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National Neonatal Audit Programme (NNAP) 2025 Data

Appendix 1: Extended Analysis Report

Published on 8th October 2026

About this report

This is a supplementary extended analysis report to accompany the National Neonatal Audit Programme (NNAP) Summary report on 2025 data. It provides results by NNAP measure based on data relating to babies cared for in neonatal units in England, Scotland, Wales and the Isles of Man between 1 January and 31 December 2025. Results are presented by unit level (Special Care Unit (SCU), Local Neonatal Unit (LNU), Neonatal Intensive Care Unit (NICU)), and by neonatal network. The report includes key findings, national recommendations, suggested actions for local quality improvement, and links to further resources and case studies.

How to use additional NNAP resources

NNAP Online provides full annual results at unit and network level, interactive reporting tools and unit posters. You can also use this dashboard to access spine plots summarising your unit or network’s performance across NNAP metrics; we recommend these plots for accountability reporting.
The Public Access Dashboard provides provisional monthly updated time-series results. Neonatal services and networks can use a restricted access version (Restricted Access Dashboard).
Neonatal services identified as outliers should use this information to review the causes of outlier status and stimulate quality improvement. See outlier analysis on NNAP Online
NNAP unit posters communicate selected NNAP results for a neonatal unit to parents and families. They should not be used for accountability reporting.
Further information for parents and families is available on our Your baby’s care page.

Further resources

Further data about maternity and perinatal services is available from the National Maternity & Perinatal Audit (NMPA) and Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK). The NMPA measures aspects of maternity and neonatal care provided by NHS maternity services in England, Scotland and Wales. MBRRACE-UK conducts national surveillance and investigates the deaths of women and babies who die during pregnancy and shortly afterwards.

RCPCH &Us seeks and shares the views of children, young people, parents and carers to influence and shape health policy and practice. Use RCPCH&Us resources to support your improvement activities.

Methodology

Case mix adjustment

A case mix adjustment process is used in the mortality, necrotising enterocolitis, BPD or death, bloodstream infection and non-invasive breathing support measures. The process produces treatment effects for each unit and network. This shows whether differences in exposure are due to the care provided or the babies’ characteristics.

The unit level treatment effect analysis is conducted only for units that have assured their data. The neonatal network level analysis includes all units, even those that did not validate their data.

The treatment effect is the percentage difference between:

the actual proportion of babies with an outcome or treatment in a unit/network, and
the expected proportion, based on the babies’ characteristics.

Expected proportions are estimated using a logistic regression model on the national dataset. Each baby is given an expected outcome (between 0 and 1). These are summed for each unit/network and divided by the number of babies to get the expected proportion.

A negative treatment effect means babies would have been less likely have an outcome in that unit/network than they would elsewhere. A positive treatment effect means babies would have been more likely to have an outcome than if treated elsewhere.

For case mix adjsutment of non-invasive breathing support (which is a process measure), this effect is reversed, so in both cases a negative treatment effect indicates better than expected performance and a positive treatment effect indicates worse than expected performance.

Gestational age standardisation

For ethnicity bar charts we present both observed and standardised proportions, which are produced using direct standardisation.

Observed proportions by ethnicity are compared to proportions that have been adjusted to account for differences in gestational age (standardised proportions). Direct standardisation applies the national gestational age distribution to each ethnic group, producing proportions that reflect what we would expect to see if all ethnicities had the same gestational age profile.

Change over time

All longitudinal results are tested for statistical significance over time using the Cochran–Armitage trend test, which produces a probability (p) value that the change over time is a statistically significant trend, rather than random variation. P values are presented as footnotes alongside findings that relate to change over time.

Methodology and statistical analysis plan

For the full NNAP methodology and statistical analysis plan, see: NNAP Methodology and outlier process

NNAP measures and standards

The NNAP Methodology and Dataset Group and Project Board conduct a regular review of the NNAP dataset and audit measures in close consultation with the wider neonatal community, taking note of the publication or amendment of any relevant professional guidance and/or standards.

Developmental standards are described for most measures of care processes. The concept of ‘developmental standard’ is derived from the screening literature. The underlying aim is that a standard is set with a view to later revision, on a pathway towards eventual universal delivery of the specified care process item. The developmental standards are described in the NNAP measures guide, and may derive from consensus rather than externally developed standards.

Full details of each measure can be found in the NNAP 2025 audit measures guide.

Data for assurance and data for improvement

It is important to distinguish between the data referred to in this report and that seen within the Public Access Dashboard. The data published here has been subject to an NNAP data assurance window, and as such is published using data abstracted in April 2024. As part of the data assurance process, units were asked to review their data and specifically to offer assurance relating to necrotising enterocolitis, bloodstream infection and preterm brain injury. The results of this NNAP data assurance survey are represented in the specific sections of what follows and inform the graphical presentation of data as well as that shown online.

Annual results for 2025 and previous years continue to be available on NNAP Online.

Data completeness and case ascertainment

All eligible neonatal units in England, Wales, Scotland and the Isle of Man participate in the NNAP. It is expected that case ascertainment is 100%; however, the NNAP is aware that issues relating to interfacing of electronic patient record and care summary systems affect the quality of data and case ascertainment for a small number of participating units.

In some past NNAP reports, certain measures have not been reported for units experiencing challenges with data completeness. No units are now excluded from NNAP reporting. Rather it is recognised that some units will have high levels of missing data for certain measures or incomplete case ascertainment. This decision was taken to facilitate maximum participation in the NNAP, identify challenges with participation, and to encourage improvements in the quality of the data flow. The Neonatal Critical Care Service Specification states that all neonatal units must submit data to the NNAP for all measures. Neonatal units with known data completeness issues are noted in the Unit participation table.

