Inequalities in birth before arrival at hospital in South West England: a multimethods study of neonatal hypothermia and emergency medical services call-handler advice.

OBJECTIVES: To examine inequalities in birth before arrival (BBA) at hospitals in South West England, understand which groups are most likely to experience BBA and how this relates to hypothermia and outcomes (phase A). To investigate opportunities to improve temperature management advice given by emergency medical services (EMS) call-handlers during emergency calls regarding BBA in the UK (phase B). DESIGN: A two-phase multimethod study. Phase A analysed anonymised data from hospital neonatal records between January 2018 and January 2021. Phase B analysed anonymised EMS call transcripts, followed by focus groups with National Health Service (NHS) staff and patients. SETTING: Six Hospital Trusts in South West England and two EMS providers (ambulance services) in South West and North East England. PARTICIPANTS: 18 multidisciplinary NHS staff and 22 members of the public who had experienced BBA in the UK. RESULTS: 35% (64/184) of babies conveyed to hospital were hypothermic on arrival. When compared with national data on all births in the South West, we found higher percentages of women with documented safeguarding concerns at booking, previous live births and 'late bookers' (booking their pregnancy >13 weeks gestation). These women may, therefore, be more likely to experience BBA. Preterm babies, babies to first-time mothers and babies born to mothers with disability or safeguarding concerns at booking were more likely to be hypothermic following BBA. Five main themes emerged from qualitative data on call-handler advice: (1) importance placed on neonatal temperature; (2) advice on where the baby should be placed following birth; (3) advice on how to keep the baby warm; (4) timing of temperature management advice and (5) clarity and priority of instructions. CONCLUSIONS: Findings identified factors associated with BBA and neonatal hypothermia following BBA. Improvements to EMS call-handler advice could reduce the number of babies arriving at hospital hypothermic.

Preterm births in South-West England before and during the COVID-19 pandemic: an audit of retrospective data.

The COVID-19 lockdown had a series of intended and unintended consequences, including reduced infections and changes in activities and behaviours. Some of these changes may have been beneficial to perinatal outcomes; however, other factors such as reduced access to face-to-face healthcare may have contributed negatively to antenatal care. The aim of this audit was to evaluate neonatal admissions in the South-West of England during the COVID-19 pandemic in 2020 and the previous two years 2018-2019. Anonymised birth and neonatal admission rates from January to December 2020 was obtained and compared to data from 2018 to 2019. The results demonstrate a decreasing in neonatal unit admissions between 2018 and 2020, 9.48% of live births in 2018 (95% CI 9.17, 9.80) to 8.89% (95% CI 8.65, 9.13) in 2020 (p = 0.002).Conclusion: There were no significant differences across gestational groups. It is unclear without nationwide data whether our observed trends, decreased neonatal admissions over the past 3 years, are generalisable and related to the COVID-19 pandemic. Future research exploring the impact of lockdowns on behaviour change during pregnancy and support services is warranted to understand the implications of pandemics on pregnancy and preterm birth. What is Known: • The COVID-19 lockdown had a series of intended and unintended consequences; some of which may have been beneficial to perinatal outcomes. • Research suggests that preterm births have not significantly changed overall, but they have decreased in high-income countries. What is New: • In our audit, analysing retrospective data of regional birth and neonatal admission from the South-West of England, we observed a decrease in live birth rates between 2018 and 2020. • A reduction in neonatal unit admissions was observed from 2018 to 2020 with no significant differences across gestational groups. The reduction from 2019 to 2020 was smaller than that from 2018 to 2019 implying that the COVID-19 pandemic in 2020 was not necessarily implicated.

Early-onset sepsis: can we screen fewer babies safely?

BACKGROUND: Over the past 2-3 years at the Southwest Peninsula tertiary neonatal unit in Plymouth, the authors have observed an increase in the number of clinically well term infants being screened and treated with antibiotics for infection in accordance with NICE guidance. The aim of our study was to assess the safety of implementing the Kaiser Permanente Early Onset Sepsis (KPEOS) calculator to minimise antibiotic usage in term infants in line with antimicrobial stewardship, reducing separation from mother at birth and facilitating earlier discharge. METHODS: A 2-year retrospective review of medical records from 2014 to 2015 inclusive revealed 9217 deliveries, with 1550 infants (16.8%) having risk factors, 945 (10.2%) being term infants. Of those, 507 (53.6%) had a clinical reason to screen and 438 (46.4%) had risk factors alone treated with antibiotics for variable periods of time. This enabled us to review our usual practice and compare it with our KPEOS implementation. INTERVENTION: National Health Service England permission was obtained to implement the KPEOS for a 6-month period. We collected data on all 175 term infants with risk factors to compare with our previous practice when The National Institute for Health and Care Excellence and Royal College of Obstetrics and Gynaecology maternal guidance was being followed. RESULTS: The percentage of infants screened with a suspected infection previously receiving 5 days of antibiotics reduced from 31% (136/438) to 5% (9/157, p<0.0001) using the KPEOS calculator. Clinically well infants with risk factors alone previously receiving 36 hours of antibiotics, reduced from 63% (275/438) to 3% (5/157, p<0.0001) of infants treated. There was no late-onset sepsis in this study cohort or any observed adverse outcomes. CONCLUSION: These results demonstrated a potentially safe and effective quality improvement (QI) in our hospital with fewer babies treated and a reduced length of stay for this cohort. Considering individual hospitals rates for term Group B Streptococcal sepsis, this QI may be a safe and economical alternative to current practices for screening well term infants.