21 39 22 24 40 12 5

1996 133 78 40 25 33 16 17 63 23 9

1997 128 79 52 28 39 17 18 51 15 7

1998 110 79 43 20 31 13 21 57 17 10

1999 126 75 55 30 29 12 24 63 22 19

2000 116 66 20 13 10 4 13 60 21 10

2001 119 74 18 11 20 7 12 76 26 16

2002 112 78 27 11 9 2 8 79 33 21

2003 128 75 26 14 19 8 14 65 26 15

2004 128 80 22 12 18 3 15 86 37 29

2005 157 76 26 18 16 1 8 82 23 14

2006 135 71 23 9 14 1 4 70 28 25

2007 111 82 15 7 16 3 6 59 21 11

2008 125 72 24 15 13 4 8 74 23 17

2009 115 74 28 14 16 5 7 70 41 19

2010 110 76 35 12 23 5 10 85 36 33

2011 86 74 24 10 28 5 9 109 39 36

2012 96 73 29 13 21 3 5 94 37 36

2013 86 59 21 3 12 1 6 104 48 45

2014 103 63 23 11 13 5 6 94 41 35

2015 107 56 21 7 15 0 6 81 34 21

2016 130 76 46 16 16 4 6 91 26 20

25

Infants <32 weeks and/or <1500g

Tables 21 & 22 show the neonatal mortality for all the very low gestation or very low

birthweight infants. Table 23 and Figure 14 show 3 rolling year mean survival by gestational

week for infants <30 weeks.

Table 21: Ward 35 1994-2016 - Survival of all infants <32 weeks to 27 days by

gestational age

<24w 24-25w 26-27w 28-29w 30-31w All <32w

Year Tot L % Tot L % Tot L % Tot L % Tot L % L Tot %

1994 4 0 0% 33 21 64% 30 23 77% 70 63 90% 74 72 97% 179 211 85%

1995 1 0 0% 20 12 60% 28 24 86% 57 51 89% 44 42 95% 129 150 86%

1996 2 2 100% 22 14 64% 38 25 66% 48 42 88% 62 61 98% 144 172 84%

1997 2 1 50% 18 8 44% 35 22 63% 53 47 89% 60 57 95% 135 168 80%

1998 2 0 0% 26 15 58% 23 21 91% 40 37 93% 64 61 95% 134 155 86%

1999 3 0 0% 19 10 53% 37 30 81% 38 32 84% 49 46 94% 118 146 81%

2000 5 2 40% 12 8 67% 20 17 85% 40 37 93% 52 51 98% 115 129 89%

2001 1 1 100% 18 11 61% 25 24 96% 51 47 92% 44 42 95% 125 139 90%

2002 3 2 67% 31 25 81% 37 31 84% 40 38 95% 54 52 96% 148 165 90%

2003 4 1 25% 31 23 74% 27 22 81% 44 40 91% 48 48 100% 134 154 87%

2004 7 7 100% 22 21 95% 47 42 89% 44 43 98% 41 38 93% 151 161 94%

2005 6 0 0% 32 25 78% 36 34 94% 47 47 100% 59 57 97% 163 180 91%

2006 3 1 33% 28 19 68% 41 32 78% 38 35 92% 52 51 98% 138 162 85%

2007 3 2 67% 24 17 71% 43 33 77% 21 19 90% 47 44 94% 115 138 83%

2008 16 9 56% 23 18 78% 45 40 89% 41 38 93% 50 48 96% 153 175 87%

2009 2 2 100% 24 18 75% 42 39 93% 46 44 96% 66 64 97% 167 180 93%

2010 4 2 50% 31 22 71% 40 40 100% 41 39 95% 61 58 95% 161 177 91%

2011 7 5 71% 28 27 96% 40 36 90% 61 60 98% 66 63 95% 191 202 95%

2012 12 8 67% 31 24 77% 36 34 94% 41 38 93% 60 59 98% 163 180 91%

2013 9 7 78% 31 28 90% 29 27 93% 39 39 100% 60 60 100% 161 168 96%

2014 2 1 50% 27 22 81% 33 29 88% 28 27 96% 60 54 90% 133 150 89%

2015 12 9 75% 25 21 84% 27 25 93% 28 27 96% 50 50 100% 132 142 93%

2016 9 6 67% 21 17 81% 38 36 95% 34 31 91% 61 56 92% 146 163 90%

Totals 119 68 57% 577 426 74% 797 686 86% 990 921 93% 1284 1234 96% 3335 3767 89%