The NNAP encourages early and frequent engagement with its dashboards so that any issues can be identified and investigated. The audit is actively engaging with affected services and networks, and with the audit commissioners and clinical system providers to consider future mitigations to these data flow issues.

1 Workstream one: Partnership in neonatal care

1.1 Parent consultation within 24 hours of admission

Measure question

Is there a documented consultation with parents by a senior member of the neonatal team within 24 hours of admission?

Senior member of the neonatal team means a consultant or middle grade doctor, or a nurse practitioner acting in such a role.

It is important that neonatal teams explain to parents the care provided to babies admitted to neonatal unit. If families are well informed, they will be more able to be fully involved in decision making for their baby. This first consultation provides an opportunity for the senior staff member to meet the parents, listen to their concerns, explain how their baby is being cared for and respond to any questions. This measure of care looks at whether parents have had a consultation with a senior member of the neonatal team within the first 24 hours of their baby being admitted. It applies for all babies who require care on a neonatal unit. A consultation should take place within 24 hours of admission for every baby, for every admission.

1.1.1 Results

1.1.1.1 Time series

Figure 1: Parent consultation in 24 hours, by year.

1.1.1.2 Network time series

Figure 2: Parent consultation in 24 hours, by neonatal network and year.

1.1.1.3 Type time series

Figure 3: Parent consultation in 24 hours, by level of neonatal unit and year.

1.1.1.4 Unit type results

Unit Type	Eligible episodes	With outcome	Adherent	Not adherent	Missing	After 24 hours	No consultation	Before admission
NICU	26,467	25,810	24,503 (94.9%)	1,307	657 (2.5%)	532	217	558
LNU	23,300	23,122	21,857 (94.5%)	1,265	178 (0.8%)	301	220	744
SCU	7,358	7,195	6,676 (92.8%)	519	163 (2.2%)	133	71	315
Total	57,125	56,127	53,036 (94.5%)	3,091	998 (1.7%)	966	508	1,617

Table 1: Parent consultation in 24 hours, by level of neonatal unit, 2025.

1.1.1.5 Network results

Network	Eligible episodes	With outcome	Adherent	Not adherent	Missing	After 24 hours	No consultation	Before admission
East Midlands	3,746	3,693	3,529 (95.6%)	164	53 (1.4%)	108	24	32
East England	5,644	5,597	5,181 (92.6%)	416	47 (0.8%)	89	37	290
Kent Surrey Sussex	4,016	3,934	3,744 (95.2%)	190	82 (2.0%)	65	35	90
London NCE	4,360	4,062	3,941 (97.0%)	121	298 (6.8%)	7	14	100
London NW	2,306	2,288	2,190 (95.7%)	98	18 (0.8%)	28	5	65
London South	2,854	2,707	2,376 (87.8%)	331	147 (5.2%)	18	23	290
North West	7,068	7,036	6,732 (95.7%)	304	32 (0.5%)	134	54	116
Northern	2,424	2,389	2,269 (95.0%)	120	35 (1.4%)	51	27	42
South West	3,717	3,693	3,477 (94.2%)	216	24 (0.6%)	81	22	113
Thames Valley Wsx	4,255	4,252	4,158 (97.8%)	94	3 (0.1%)	43	25	26
West Midlands	4,649	4,524	4,189 (92.6%)	335	125 (2.7%)	155	70	110
Yorkshire Humber	5,194	5,161	4,897 (94.9%)	264	33 (0.6%)	84	94	86
Scotland	4,288	4,227	3,913 (92.6%)	314	61 (1.4%)	72	73	169
Wales	2,543	2,503	2,390 (95.5%)	113	40 (1.6%)	31	4	78
Total	57,064	56,066	52,986 (94.5%)	3,080	998 (1.7%)	966	507	1,607

Table 2: Parent consultation in 24 hours, by neonatal network, 2025.

1.1.1.6 Caterpillar plot

Figure 4: Caterpillar plot of parent consultation in 24 hours, by neonatal unit, 2025.

1.1.1.7 Network caterpillar plot

Figure 5: Caterpillar plot of parent consultation in 24 hours, by neonatal network, 2025.

1.1.1.8 Ethnicity bar chart

Figure 6: Parent consultation in 24 hours by ethnicity, 2025.

1.1.2 Findings

Parents had a consultation with a senior member of the neonatal team within 24 hours for 94.5% (53,036 of 56,127) of admissions (Figure 1).
Although this is achieved for most admissions, there has been a minor aggregate decline in adherence over the last three years which may reflect that this measure is no longer subject to outlier management.¹
A marked decline in adherence in the London South Network, where there are known data flow issues affecting some neonatal units, may also have contributed (Figure 2).
Adherence is lower in SCUs (92.8% (6,676 of 7,195)) compared to LNUs (94.5% (21,857 of 23,122)) and NICUs (94.9% (24,503 of 25,810)) (Table 1).
Parental consultation within 24 hours took place for a lower proportion of admissions when the mother was Black (93.3% (CI: 92.6% - 94%)) than for Asian mothers (94.6% (CI: 94.1% - 95.1%)), White mothers (95% (CI: 94.8% - 95.2%)), or those grouped as Mixed/Other (94.9% (CI: 94.1% - 95.7%)). These results are unadjusted for background variables, but standardisation for gestational age does not alter the interpretation of the finding (Figure 6).

