Transfer to neonatal care services#
Executive summary
Outcome: Admission to neonatal care services (transitional, special, high dependency or intensive care)
Specific to HIE?
No - NHS statistics on reason for admission indicates 2.5% admissions to any care services, and 5% admissions to intensive care, are due to suspected HIE
Which infants with HIE?
Depends on type of service - intensive care will be the most unwell/unstable - whilst any care service reflects any infants requiring additional support
Haven’t identified the percentage of infants with HIE who are admitted to neonatal care
Any other benefits or caveats not already mentioned?
Outcome of interest since admission is costly
Doesn’t necessarily mean poor long-term outcomes
Conclusion: Potentially recommended. Alone, this is not suitable as 95%+ of admitted infants will not have HIE. However, in combination with other indicators of HIE, it could support identifying more unwell infants with HIE (most unwell, if focussed on NICU).
Neonatal care services#
Neonatal care services ‘provide care for all babies less than 44 weeks post menstrual age that require on-going medical care’. Each year, around 10% of all births ‘will receive some type of neonatal care’.
Types of neonatal unit:
Neonatal Intensive Care Unit (NICU)
Local Neonatal Unit (LNU)
Special Care Unit (SCU)
Types of care:
Intensive Care - ‘for babies who are the most unwell or unstable and have the greatest needs in relation to staff skills and staff to patient ratios’
High Dependency Care - ‘for babies who require skilled staff but where the ratio of nurse to patient is less than intensive care’
Special Care - ‘for babies who require additional care delivered by the neonatal service but do not require either intensive or high dependency care’
Transitional care - also known as ‘Special Care with Primary Carer Resident’. Either delivered by a dedicated transitional care unit or on a postnatal ward. This is when more care is needed than normal, and this is provided by the parent with support from a midwife/healthcare professional trained in ‘elements of special care but does not require a specifialist neonatal qualitfication’
[Source (NHS England Neonatal Critical Care Service Specification)]
Statistics#
Reason for admission to NICU#
South West England 2017 report on term admissions to NICUs:
Respiratory syndromes (44%)
Other (26%)
Hypoglycaemia (9%)
Suspected HIE (7%)
Monitoring (7%)
Infection (7%)
Reason for admission to any neonatal care services#
NHS England 2017 report looked at term admissions at neonatal units (all types). They focussed on and reported the percentage of admissions due to:
Respiratory conditions (25%)
Hypoglycaemia (12%)
Jaundice (6%)
HIE (2.5%)
South West England 2017 report on term admissions at neonatal units (all types)found slightly different stats:
Respiratory syndromes (36%)
Suspected infection (23%)
Hypoglycaemia (9%)
Monitoring (6%)
Suspected HIE (5%)
Differences over time and between places#
In the 2017 NHS England report, suspected HIE was the fifth most common reason for term admission to neonatal care services (n=138 infants) - equating to 2.4 admission per 1000 births - and this was a substantial increase from 2012 where only one baby was admitted for suspected HIE in the region.
2012 - 1
2013 - 3
2014 - 5
2015 - 128
2016 - 138
In the latest data (2020-21), South West had suspected HIE as cause of 5.8% admissions (n=121) - whilst it was 2.2% (n=55) for Thames Valley and Wessex, and 2.6% (n=50) for Kent Surrey Sussex.
Other considerations#
Admission is an important outcome due to cost - admission is expensive, and transfer to neonatal care services can be important for cost-benefit analyses.
Availability of data is uncertain - e.g. anecdotally, some datasets won’t state the type of admission.
Whilst this reflects a poor short-outcome outcome, I haven’t yet identified data on long-term outcomes - but we know it’s likely that milder HIE cases won’t be admitted, whilst moderate to severe are more likely - and there is data on outcomes of moderate to severe HIE. Anecdotally, many of the babies will only need a short period of care and will not have poor long-term outcome.