26

Table 22: Ward 35 RVI 1994-2016 - Survival of all infants <1500g to 27 days by

birthweight

<500g 500-749g 750-999g 1000-1249g 1250-1499g All <1500g

Year Tot L % Tot L % Tot L % Tot L % Tot L % L Tot %

1994 1 1 100% 34 18 53% 50 41 82% 52 50 96% 58 55 95% 165 195 85%

1995 0 0 0% 13 9 69% 35 26 74% 43 40 93% 55 48 87% 123 146 84%

1996 2 0 0% 28 18 64% 38 29 76% 44 38 86% 44 42 95% 127 156 81%

1997 1 1 100% 26 12 46% 31 21 68% 53 49 92% 50 46 92% 129 161 80%

1998 1 1 100% 21 12 57% 29 25 86% 45 40 89% 39 37 95% 115 135 85%

1999 3 0 0% 19 10 53% 31 23 74% 46 42 91% 45 40 89% 115 144 80%

2000 0 0 0% 17 10 59% 29 26 90% 41 37 90% 42 42 100% 115 129 89%

2001 2 1 50% 19 14 74% 37 34 92% 40 36 90% 30 30 100% 115 128 90%

2002 1 0 0% 35 28 80% 44 42 95% 33 29 88% 45 44 98% 143 158 91%

2003 6 3 50% 29 21 72% 32 27 84% 41 39 95% 33 33 100% 123 141 87%

2004 1 1 100% 30 29 97% 42 40 95% 45 40 89% 33 32 97% 142 151 94%

2005 5 1 20% 30 22 73% 32 30 94% 41 39 95% 46 46 100% 138 154 90%

2006 1 1 100% 30 18 60% 37 32 86% 38 33 87% 42 39 93% 123 148 83%

2007 1 0 0% 26 21 81% 37 29 78% 39 33 85% 41 39 95% 122 144 85%

2008 4 1 25% 42 34 81% 45 37 82% 36 34 94% 40 39 98% 145 167 87%

2009 2 1 50% 35 30 86% 35 33 94% 42 40 95% 42 40 95% 144 156 92%

2010 4 2 50% 26 21 81% 42 37 88% 40 39 98% 57 54 95% 153 169 91%

2011 0 0 0% 36 33 92% 43 38 88% 55 55 100% 52 52 100% 178 186 96%

2012 3 2 67% 35 27 77% 40 36 90% 44 43 98% 56 54 96% 162 178 91%

2013 4 3 75% 33 29 88% 35 34 97% 24 23 96% 53 53 100% 142 149 95%

2014 2 0 0% 24 21 88% 34 31 91% 36 34 94% 49 44 90% 130 145 90%

2015 0 0 0% 30 24 80% 32 31 97% 38 34 89% 28 28 100% 117 128 91%

2016 2 0 0% 35 30 86% 36 30 83% 35 35 100% 49 49 100% 144 157 92%

Totals 46 19 41% 653 491 75% 846 732 87% 951 882 93% 1029 986 96% 3110 3525 88%

27

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

GA

<24 Survived/Total 1/3 2/3 6/16 2/2 2/4 5/7 6/12 6/9 1/2 9/12 6/9

3 yr rolling mean

survival (95% CI)

25.0

(8.9 – 53.2)

40.9

(23.2 – 61.3)

47.6

(28.3 – 67.6)

45.5

(26.9 – 65.3)

69.2

(42.4 – 87.3)

56.5

(36.8 – 74.4)

60.7

(42.4 – 76.4)

56.5

(36.8 – 74.4)

69.6

(49.1 – 84.4)

69.6

(49.1 – 84.4)

24 Survived/Total 8/14 9/10 10/16 9/17 6/12 11/12 11/18 10/15 13/17 10/12 8/10

3 yr rolling mean

survival (95% CI)

64.1

(48.4 – 77.3)

67.5

(52.0 – 79.9)

65.1

(50.2 – 77.6)

55.6

(41.2 – 69.1)

63.4

(48.1 – 76.4)

66.7

(51.6 – 79.0)

71.1

(56.6 – 82.3)

68.0

(54.2 – 79.2)

60.6

(44.0 – 75.0)

79.5

(64.5 – 89.2)

25 Survived/Total 11/14 8/14 5/7 7/7 14/19 14/16 13/13 15/16 9/10 11/13 9/11

3 yr rolling mean

survival (95% CI)

68.9

(54.3 – 80.5)

68.6

(52.0 – 81.4)

71.4

(52.9 – 84.7)

78.8

(62.2 – 89.3)

83.3

(69.4 – 91.7)

85.4

(72.8 – 92.8)

93.3

(82.1 – 97.7)