1.2 Parent involvement in consultant ward rounds

Measure question

What proportion of baby care days had a consultant-led ward round with at least one parent included?

Consultant-led ward round means any ward round where a consultant is in attendance, at any time of the day.

Parents, parents’ advocates and professionals agree that including parents in consultant ward rounds supports parental partnership in care. Consultant ward rounds occur regularly (usually daily, or more often) on neonatal units. This measure looks at the proportion of baby care days that had a consultant-led ward round with at least one parent included.

1.2.1 Results

1.2.1.1 Time series

Figure 7: Parental inclusion on ward rounds, by year.

1.2.1.2 Network time series

Figure 8: Parental inclusion on ward rounds, by neonatal network and year.

1.2.1.3 Type time series

Figure 9: Parental inclusion on ward rounds, by level of neonatal unit and year.

1.2.1.4 Unit type results

Unit Type	Eligible ward days	With outcome	Adherent	Not adherent	Missing
NICU	414,783	406,826	135,162 (33.2%)	271,664	7,957 (1.9%)
LNU	275,694	274,238	124,469 (45.4%)	149,769	1,456 (0.5%)
SCU	67,472	67,334	24,798 (36.8%)	42,536	138 (0.2%)
Total	757,949	748,398	284,429 (38.0%)	463,969	9,551 (1.3%)

Table 3: Parental inclusion on ward rounds, by level of neonatal unit, 2025.

1.2.1.5 Network results

Network	Eligible ward days	With outcome	Adherent	Not adherent	Missing
East Midlands	45,999	45,899	14,253 (31.1%)	31,646	100 (0.2%)
East England	66,161	65,305	28,596 (43.8%)	36,709	856 (1.3%)
Kent Surrey Sussex	44,586	44,580	13,608 (30.5%)	30,972	6 (0.0%)
London NCE	65,945	60,839	36,461 (59.9%)	24,378	5,106 (7.7%)
London NW	31,669	31,661	10,471 (33.1%)	21,190	8 (0.0%)
London South	41,418	38,682	14,282 (36.9%)	24,400	2,736 (6.6%)
North West	95,993	95,776	32,932 (34.4%)	62,844	217 (0.2%)
Northern	31,699	31,693	8,981 (28.3%)	22,712	6 (0.0%)
South West	46,909	46,735	23,838 (51.0%)	22,897	174 (0.4%)
Thames Valley Wsx	55,334	55,303	26,441 (47.8%)	28,862	31 (0.1%)
West Midlands	66,183	66,072	20,261 (30.7%)	45,811	111 (0.2%)
Yorkshire Humber	70,410	70,377	22,218 (31.6%)	48,159	33 (0.0%)
Scotland	61,986	61,951	16,368 (26.4%)	45,583	35 (0.1%)
Wales	32,990	32,858	15,399 (46.9%)	17,459	132 (0.4%)
Total	757,282	747,731	284,109 (38.0%)	463,622	9,551 (1.3%)

Table 4: Parental inclusion on ward rounds, by neonatal network, 2025.

1.2.1.6 Caterpillar plot

Figure 10: Caterpillar plot of parent inclusion on ward rounds, by neonatal unit, 2025.

1.2.1.7 Network caterpillar plot

Figure 11: Caterpillar plot of parent inclusion on ward rounds, by neonatal network, 2025.

1.2.1.8 Ethnicity bar chart

Figure 12: Parent inclusion on ward rounds by ethnicity, 2025.

1.2.2 Findings

The NNAP looks at whether a parent is involved in the ward round for each day of a baby’s stay. Overall, this was reported for 38% (284,429 of 748,398 baby care days); an improvement since 2024, when the proportion was 36% (Figure 7).
Due to a change to the BadgerNet clinical system (no answer to the question resulting in auto-population of field to ‘no parent on ward round’), missing data has reduced to a very low level (1.3% in 2025) (Figure 7). This change, and a change in the focus of NNAP measurement in 2023 means that it is not possible to interpret result for this measure prior to 2023.
Variation between neonatal units may be implausibly high; between 1.4% and 97.8% (Figure 10).
There continues to be wide variation in how well daily parent involvement in ward rounds is reported geographically, from 26.4% (16,368 of 61,951) to 59.9% (36,461 of 60,839) between networks (Figure 11).
Parental inclusion on the consultant ward round took place for a lower proportion of baby care days when the mother was Asian (32.1% (CI: 31.9% - 32.3%)), Black (36% (CI: 35.7% - 36.3%)), or Mixed or other ethnic background (36.3% (CI: 35.8% - 36.8%)) than for White mothers (40.4% (CI: 40.3% - 40.5%)). These results are unadjusted for background variables, but standardisation for gestational age does not alter the interpretation of the finding (Figure 12).
Changes to the way that ward round data are recorded in clinical systems make it difficult to compare data over time, and to effectively interpret the impact of missing data, and therefore the NNAP recommends caution when comparing and interpreting results. Feedback to the audit team from some users has indicated that parent partnership could be measured in ways which better take into account other opportunities for parents’ inclusion. The NNAP is exploring what parent partnership in care means to parents and families, and how to measure it better.

1.3 Breastmilk feeding on day 14 of life

Measure question

Does a baby born at less than 34 weeks’ gestational age receive any of their own mother’s milk at day 14 of life?

For babies to benefit from both early and long term benefits of breastmilk, mothers of very preterm babies have to be successful in establishing expression, and to sustain this expression and intent to breastmilk feed over a long period. This measure is designed to assess the success of initiation of breastmilk expression, to support comparison between units, and quality improvement activities based on this.

