Shortage of nurses contributing to postcode lottery in neonatal care, warns RCN

A severe shortage of specialist neonatal nurses is contributing to a ‘postcode lottery’ in neonatal care, the RCN has warned.

The latest National Neonatal Audit Programme report (NNAP), published by the Royal College of Paediatrics and Child Health (RCPCH), shows improvements in care for preterm babies in England, Scotland and Wales, but also reveals variations in service delivery which means many babies are still not getting the care they need.

The audit highlighted improvements in measures including timely screening for retinopathy of prematurity, maintaining a baby’s temperature within the recommended range, and parents receiving a timely consultation with a senior member of the neonatal unit team.

Wide variations

However, the RCPCH said the audit, using data collected in 2016, also revealed wide variations including:

• Rates of administration of magnesium sulphate to mothers likely to deliver a preterm baby, which is recommended to reduce risk of cerebral palsy developing later, varied from 26% to 70%.
• The proportion of preterm babies discharged from hospital while receiving at least some of their own mother’s breastmilk varied from 39% to 78%.
• Four out of ten babies born more than ten weeks early had no two-year follow up clinical information of any type reported to the NNAP.

There are also several examples cited in the report of regional neonatal networks making significant improvements in the year since the last audit, including:

• In Wales, the number of babies born at less than 32 weeks whose temperature is recorded within an hour of admission within the recommended range of 36.5-37.5 degrees has increased from 56% in 2015, to 67% in 2016.
• Also in Wales, reporting of health data from a two-year follow up check for babies born at less than 30 weeks has risen from 31% in 2015 to 60% in 2016.
• In the Shropshire, Staffordshire and Black Country neonatal network, ‘on time’ screening for retinopathy of prematurity improved from 87% in 2015 to 98% in 2016.

‘Poorer outcomes’

RCN professional lead for children and young people’s nursing Fiona Smith said: ‘Neonatal care should not be a postcode lottery. 

‘While it is encouraging that improvements are being made to the care of preterm babies, services are under pressure and there continues to be a severe shortage of neonatal nurses.

‘The evidence is clear, poorer outcomes occur when there are less specialist neonatal nurses available. Staffing shortages must be addressed if we are to provide the 24/7 care these vulnerable babies need.’

NNAP clinical lead and consultant neonatologist Sam Oddie said: ‘There is no reason why many of these measures could not be achieved far more successfully. Paying attention to the clinical processes and working with the whole team to improve them are the keys to improvement.’

Further information

National Neonatal Audit Programme 2017 Annual Report on 2016 data

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