94.9

83.1 – 98.6)

89.7

(76.4 – 95.9)

85.3

(69.9 – 93.6)

26 Survived/Total 11/13 10/17 21/23 19/20 16/18 14/17 15/17 7/9 13/14 11/11 18/19

3 yr rolling mean

survival (95% CI)

81.6

(68.6 – 90.0)

79.2

(66.5 – 87.9)

83.3

(72.0 – 90.7)

91.8

(82.2 – 96.4)

89.1

(78.2 – 94.9)

86.5

(74.7 – 93.3)

83.7

(70.0 – 91.9)

87.5

(73.9 – 94.5)

91.2

(77.0 – 97.0)

95.5

(84.9 – 98.7)

27 Survived/Total 21/28 23/26 18/22 20/22 21/22 21/23 17/19 17/20 16/19 14/16 18/19

3 yr rolling mean

survival (95% CI)

78.9

(68.0 – 86.8)

81.6

(71.4 – 88.7)

87.1

(77.3 – 93.1)

89.4

(79.7 – 94.8)

92.5

(83.7 – 96.8)

92.2

(83.0 – 96.6)

88.7

(78.5 – 94.4)

86.2

(75.1 – 92.8)

85.5

(73.8 – 92.4)

88.9

(77.8 – 94.8)

28 Survived/Total 13/16 6/7 21/22 21/22 24/26 20/20 19/22 14/14 11/11 14/15 14/17

3 yr rolling mean

survival (95% CI)

90.9

(78.8 – 96.4)

88.9

(76.5 – 95.1)

94.1

(84.1 – 98.0)

94.3

(86.2 – 97.8)

95.6

(87.8 – 98.5)

92.6

(83.9 – 96.8)

94.6

(85.4 – 98.2)

93.6

(82.8 – 97.8)

97.5

(87.1 – 99.6)

90.7

(78.4 – 96.3)

29 Survived/Total 22/22 13/14 17/19 23/24 15/15 40/41 19/19 25/25 16/17 13/13 17/17

3 yr rolling mean

survival (95% CI)

96.8

(89.0 – 99.1)

94.5

(85.1 – 98.1)

93.0

(83.3 – 97.2)

94.8

(85.9 – 98.2)

97.5

(91.3 – 99.3)

98.7

(92.8 – 99.8)

98.8

(93.6 – 99.8)

98.4

(91.3 – 99.7)

98.2

(90.4 – 99.7)

97.9

(88.9 – 99.6)

Table 23: 3 year rolling survival for all infants <30 weeks 2006-2016

28

Transfers from other hospitals

224 infants were transferred in from other hospitals because of an anticipated or actual need

for intensive or high dependency care. Their hospital of origin is shown in Table 24

(antenatal transfers) and Table 25 (postnatal transfers) along with the details of infants

transferred since 1994. The numbers of transfers continue to fall significantly as our cot

occupancy has led to us refusing a proportion of our antenatal and postnatal transfer requests

in order to prioritise the most preterm, sick or complex infants.

Figure 14: Ward 35 RVI - 3 year rolling survival for all infants <30 weeks 1994-2016

29

Table 24: Antenatal transfers in to the RVI and their hospital of booking 1994-2016

30

Table 25: Postnatal transfers in to the RVI and their hospital of booking 1994-2016

31

Neonatal Transfer Team

Following the 2015 RCPCH report on the Northern Neonatal Network’s intensive care

services the Northern Neonatal Transport Service (NNeTS) team was established, based at the

RVI. The service aims to have Specialist Transport Nurses providing non-acute and

repatriation work, with Transport Nurse Practitioners (trained to Advanced Neonatal Nurse

Practitioner level) for acute uplifts.

NNeTS has currently reached full establishment for the Specialist Transport Nurses and has

recruited half of the required Transport Nurse Practitioners (who are undergoing training).

There is also established and ongoing telephone access to a Neonatal Intensive Care

Consultant for advice and support. During the transition to a Nurse Practitioner delivered

service, acute uplifts remain supported by a team of experienced, neonatal-trained medical

staff from Ward 35. Governance links into the host Trust have been formalised and ongoing

work is being done to improve the process of receiving and assigning referrals by establishing

call conferencing and recording. In the next year service user feedback will be collected

routinely as part of service development.

The data below include the period of transition as the NNeTS team became operational and

transfers undertaken by the team from James Cook University Hospital ceased. We anticipate

that patient flows will change as cots reopen at the RVI (in particular transfers out of the

RVI). Though type of transport may change between centres in the south of the region with

reconfiguration, there will not be a substantial drop in the numbers of transfers completed.