1.3.1 Results

1.3.1.1 Time series

Figure 13: Breastmilk at day 14, by year.

Figure 14: Exclusive breastmilk at day 14, by year.

1.3.1.2 Network time series

Figure 15: Breastmilk at day 14, by neonatal network and year.

Figure 16: Exclusive breastmilk at day 14, by neonatal network and year.

1.3.1.3 Type time series

Figure 17: Breastmilk at day 14, by level of neonatal unit and year.

Figure 18: Exclusive breastmilk at day 14, by level of neonatal unit and year.

1.3.1.4 Unit type results

Unit Type	Eligible babies	With outcome	Any mother's milk	No mother's milk	Missing	Mother's milk only	Mixed feeding	Other feeding	Nil by mouth
NICU	6,527	6,474	5,284 (81.6%)	1,190	53 (0.8%)	3,819 (59.0%)	1,465	921	269
LNU	4,149	4,130	3,419 (82.8%)	711	19 (0.5%)	2,239 (54.2%)	1,180	673	38
SCU	607	607	470 (77.4%)	137	0 (0.0%)	307 (50.6%)	163	136	1
Total	11,283	11,211	9,173 (81.8%)	2,038	72 (0.6%)	6,365 (56.8%)	2,808	1,730	308

Table 5: Breastmilk at day 14, by level of neonatal unit, 2025.

1.3.1.5 Network results

Network	Eligible babies	With outcome	Any mother's milk	No mother's milk	Missing	Mother's milk only	Mixed feeding	Other feeding	Nil by mouth
East Midlands	677	675	540 (80.0%)	135	2 (0.3%)	372 (55.1%)	168	112	23
East England	957	950	757 (79.7%)	193	7 (0.7%)	538 (56.6%)	219	169	24
Kent Surrey Sussex	726	722	582 (80.6%)	140	4 (0.6%)	422 (58.4%)	160	127	13
London NCE	859	845	732 (86.6%)	113	14 (1.6%)	492 (58.2%)	240	79	34
London NW	509	507	448 (88.4%)	59	2 (0.4%)	307 (60.6%)	141	48	11
London South	587	568	490 (86.3%)	78	19 (3.2%)	330 (58.1%)	160	55	23
North West	1,386	1,386	1,116 (80.5%)	270	0 (0.0%)	773 (55.8%)	343	229	41
Northern	525	524	393 (75.0%)	131	1 (0.2%)	252 (48.1%)	141	126	5
South West	753	753	630 (83.7%)	123	0 (0.0%)	444 (59.0%)	186	103	20
Thames Valley Wsx	821	821	706 (86.0%)	115	0 (0.0%)	487 (59.3%)	219	94	21
West Midlands	1,146	1,126	928 (82.4%)	198	20 (1.7%)	642 (57.0%)	286	162	36
Yorkshire Humber	1,022	1,022	820 (80.2%)	202	0 (0.0%)	599 (58.6%)	221	184	18
Scotland	869	868	676 (77.9%)	192	1 (0.1%)	462 (53.2%)	214	168	24
Wales	438	436	349 (80.0%)	87	2 (0.5%)	240 (55.0%)	109	72	15
Total	11,275	11,203	9,167 (81.8%)	2,036	72 (0.6%)	6,360 (56.8%)	2,807	1,728	308

Table 6: Breastmilk at day 14, by neonatal network, 2025.

1.3.1.6 Caterpillar plot

Figure 19: Caterpillar plot of breastmilk at day 14, by neonatal unit, 2025.

Figure 20: Caterpillar plot of exclusive breastmilk at day 14, by neonatal unit, 2025.

1.3.1.7 Network caterpillar plot

Figure 21: Caterpillar plot of breastmilk at day 14, by neonatal network, 2025.

Figure 22: Caterpillar plot of exclusive breastmilk at day 14, by neonatal network, 2025.

1.3.1.8 Ethnicity bar chart

Figure 23: Breastmilk feeding at day 14 by ethnicity, 2025.

1.3.2 Findings

There has been progressive improvement in the proportion of babies receiving any breastmilk on day 14 of life over the last three years, from 78.6% in 2022, to 81.8% (9,173 of 11,211) in 2025 (Figure 13).
Improvement is also seen in the proportion of babies exclusively receiving their mother’s milk, from 52.1% in 2022, to 56.8% (6,365 of 11,211) in 2025 (Figure 14).
Variation between networks appears to have reduced since 2024. Networks ranged from 75% (CI: 71.3 - 78.7%, 393 of 524) to 88.4% (CI: 85.6 - 91.2%, 448 of 507) in 2025 (Figure 15).
Comparing unit types, proportions of any breastmilk on day 14 are higher in LNUs (82.8% (3,419 of 4,130)) than NICUs (81.6% (5,284 of 6,474)) and SCUs (77.4% (470 of 607)). Exclusive breastmilk feeding at this time point is higher in NICUs (59% (3,819 of 6,474), than LNUs (54.2% (2,239 of 4,130)) and SCUs (50.6% (307 of 607)) (Table 5).
A lower proportion of babies received any of their mother’s milk at day 14 when the mother was White (78% (CI: 77% - 79%)) than when the mother was Asian (89.2% (CI: 87.9% - 90.5%)), Black (88.1% (CI: 86.2% - 90%)), or grouped as Mixed/Other (86.5% (CI: 83.9% - 89.1%)). These results are unadjusted for background variables, but standardisation for gestational age does not alter the interpretation (Figure 23).

