Exploring the relationship between care provided and clinical outcomes for preterm babies born between 27-31 weeks of gestation in England

My PhD investigated relationships between care provided for babies born between 27-31 weeks gestation in England and their outcomes.

It comprised: a systematic review examining whether place of birth/care affects outcomes for babies born between 27-31 weeks; literature reviews exploring (a) heterogeneity in outcomes for this cohort, (b) heterogeneity of structure and process within neonatal units and (c) concepts around measurement of quality of care; a study exploring the relationship between quality of care and outcomes for these babies.

Systematic review revealed a lack of evidence to guide optimisation of place of birth. Literature reviews demonstrated heterogeneity of outcomes related to degrees of fetal maturity between 27-31 weeks, and that variation in structure and process within neonatal units can impact outcomes.

In exploring relationships between quality of care and outcomes, plans for data collection using questionnaires proved unsuitable during piloting. Data from the National Neonatal Research Database (NNRD) were therefore utilised. To analyse care provided I measured unit compliance with pre-determined, evidence-based standards (administration of antenatal steroids, normothermia on admission, early use of non-invasive ventilation, and appropriate nurse staffing ratio), and then assessed data completion and compliance with National Neonatal Audit Programme (NNAP) measures. I categorised neonatal units (n=113, 4986 babies) into two groups, and compared the top quartile with the rest, using multivariate analyses to look for associations with length of stay (LOS) and pre-discharge mortality. I found no difference in mortality, but demonstrated a mean reduction in LOS by one day for babies born in neonatal units within the top quartile for compliance with evidence-based and NNAP measures. This supports a relationship between quality of care and outcomes, and the hypothesis that units striving to comply with national guidance and provide evidence-based care have better outcomes. This has potential implications for patient-flow and cost-effectiveness in neonatal care.