616 transfers were undertaken during the year, a significant increase from 2015, reflecting the

change in regional transport activity as outlined above. The annual totals by type of transfer

1997-2016 are shown in Table 26. Trends in back transfers 1997-2016 are shown in Figure

15: the sustained number of repatriations to the RVI continues in part to reflect returns to the

following acute transfer out for capacity reasons after delivery.

32

33

Table 26: Neonatal transfer service activity 1997-2016 by type

Year 1997 98 99 2000 01 02 03 04 05 06 07 08 09 2010 11 12 13 14 15 16

Neonatal

Medicine 156 173 198 176 167 217 238 291 329 302 255 283 268 286 306 366 341 337 332 471

Surgery 28 21 26 16 18 30 16 29 23 26 27 24 32 31 35 43 21 32 47 49

Cardiology 28 37 41 35 43 63 64 76 69 70 63 70 63 56 64 63 83 48 63 69

Paediatric

Medicine 28 26 22 30 21 27 21 41 28 39 36 28 20 27 24 18 9 7 10 10

Surgery 2 4 0 1 1 0 1 2 2 2 3 1 1 0 2 1 1 1 1 1

Cardiology 8 2 3 1 2 2 3 6 4 3 5 3 3 2 2 0 3 4 2 4

ECMO 11 11 16 11 19 24 16 11 10 4 5 9 7 10 5 8 3 8 1 9

Other 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 3

Totals 262 274 306 270 271 363 359 456 465 446 394 418 394 412 438 499 461 438 456 616

34

Developmental follow up 2016: Infants born in 2014

The following is a summary of the 2 year outcome data for infants born <30 weeks or

who underwent therapeutic hypothermia. The data was obtained by performing a

query on the Badger database and reviewing the data from here, the unit database and

from local clinic letters.

There were 58 patients in total. 50 in the <30 weeks and 8 who received therapeutic

hypothermia. This is significantly less than previously, due to a combination of

increasing numbers of babies refused admission to or referred out of the RVI and

secondly the national directive that responsibility for follow-up data lies with the

hospital from where a baby is discharged home.

Data were available from either Badger or clinic letters for 52 (90%) patients (44/50

(88%) in those <30 weeks and all 8 infants who received therapeutic hypothermia).

There were 2 patients who did not attend appointments despite multiple opportunities.

This has also been recorded on Badger.

For the patients without data the breakdown is as follows:

1 Moved out of area

3 No appointment given but should have been seen

In the 58 patients who were seen the breakdown is in Tables 27 & 28. The

proportions of infants by disability outcome at each gestational week <30 weeks or

those following therapeutic hypothermia are shown in Figures 16 & 17. Aggregate

outcome data for infants born in the period 1st January 2011 – 31

st December 2014 are

shown in Figures 18 & 20. Figure 19 shows Epicure 2 data for infants <26 weeks for

comparison.

The Disability Outcome Evaluation was classified as follows:

Severe Impairment Non-ambulatory CP (GMFCS levels III-IV)

Profound sensineural hearing loss – not improved by aids

Developmental quotient <3SD mean for age (<0.1st centile)

Moderate Impairment Ambulant CP (GMFCS level II)

Functionally impaired vision

Hearing loss improved by aids

Developmental score 2-3SD < mean (0.4th

– 2nd

centile)

Mild Abnormal neurological signs but minimal functional

impairment (level I)

Squint or refractive errors

Hearing loss not sufficient to require aids

Developmental scores 1 or 2SD below mean (5th

- 9th

centile)

For those patients with a diagnosis of Cerebral palsy we used the Gross Motor

Function Classification (GMFCS).

35

Level 1 Infants move in and out of sitting and floor sit with both hands

free to manipulate objects. Crawl on hands and knees, pull to

stand and take steps holding onto furniture. Walk between 18

months and 2 years without need for any assistive device.

Level II Maintain floor sitting but may need hands for support to

maintain balance. Creep on stomach or crawl on hands and

knees. May pull to stand and take steps holding onto furniture.

Level III Maintain floor sitting when low back is supported. Roll and

creep forward on stomach.

Level IV Have head control but trunk support required for floor sitting.

Can roll to supine and may roll to prone.

Level V Physical impairments limit voluntary control of movement.

Infants unable to maintain antigravity head and trunk postures

in prone and sitting. Require assistance to roll.