1.4 Breastmilk feeding at discharge home

Measure question

Does a baby born at less than 34 weeks’ gestational age receive any of their own mother’s milk at discharge to home from a neonatal unit?

For babies to benefit from both early risk modification (e.g. reduction in NEC) and long-term benefits of breastmilk, mothers of very preterm babies have to be successful in establishing expression, and to sustain this expression and intent to breastmilk feed over a long period. This measure of the prevalence of any breastmilk feeding at discharge home assesses establishment of expression and its continuation to such a point where a baby can be discharged breastmilk feeding.

1.4.1 Results

1.4.1.1 Time series

Figure 24: Breastmilk at discharge, by year.

Figure 25: Exclusive breastmilk at day 14, by year.

1.4.1.2 Network time series

Figure 26: Breastmilk at discharge, by neonatal network and year.

Figure 27: Exclusive breastmilk at discharge, by neonatal network and year.

1.4.1.3 Type time series

Figure 28: Breastmilk at discharge, by level of neonatal unit and year.

Figure 29: Exclusive breastmilk at discharge, by level of neonatal unit and year.

1.4.1.4 Unit type results

Unit Type	Eligible babies	With outcome	Any mother's milk	No mother's milk	Missing	Mother's milk only	Mixed feeding
NICU	4,270	4,222	2,872 (68.0%)	1,352	48 (1.1%)	1,746 (41.4%)	1,126
LNU	5,254	5,251	3,848 (73.3%)	1,406	3 (0.1%)	2,227 (42.4%)	1,621
SCU	1,651	1,647	1,140 (69.2%)	508	4 (0.2%)	676 (41.0%)	464
Total	11,175	11,120	7,860 (70.7%)	3,266	55 (0.5%)	4,649 (41.8%)	3,211

Table 7: Breastmilk at discharge, by level of neonatal unit, 2025.

1.4.1.5 Network results

Network	Eligible babies	With outcome	Any mother's milk	No mother's milk	Missing	Mother's milk only	Mixed feeding
East Midlands	746	744	531 (71.4%)	213	2 (0.3%)	295 (39.7%)	236
East England	1,018	1,018	722 (70.9%)	297	0 (0.0%)	420 (41.3%)	302
Kent Surrey Sussex	761	761	533 (70.0%)	228	0 (0.0%)	354 (46.5%)	179
London NCE	786	785	647 (82.4%)	139	1 (0.1%)	311 (39.6%)	336
London NW	437	437	386 (88.3%)	51	0 (0.0%)	227 (51.9%)	159
London South	546	544	454 (83.5%)	90	2 (0.4%)	237 (43.6%)	217
North West	1,345	1,345	893 (66.4%)	452	0 (0.0%)	502 (37.3%)	391
Northern	495	493	301 (61.1%)	192	2 (0.4%)	180 (36.5%)	121
South West	743	743	554 (74.6%)	189	0 (0.0%)	357 (48.0%)	197
Thames Valley Wsx	794	794	595 (74.9%)	199	0 (0.0%)	354 (44.6%)	241
West Midlands	1,160	1,118	750 (67.1%)	368	42 (3.6%)	459 (41.1%)	291
Yorkshire Humber	1,043	1,043	685 (65.7%)	358	0 (0.0%)	429 (41.1%)	256
Scotland	867	861	522 (60.6%)	343	6 (0.7%)	342 (39.7%)	180
Wales	423	423	280 (66.2%)	143	0 (0.0%)	175 (41.4%)	105
Total	11,164	11,109	7,853 (70.7%)	3,262	55 (0.5%)	4,642 (41.8%)	3,211

Table 8: Breastmilk at discharge, by neonatal network, 2025.

1.4.1.6 Caterpillar plot

Figure 30: Caterpillar plot of breastmilk at discharge, by neonatal unit, 2025.

Figure 31: Caterpillar plot of exclusive breastmilk at discharge, by neonatal unit, 2025.

1.4.1.7 Network caterpillar plot

Figure 32: Caterpillar plot of breastmilk at discharge, by neonatal network, 2025.

Figure 33: Caterpillar plot of exclusive breastmilk at discharge, by neonatal network, 2025.

1.4.1.8 Ethnicity bar chart

Figure 34: Breastmilk feeding at discharge by ethnicity, 2025.

1.4.2 Findings

There continues to be year-on-year improvement in the proportion of babies receiving any breastmilk at the time of discharge home, from 64% in 2022, to 70.7% (7,860 of 11,120) in 2025 (Figure 24).
This improvement trajectory is also seen in the proportion of babies receiving exclusive breastmilk feeding over this period; from 36.8% in 2022, to 41.8% (4,649 of 11,120) in 2025 (Figure 25).
Most neonatal networks continue to improve, with proportions ranging from 60.6% (CI: 57.3 - 63.9%, 522 of 861) to 88.3% (CI: 85.3 - 91.3%, 386 of 437) (Figure 26).
There appears to be less variation in proportions of exclusive breastmilk feeding between networks; from 36.5% (CI: 32.2 - 40.8%, 180 of 493) to 51.9% (CI: 47.2 - 56.6%, 227 of 437) (Figure 27), than is observed in variation in rates of ‘any breastmilk feeding’.
Comparing unit types, proportions of any breastmilk at discharge home are higher in LNUs (73.3% (3,848 of 5,251)) than SCUs (69.2% (1,140 of 1,647)) and NICUs (68% (2,872 of 4,222)) (Table 7)
Proportions of any breastmilk at discharge home are higher among women of Black (83.4% (CI: 81.2% - 85.6%)), Asian (82.2% (CI: 80.6% - 83.8%)), and Mixed/other ethnicities (79.3% (CI: 76.2% - 82.4%)), compared to White women (64% (CI: 62.9% - 65.1%)). These results are unadjusted for background variables, but standardisation for gestational age does not alter the interpretation (Figure 34).

