The National Institute for Health and Care Excellence (NICE) has published an impact report on maternity and neonatal care which looks at progress made in implementing NICE guidance since its last report in May 2018.
The report is published against a background of moves to improve maternity and neonatal services.
In 2015, the Department of Health and Social Care (DHCS) announced its commitment to reduce the rate of stillbirths, neonatal and maternal deaths in England by 50% by 2030. Better births, improving outcomes of maternity services in England, published in February 2016, set out a vision for the transformation of maternity services. It envisaged safer, more personalised, kinder, professional and more family friendly maternity services across England, where women would have access to the information they needed to make decisions about their care and to access support for themselves and their babies. In July 2016, NHS England launched the Maternity Transformation Programme with the aim of achieving the goals set out in Better births. The aim of the NHS long term plan is now to halve the rates of stillbirths, neonatal and maternal deaths in England by 2025.
This article focuses on four aspects of the NICE impact report.
The impact report highlights the findings of the Twins and Multiple Births Association (TAMBA) three year Maternity Engagement Project. This project, which ran from 2016 to 2019, worked with 30 maternity units in England to improve outcomes for families experiencing multiple pregnancy by encouraging the implementation of the NICE guidance on twin and triplet pregnancies.
The Department of Health funded project involved specialist multiple midwives and Tamba staff supporting NHS staff within the 30 units. The units were audited and then re-visited 12 months later in order to assess the changes and their impact. The project found that, in those maternity units that made improvements, 65% of the units reduced neonatal admissions and 60% reduced their rates of emergency caesarean section.
The NICE impact report commented that, if all maternity units applied the NICE guidance on twin and triplet pregnancies, this could result in 634 fewer emergency caesarean sections and 1,308 fewer neonatal admissions in England every year, preventing 1 in 10 neonatal admissions involving babies from multiple births each year.
Where a baby’s rhesus D status is different to that of its mother, this can cause serious complications for the baby, including anaemia, jaundice and brain damage.
In November 2016, NICE recommended the introduction of the first reliable test for the D status of a baby prior to birth. The impact report says that, since the last impact report, in May 2018, the number of NHS trusts providing this test has increased from 40 to 54 and the number of tests carried out continues to increase. The test is due to be rolled out nationally by 2021/22.
When a new-born baby needs to be transferred to and from a specialist neonatal care service, it may well have problems such as respiratory difficulties or problems maintaining its body temperature. Accordingly, these babies may need extra support during transfer. NICE guidance recommends that neonatal transfer services are available so that babies can have safe and efficient transfers.
The impact report says that, based on data from the National Neonatal Audit Programme (NNAP), over the last three years, there has been a decrease in the number of babies born under 32 weeks who were admitted, following transfer, with a temperature of less than 36°C, which suggests that transfer services have improved in this area.
The NNAP audit also showed that, between 2014 and 2017, there was an increase in the number of babies who received specialist neonatal care who went on to receive a two-year follow-up of their health outcomes. For those babies who were born at less than 30 weeks gestation, there was a decrease of 5% (from 55% to 50%) in neurodevelopmental impairment at the two-year follow-up. The impact report considers that improvements in neonatal specialist care are likely to have contributed to this reduction.
Babies exposed to Sodium Valproate in the womb are at high risk of serious complications. According to data from the Medicines and Healthcare Products Regulatory Agency (MHRA), up to 4 in 10 of these babies may have developmental problems and 1 in 10 may have a birth defect.
The impact report highlights that NICE guidance has been updated so that it is aligned with the advice from the MHRA which says that Sodium Valproate must not be used by any women or girls able to have children unless there is a pregnancy prevention programme in place.
The impact report notes that, despite this, more can be done to reduce the risk. Although total prescribing of Sodium Valproate for women or girls between 14 and 45 in England has reduced in recent years, between January and March 2019, across the Clinical Commissioning Groups (CCGs), the proportion of women or girls between 14 and 45 who received prescriptions for Sodium Valproate ranged from 6% to 13%.
Camilla Wonnacott, associate in the Penningtons Manches Cooper clinical negligence team, said: “The latest NICE impact report highlights the work being done to improve maternity and neonatal care in a number of areas. Although it is encouraging to read about improvements and to see that the Government continues to be committed to increasing the standard of maternity and neonatal care, there is still clearly much to do. All too often we see the heart breaking results of care where improvement in standards could have transformed the outcome for both mother and baby.”