Table 27: Ward 35 RVI – 2 year corrected neurodevelopmental outcome of

infants 23-26 weeks gestation born in 2014

Gestation (weeks) 23 24 25 26

Total number 1 5 7 9

Visual Problems

Strabismus 0 0 0 0

Myopia 1 0 0 0

Hyperopia 0 0 0 0

Blind 0 0 1 0

Cerebral Palsy GMFCS

Severe 3-5 0 0 1 0

Moderate 2 0 0 0 0

Mild 1 1 0 0 0

Hearing Impairment 1 0 0 0

Home Oxygen 0 0 0 0

Expressive Speech Delay 0 2 2 0

Developmental Delay

Normal 0 3 6 6

Mild 0 1 2 2

Moderate 0 0 1 1

Severe 1 1 0 0

36

Figure 16: Ward 35 RVI neurodisability data for infants born <26 weeks

gestation in 2014

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

23 24 25 26

Gestation

Severe

Moderate

Mild

NormalProportion(%)

37

Table 28: Ward 35 RVI – 2 year corrected neurodevelopmental outcome of

infants 27-29 weeks gestation & term infants with HIE born in 2014

Gestation (weeks) 27 28 29 HIE

Total Number 7 5 10 8

Visual Problems

Strabismus 0 0 0 0

Myopia 0 0 0 0

Hyperopia 0 0 0 0

Blind 0 0 0 0

Cerebral Palsy (GMFCS)

Severe 3-5 0 0 1 2

Moderate 0 0 0 2

Mild 0 1 0 0

Hearing Impairment 0 0 2 0

Home Oxygen 0 0 0 0

Expressive Speech Delay 3 0 0 0

Global Delay

Normal 11 13 13 5

Mild 0 0 2 1

Moderate 2 0 4 1

Severe 0 0 0 1

Figure 17 : Ward 35 RVI neurodisability data for infants born 27-29 weeks

gestation or with HIE in 2014

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

27 28 29 HIE

Proportion(%)

Gestation/Diagnosis

Severe

Moderate

Mild

Normal

38

Figure 18: Ward 35 RVI neurodisability data for infants born <26 weeks

gestation in 2011-14

Figure 19: Epicure 2 data (at 3 years corrected age) for comparison

39

Figure 20 : Ward 35 RVI neurodisability data for infants born 27-29 weeks

gestation or with HIE in 2011 - 14

40

Nursing Initiatives 2016/17

Staff Recruitment

During the last two years we have found it challenging to maintain the service at 34 cots. The

unit reached a critical point in 2015 and a decision was made to close a number of

intensive/high dependency and low dependency cots. Significant investment was necessary to

improve the nurse staffing levels closer to BAPM standards. As part of our efforts to achieve

this we hosted an open day in March and September and managed to recruit 34 nurses in

2016. In addition we have increased our practice support establishment from 2 nurses to 6

nurses working in a team to support the new staff. The increase in staff has enabled us to re-

open the closed intensive/high dependency cots in May 2017 and some of the low

dependency cots in June 2017. We are hoping that we will be successful with a business case

to improve staffing levels further, aided by our gaining permission to over-recruit at Band 5 to

offset vacancies.

Transport Team

In 2016 we were given funding from the Specialised Commissioners to set up a stand-alone

transfer service for the Northern Network. This has been a significant challenge, particularly

with regard to recruiting a team of 25 whole time equivalents. To date we have recruited to all

the nursing and administrative support roles. All of the Specialist Nurses are involved in audit

and service improvement so that we continually review and improve the service. The team is

now up and running and embracing the considerable challenges this new venture has posed.

This has been a magnificent achievement and we are very proud of what the team have

achieved to date.

41

Newcastle Neonatal Service Publications 2016-17

Abbott J, Berrington J, Bowler U, Boyle E, Dorling J, Embleton N, Juszczak E, Leaf A,

Linsell L, Johnson S, McCormick K, McGuire W, Roberts T, Stenson B. The Speed of

Increasing milk Feeds: A randomised controlled trial (2017) BMC Pediatrics, 17 (1), art. no.

39.

Abdulkadir B, Nelson A, Skeath T, Marrs ECL, Perry JD, Cummings SP, Embleton ND,

Berrington JE, Stewart CJ. Stool bacterial load in preterm infants with necrotising

enterocolitis (2016) Early Human Development, 95, pp. 1-2.

Abdulkadir B, Nelson A, Skeath T, Marrs ECL, Perry JD, Cummings SP, Embleton ND,

Berrington JE, Stewart CJ. Routine Use of Probiotics in Preterm Infants: Longitudinal Impact

on the Microbiome and Metabolome (2016) Neonatology, 109 (4), pp. 239-247.

Ball HL, Howel D, Bryant A, Best E, Russell C, Ward-Platt M.