1.5 Neurodevelopmental follow-up at two years of age

Measure question

Does a baby born at less than 30 weeks’ gestational age receive medical follow-up at two years gestationally corrected age (18-30 months’ gestationally corrected acceptable age range)?

The NICE guideline on the developmental follow-up of children and young people born preterm recommends that all children born at less than 30 weeks gestational age should receive a developmental assessment at two years (corrected age), with follow up also required at high gestational ages where there are additional risk factors. A developmental assessment is also recommended at four years for babies born before 28 weeks gestation.²

The NNAP measure currently focusses on whether a follow-up developmental assessment took place at two years of age. The long-term intention of the NNAP is to report the outcomes of this assessment, and the NICE guideline recommends the recording of the results of the assessment for audit purposes.

1.5.1 Results

1.5.1.1 Time series

Figure 35: Two year follow-up, by year.

1.5.1.2 Network time series

Figure 36: Two year follow-up, by neonatal network and year.

1.5.1.3 Type time series

Figure 37: Two year follow-up, by level of neonatal unit and year.

1.5.1.4 Unit type results

Unit Type	Eligible babies	With outcome	Health data entered	Died post discharge	Follow up completed	No health data entered in window	Follow up outside of window	No follow up
NICU	1,617	1,617	1,361 (84.2%)	24	1,337	256	55	201
LNU	1,636	1,636	1,275 (77.9%)	11	1,264	361	67	294
SCU	459	459	352 (76.7%)	3	349	107	15	92
Total	3,712	3,712	2,988 (80.5%)	38	2,950	724	137	587

Table 9: Two year follow-up, by level of neonatal unit, 2025.

1.5.1.5 Network results

Network	Eligible babies	With outcome	Health data entered	Died post discharge	Follow up completed	No health data entered in window	Follow up outside of window	No follow up
East Midlands	277	277	221 (79.8%)	1	220	56	16	40
East England	337	337	260 (77.2%)	5	255	77	13	64
Kent Surrey Sussex	221	221	172 (77.8%)	1	171	49	9	40
London NCE	290	290	213 (73.4%)	4	209	77	10	67
London NW	177	177	140 (79.1%)	3	137	37	1	36
London South	181	181	138 (76.2%)	2	136	43	4	39
North West	439	439	365 (83.1%)	4	361	74	16	58
Northern	156	156	130 (83.3%)	1	129	26	1	25
South West	205	205	166 (81.0%)	0	166	39	4	35
Thames Valley Wsx	270	270	220 (81.5%)	6	214	50	13	37
West Midlands	371	371	308 (83.0%)	3	305	63	19	44
Yorkshire Humber	355	355	286 (80.6%)	4	282	69	19	50
Scotland	270	270	228 (84.4%)	2	226	42	11	31
Wales	161	161	141 (87.6%)	2	139	20	1	19
Total	3,710	3,710	2,988 (80.5%)	38	2,950	722	137	585

Table 10: Two year follow-up, by neonatal network, 2025.

1.5.1.6 Caterpillar plot

Figure 38: Two year follow-up, by neonatal unit, 2025.

1.5.1.7 Network caterpillar plot

Figure 39: Two year follow-up, by neonatal network, 2025.

1.5.1.8 Ethnicity bar chart

Figure 40: Two year follow-up by ethnicity, 2025.

1.5.2 Findings

Overall, there has been a year-on-year improvement in the delivery of neurodevelopmental follow-up at two years of age over the last 5 years, from 70% in 2020, to 80.5% (2,988 of 3,712) in 2025 (Figure 35).
Variation between networks appears to have reduced since 2024, and in 2025 ranged from 73.4% (CI: 68.3 - 78.5%, 213 of 290) to 87.6% (CI: 82.5 - 92.7%, 141 of 161) (Figure 36).
Proportions of two year follow up are lower where the mother is of Mixed/other ethnicity (69.7% (CI: 62.9% - 76.5%)), than for White (80.5% (CI: 78.9% - 82.1%)), Asian (84% (CI: 81% - 87%)), and Black mothers (81.5% (CI: 77.6% - 85.4%)) (Figure 40). These differences persist when results are standardised for gestational age, however the analysis is unadjusted for background variables.
The NNAP is currently undertaking an exploratory analysis to understand the neurodevelopmental outcome of very preterm babies at two years of age. Fifty-nine units achieving a follow up rate of 90% or higher in 2025 will be included in this exploratory analysis. To support better reporting of neurodevelopmental outcomes, the NNAP will be issuing updated guidance around entering data onto BadgerNet, alongside introducing this reporting into the Restricted Access Dashboard.

1.6 Neonatal nurse staffing

Measure question

What proportion of nursing shifts are numerically staffed according to guidelines and service specification?

Recommended nurse staffing levels are defined in the Neonatal Critical Care Service Specification³, Toolkit for High Quality Neonatal Services⁴ and the BAPM Service Standards for Hospitals Providing Neonatal Care⁵ according to the level of care being provided. The NNAP looks at the total nurses required per shift and reports the proportion of shifts with sufficient nurses to meet the requirements of the Service Specification and Standards.

1.6.1 Results

1.6.1.1 Time series

Figure 41: Neonatal nurse staffing, by year.

1.6.1.2 Network time series

Figure 42: Neonatal nurse staffing, by neonatal network and year.

1.6.1.3 Type time series

Figure 43: Neonatal nurse staffing, by level of neonatal unit and year.

1.6.1.4 Unit type results

Unit Type	Eligible shifts	With outcome	Sufficiently staffed	Not sufficiently staffed	Missing
NICU	37,230	36,971	28,301 (76.5%)	8,670	259 (0.7%)
LNU	57,488	56,101	46,836 (83.5%)	9,265	1,387 (2.4%)
SCU	34,184	33,826	30,062 (88.9%)	3,764	358 (1.0%)
Total	128,902	126,898	105,199 (82.9%)	21,699	2,004 (1.6%)

Table 11: Neonatal nurse staffing, by level of neonatal unit, 2025.

1.6.1.5 Network results

Network	Eligible shifts	With outcome	Sufficiently staffed	Not sufficiently staffed	Missing
East Midlands	8,030	7,701	6,894 (89.5%)	807	329 (4.1%)
East England	12,410	12,395	10,091 (81.4%)	2,304	15 (0.1%)
Kent Surrey Sussex	9,490	9,461	7,324 (77.4%)	2,137	29 (0.3%)
London NCE	6,388	6,028	4,775 (79.2%)	1,253	360 (5.6%)
London NW	4,380	4,322	3,135 (72.5%)	1,187	58 (1.3%)
London South	5,840	5,456	4,559 (83.6%)	897	384 (6.6%)
North West	16,060	15,900	12,957 (81.5%)	2,943	160 (1.0%)
Northern	6,934	6,934	6,401 (92.3%)	533	0 (0.0%)
South West	8,332	8,252	6,627 (80.3%)	1,625	80 (1.0%)
Thames Valley Wsx	10,220	10,108	8,172 (80.8%)	1,936	112 (1.1%)
West Midlands	10,220	10,154	8,887 (87.5%)	1,267	66 (0.6%)
Yorkshire Humber	13,140	12,906	10,781 (83.5%)	2,125	234 (1.8%)
Scotland	10,220	10,138	8,049 (79.4%)	2,089	82 (0.8%)
Wales	6,508	6,415	5,864 (91.4%)	551	93 (1.4%)
Other	730	728	683 (93.8%)	45	2 (0.3%)
Total	128,902	126,898	105,199 (82.9%)	21,699	2,004 (1.6%)

Table 12: Neonatal nurse staffing, by neonatal network, 2025.

1.6.1.6 Caterpillar plot

Figure 44: Neonatal nurse staffing, by neonatal unit, 2025.

1.6.1.7 Network caterpillar plot

Figure 45: Neonatal nurse staffing, by neonatal network, 2025.

1.6.2 Findings

Overall, neonatal nurse staffing levels continue to improve. In 2025, 82.9% (105,199 of 126,898) of shifts were numerically staffed according to guidelines and service specification, compared to 81.5% in 2024 (Figure 41).
This continued improvement is likely to reflect central investment in neonatal nurse staffing in England, Scotland and Wales.⁶,⁷,⁸
Between networks, the proportion of fully staffed shifts ranged from 72.5% (CI: 69.5 - 75.5%, 3,135 of 4,322) to 92.3% (CI: 91.3 - 93.3%, 6,401 of 6,934) (Figure 42).
SCUs achieve a higher proportion of fully staffed shifts (88.9% (30,062 of 33,826)) compared to LNUs (83.5% (46,836 of 56,101)) and NICUs (76.5% (28,301 of 36,971)) (Table 11).

1.7 Summary

1.7.1 Recommendations

Recommendations

As recommended in 2024, to monitor and act upon ethnicity disparities, Neonatal networks should work with the perinatal teams in their constituent neonatal units to:

ensure that staff receive appropriate and consistent training to confidently ask families about their ethnicity and that of their baby, and to accurately record demographic information,
use the NNAP dashboard to review how well NNAP partnership in care and care process measures are delivered locally, and then whether this differs by ethnicity,
where differences exist, seek to understand the underlying causes, and
with families, co-design quality improvement programme that directly address those causes.

So that early breastmilk feeding is prioritised and achieved equitably for all babies, the Royal College of Paediatrics and Child Health (RCPCH), the Royal College of Obstetricians and Gynaecologists (RCOG), and the Nursing and Midwifery Council (NMC) should review their standards and curricula and, where necessary, strengthen them to ensure that the importance of early breastmilk feeding for preterm babies during neonatal care is embedded in early obstetric, midwifery, neonatal medical and nursing training.

1.7.2 Actions for local quality improvement

Perinatal teams should:
- seek to learn from services that have achieved improvement in the proportion of babies receiving early breastmilk, and
- prioritise consistent delivery of early breastmilk feeding support through standardised pathways including antenatal counselling, immediate postnatal care, and the neonatal admission process.
All neonatal units should:
- Undertake steps to improve their rates of neurodevelopmental follow-up at two years of age, so that their unit can be included in future neurodevelopmental outcomes analyses.
- Use new NNAP guidance to fully describe their two-year follow-up outcomes, so that they can accurately interpret the neurodevelopmental outcomes at two years of age of their babies when NNAP reporting starts.
Neonatal units and neonatal networks with low rates of breastmilk feeding (within 2 days, at 14 days and at discharge), should identify opportunities to improve, and use existing quality improvement programmes and resources to support their improvement work, such as:
- The Baby Friendly Initiative
- West of England Acadmeic Health Sciences Network, PERIPrem
- PERIPrem Cymru
- BAPM toolkits and resources:
  - Maternal Breast Milk Toolkit
  - Perinatal Optimisation Passports
- Bliss resources:
  - Information for parents about feeding
  - Emotional and practical support
  - Bliss Baby Charter (Action repeated from the 2024 extended analysis report.)