Bed-sharing by breastfeeding mothers: who bed-shares and what is the relationship with

breastfeeding duration? Acta Paediatr. 2016 Jun;105(6):628-34. doi: 10.1111/apa.13354.

Banerjee J, Kaur C, Ramaiah S, Roy R, Aladangady N. Factors influencing the uptake of

neonatal bereavement support services - Findings from two tertiary neonatal centres in the

UK. BMC Palliat Care. 2016 Jun 29; 15(1):54.

Berrington J, Ward Platt M. Recent advances in the management of infants born <1000 g.

Arch Dis Child. 2016 Nov;101(11):1053-1056. doi: 10.1136/archdischild-2015-309583.

Boardman J, Harigopal S, Heep A et al. Fetal and Neonatal Brain Magnetic Resonance

Imaging: Clinical Indications, Acquisitions and Reporting A Framework for Practice. British

Association of Perinatal Medicine. February 2016.

http://www.bapm.org/publications/documents/guidelines/BAPM%20MRI%20standards%20f

or%20fetal%20neonatal%20brain%20imaging_FINAL%20SUBMISSION%20080216.pdf

Brown JV, Embleton ND, Harding JE, Mcguire W. Multi-nutrient fortification of human milk

for preterm infants (2016) Cochrane Database of Systematic Reviews, 2016 (5), art. no.

CD000343.

Cleminson JS, Zalewski SP, Embleton ND. Nutrition in the preterm infant: What's new?

(2016) Current Opinion in Clinical Nutrition and Metabolic Care, 19 (3), pp. 220-225.

Cormack BE, Embleton ND, Van Goudoever JB, Hay WW, Bloomfield FH. Comparing

apples with apples: It is time for standardized reporting of neonatal nutrition and growth

studies (2016) Pediatric Research, 79 (6), pp. 810-820.

Cronin de Chavez A, Ball HL, Ward-Platt MP. Bi-ethnic thermal care beliefs in Bradford,

UK. International Journal of Human Rights in Healthcare 2016;9:120-134.

Draper ES, Manktelow BN, Cuttini M, Maier RF, Fenton AC, Van Reempts P, Bonamy AK,

Mazela J, Borch K, Koopman-Esseboom C, Varendi H, Barros H Zeitlin J on behalf of the

EPICE cohort. High variability in very preterm stillbirth and in-hospital mortality across

Europe: EPICE study. Pediatrics (in press).

42

Edstedt Bonamy A-K, Gudmundsdottir A, Maier RF, Toome L, Zeitlin J, Bonet M,

Fenton A, Hasselager A.B, van Heijst A, Gortner L, Milligan D, Van Reempts P, Boyle

E.M, Norman M and collaborators from the EPICE Research Group. Patent ductus arteriosus

treatment in very preterm infants: a European population-based cohort study (EPICE) on

variation and outcomes. Neonatology 2017; 111:367-375.

Embleton ND, Korada M., Wood, C.L., Pearce, M.S., Swamy, R., Cheetham, T.D. Catch-up

growth and metabolic outcomes in adolescents born preterm (2016) Archives of Disease in

Childhood, 101 (11), pp. 1026-1031.

Embleton ND, Zalewski S, Berrington JE. Probiotics for prevention of necrotizing

enterocolitis and sepsis in preterm infants (2016) Current Opinion in Infectious Diseases, 29

(3), pp. 256-261.

Embleton ND, Fewtrell M. Complementary feeding in preterm infants (2017) The Lancet

Global Health, 5 (5), pp. e470-e471.

Embleton ND, Cleminson J, Zalewski S. What growth should we aim for in preterm

neonates? (2017) Paediatrics and Child Health (United Kingdom), 27 (1), pp. 18-22.

Embleton N, Cleminson J. Randomized trial of exclusive human milk versus preterm formula

diets in extremely premature infants (2017) Acta Paediatrica, International Journal of

Paediatrics. In Press.

Fewtrell M, Bronsky J, Campoy C, Domellöf M, Embleton N, Mis NF, Hojsak I, Hulst JM,

Indrio F, Lapillonne A, Molgaard C. Complementary feeding: A position paper by the

European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

committee on nutrition (2017) Journal of Pediatric Gastroenterology and Nutrition, 64 (1), pp.

119-132.

Hojsak I, Colomb V, Braegger C, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler

Mis N, Hulst JM, Indrio F, Lapillonne A, Mihatsch W, Molgaard C, Van Goudoever J,

Fewtrell M. ESPGHAN committee on nutrition position paper. Intravenous lipid emulsions

and risk of hepatotoxicity in infants and children: a systematic review and meta-analysis

(2016) Journal of Pediatric Gastroenterology and Nutrition, 62 (5), pp. 776-792.

Kent A, Kortsalioudaki C, Monahan IM, Bielicki J, Planche TD, Heath PT, Sharland M,

Bedford-Russell A, Bromage B, Chang J, Claxton A, Collinson A, Embleton N, Grey J,

Kapellou O, Narayanan M, Neal T, Perks V, Scorrer T, Turner M, Twagira M. Neonatal

gram-negative infections, antibiotic susceptibility and clinical outcome: An observational

study (2016) Archives of Disease in Childhood. In Press.

Kuttysankaran R, Baglietto A, Harigopal S. Identifying neonatal potential for solid organ and

tissue donation, Transplantation, July 2016, Volume 100 – Supplement 7S-1.

Kuttysankaran R, Athiraman N, Fenton AC, Ramaiah S. Does the use of nasal continuous

positive airway pressure increase the risk of a significant pneumothorax in late preterm and

term neonates? Pediatrics & Neonatology. In Press.

Lapillonne A, Nardecchia S, Carnielli VP, Mihatsch W, Embleton ND.

Parenteral nutrition of preterm infants may lead to inadequate phosphorus supply (2016)

Journal of Pediatric Gastroenterology and Nutrition, 63 (1), pp. e20-e21.

Mihatsch WA, Braegger C, Bronsky J, Campoy C, Domellöf M, Fewtrell M, Mis NF, Hojsak

I, Hulst J, Indrio F, Lapillonne A, Molgaard C, Embleton N, Van Goudoever J. Prevention of

43

Vitamin K deficiency bleeding in newborn infants: A position paper by the ESPGHAN

committee on nutrition (2016) Journal of Pediatric Gastroenterology and Nutrition, 63 (1), pp.

123-129.

Ng DHC, Klassen J, Embleton ND, Mcguire W. Protein hydrolysate versus standard formula

for preterm infants (2016) Cochrane Database of Systematic Reviews, 2016 (10), art. no.

CD012412.

Rankin J, Glinianaia SV, Jardine J, Mcconachie H, Borrill H, Embleton ND. Measuring self-

reported quality of life in 8- to 11-year-old children born with gastroschisis: Is the

KIDSCREEN questionnaire acceptable? (2016) Birth Defects Research Part A - Clinical and

Molecular Teratology, 106 (4), pp. 250-256.

Richards J, Graham RH, Embleton ND, Rankin J. Health professionals' perspectives on

bereavement following loss from a twin pregnancy: A qualitative study (2016) Journal of

Perinatology, 36 (7), pp. 529-532.

Sapuan S, Kortsalioudaki C, Anthony M, Chang J, Embleton ND, Geethanath RM, Gray J,

Greenough A, Lal MK, Luck S, Pattnayak S, Reynolds P, Russell AB, Scorrer T, Turner M,

Heath PT, Vergnano S. Neonatal listeriosis in the UK 2004–2014 (2017) Journal of Infection,

74 (3), pp. 236-242.

Shillitoe BMJ, Berrington J, Athiraman N. Congenital pleural effusions: 15 years single-

centre experience from North-East England (2017) Journal of Maternal-Fetal and Neonatal

Medicine, pp. 1-4. In Press.

Skeath T, Stewart C, Waugh S, Embleton N, Cummings S, Berrington J. Cytomegalovirus

and other common enteric viruses are not commonly associated with NEC (2016) Acta

Paediatrica, International Journal of Paediatrics, 105 (1), pp. 50-52.

Sproat T, Hearn R, Harigopal S. Outcome of babies with no detectable heart rate before 10 minutes of age, and the effect of gestation. Arch Dis Child Fetal Neonatal Ed. 2017

May;102(3):F262-F265. doi: 10.1136/archdischild-2016-311041. Epub 2016 Oct 25.

Stewart CJ, Nelson A, Treumann A, Skeath T, Cummings SP, Embleton N, Berrington JE.

Metabolomic and proteomic analysis of serum from preterm infants with necrotising

entercolitis and late-onset sepsis (2016) Pediatric Research, 79 (3), pp. 425-431.

Stewart CJ, Embleton ND, Clements E, Luna PN, Smith DP, Fofanova TY, Nelson A, Taylor

G, Orr CH, Petrosino JF, Berrington JE, Cummings SP. Cesarean or vaginal birth does not

impact the longitudinal development of the gut microbiome in a cohort of exclusively preterm

infants (2017) Frontiers in Microbiology, 8 (JUN), art. no. 1008.

Subhedar N, Deshpande S, Harigopal S, Calvert S. Pulmonary hypertension in neonates:

sildenafil. NICE advice [ESUOM51], March 2016.

Teller IC, Embleton ND, Griffin IJ, van Elburg RM. Post-discharge formula feeding in

preterm infants: A systematic review mapping evidence about the role of macronutrient

enrichment (2016) Clinical Nutrition, 35 (4), pp. 791-801.

Tinnion R. Appendix F: Resuscitation at birth. In: Advanced Paediatric Life Support: A

Practical Approach to Emergencies (APLS) 6th Edition (2016). Eds: Samuels M, Weiteska S.

44

Ward Platt M. The MBRRACE-UK perinatal surveillance report. Arch Dis Child Fetal

Neonatal Ed. 2016 Jan;101(1):F4-5. doi: 10.1136/archdischild-2015-309271.

Wyllie J, Ainsworth S, Tinnion R, Hampshire S (eds). Newborn Life Support, 4th Edition.

Resuscitation Council (UK). 2016. ISBN 978-1-903812-33-4.

https://www.resus.org.uk/publications/newborn-life-support-resuscitation-at-birth-manual

Young L, Embleton ND, Mcguire W. Nutrient-enriched formula versus standard formula for

preterm infants following hospital discharge (2016) Cochrane Database of Systematic

Reviews, 2016 (12), art. no. CD004696.

Zilbauer M, Zellos A, Heuschkel R, Gasparetto M, Kraiczy J, Postberg J, Greco L, Auricchio

R, Galatola M, Embleton N, Wirth S, Jenke A. Epigenetics in paediatric gastroenterology,

hepatology, and nutrition: Present trends and future perspectives (2016) Journal of Pediatric

Gastroenterology and Nutrition, 62 (4), pp. 521-529.

45

Ward 35 RVI 2016 - Audits

TITLE

Undertaken by

Supervisor

Date

Maternal Antibodies and the Haemolytic

Disease of Newborn

Otilia

Osmulikevici

N Athiraman Jan 2016

Neonatal seizures Jenna Gillone N Athiraman Jan 2016

Head Circumference and Heart sounds Hannah Tumelty Sri Ramaiah Feb 2016

Management of Jaundice Fatima Jenabi N Athiraman Feb 2016

Central lines and fungi Sahar Habibollah N Athiraman Feb 2016

Hypoglycemia on ward 33 Rowan Giller S Harigopal Mar 2016

Communication on the neonatal ward

round

Nicole Sloan N Athiraman Mar 2016

An audit on prescribing and

administration of antibiotics on delivery

suite/post-natal wards

Sahar Habibollah N Athiraman Mar 2016

Management of PDA Liz Hodgson N Athiraman Apr 2016

Management of Post-op pain Ann Gardiner N Athiraman Aug 2016

NEWTT audit David McReary J Berrington Dec 2016

Temperature on admission in premature

babies audit

Lucy Baggot J Berrington Dec 16

Management of Hypoglycemia Noureen Afzal R Hearn Dec 16

Blood products transfusion audit results Lizzie Worrall Dec 2016

MBRRACE-UK R Hearn R Hearn Yearly

Matching Michigan infection audit A Fenton

A Fenton

Rolling

Specialised Services Quality Dashboard A Fenton

A Fenton

Rolling

46

Northern Neonatal Network Dashboard A Fenton

A Fenton

Rolling

Breast feeding audit Helen Smith H Smith

N Embleton

Rolling

Resuscitation Equipment check- Audit Andreas

Kakaroukas

N Athiraman Rolling

NNAP audits N Athiraman Rolling

Neurodevelopmental Outcome in babies

<30 weeks gestation

Jenny Dixon Rolling

QAF Audits: 1) Patient experience:

Senior team walkabouts, Buddy group,

Neonatal audit tool/Baby charter, BFI

Numerous staff Collated by S

Harigopal

Annual

QAF Audits: 2) Training: Clinical skills

training, Skills drills, Arterial sampling,

Mentorship, Neonatal modules, Induction

& orientation for new staff, NLS

Numerous staff Collated by S

Harigopal

Annual

QAF Audits: 3) Neonatal services: Risk

reviews, Child death reviews, 2 yr

developmental follow-up (<29 weeks &

those cooled for HIE), Fetal medicine

handover, Availability of resus

equipment, Unexpected term admissions,

Annual report

Numerous staff Collated by S

Harigopal

Annual

QAF Audits: 4) NNAP: Admission

temperature, ROP screening, Parental

discussion <24 hours, Breast milk feeding

at discharge

Numerous staff Collated by S

Harigopal

Annual