1.7.3 Improvement case studies and useful resources

Breastmilk feeding by day two

Improving the delivery of breastmilk in the first two days of life Dr R. Garr et al., Perinatal Team, Whiston Hospital, Mersey & West Lancashire Teaching Hospitals NHS Trust.

2 Workstream two: Care processes

2.1 Perinatal optimisation

Measure question

Does a baby born at less than 34 weeks’ gestational age receive all reported perinatal optimisation measures (appropriate to their gestational age at birth)?

Optimising perinatal care for very preterm infants has been identified nationally as a driver to improve the safety and outcomes of neonatal care, and to reducing neonatal deaths and preterm brain injuries.⁹,¹⁰,¹¹ The NNAP reports on a number of elements of optimal perinatal care both separately and as part of this composite metric; antenatal steroid administration, antenatal magnesium sulphate administration, birth in the right place, temperature on admission, deferred cord clamping, and early breastmilk feeding. The composite metric is an area of focus in the NNAP Quality Improvement Strategy. There is a significant improvement opportunity to both drive towards achieving the developmental standards set for each intervention, and to increase the proportion of babies receiving all of them, and therefore improving overall outcomes.

2.1.0.1 Time series

Figure 46: Perinatal optimisation composite, by year.

2.1.0.2 Network time series

Figure 47: Perinatal optimisation composite, by neonatal network and year.

2.1.0.3 Type time series

Figure 48: Perinatal optimisation composite, by level of neonatal unit and year.

2.1.0.4 Unit type results

Unit Type	Eligible babies	With outcome	Optimal	Not optimal	Missing
NICU	6,901	6,797	1,801 (26.5%)	5,100	104 (1.5%)
LNU	4,889	4,828	1,195 (24.8%)	3,694	61 (1.2%)
SCU	1,092	1,076	225 (20.9%)	867	16 (1.5%)
Other	3	3	0 (0.0%)	3	0 (0.0%)
Total	12,885	12,704	3,221 (25.4%)	9,664	181 (1.4%)

Table 13: Perinatal optimisation composite, by level of neonatal unit, 2025.

2.1.0.5 Network results

Network	Eligible babies	With outcome	Optimal	Not optimal	Missing
East Midlands	818	812	142 (17.5%)	676	6 (0.7%)
East England	1,108	1,095	241 (22.0%)	867	13 (1.2%)
Kent Surrey Sussex	882	871	214 (24.6%)	668	11 (1.2%)
London NCE	961	912	262 (28.7%)	699	49 (5.1%)
London NW	569	566	149 (26.3%)	420	3 (0.5%)
London South	735	709	184 (26.0%)	551	26 (3.5%)
North West	1,535	1,531	462 (30.2%)	1,073	4 (0.3%)
Northern	572	571	139 (24.3%)	433	1 (0.2%)
South West	835	830	251 (30.2%)	584	5 (0.6%)
Thames Valley Wsx	945	934	257 (27.5%)	688	11 (1.2%)
West Midlands	1,321	1,297	330 (25.4%)	991	24 (1.8%)
Yorkshire Humber	1,142	1,138	258 (22.7%)	884	4 (0.4%)
Scotland	974	953	199 (20.9%)	775	21 (2.2%)
Wales	480	477	132 (27.7%)	348	3 (0.6%)
Other	8	8	1 (12.5%)	7	0 (0.0%)
Total	12,885	12,704	3,221 (25.4%)	9,664	181 (1.4%)

Table 14: Perinatal optimisation composite, by neonatal network, 2025.

2.1.0.6 Caterpillar plot

Figure 49: Perinatal optimisation composite, by neonatal unit, 2025.

2.1.0.7 Network caterpillar plot

Figure 50: Perinatal optimisation composite, by neonatal network, 2025.

2.1.1 Findings

A greater proportion of babies are now receiving all relevant measured optimal perinatal care interventions¹²; 25.4% in 2025 (3,221 of 12,704), an increase from 7.7% in 2021 (Figure 46). However, three out of four babies still do not have an optimal perinatal care journey, with evidence of unwarranted geographical variation (network range – 17.5% to 30.2%) in use of these well-established interventions.
Between networks, the proportion of babies experiencing optimal perinatal care ranged from 17.5% (CI: 14.9 - 20.1%, 142 of 812) to 30.2% (CI: 27.1 - 33.3%, 251 of 830) (Figure 49).
This suggests that reliable, standardised multidisciplinary processes are not yet embedded consistently. Improvement requires a whole-pathway approach spanning obstetrics, neonatology and network configuration.
It is important to consider when interpreting this measure, that it includes a measure of antenatal steroid administration that is considered adherent even if not administered according to RCOG guidelines relating to dosing intervals.¹³

2.2 Antenatal steroids

Measure question

Does a mother who delivers a baby between 22 and 33 weeks’ gestational age receive a full course of antenatal corticosteroids within 1 week prior to delivery?

Babies born at less than 34 weeks’ gestational age sometimes have breathing difficulties in the first few days after they are born. Antenatal steroids are a powerful health intervention, given to mothers by obstetricians and midwives before delivery of a preterm baby. Antenatal steroids help reduce mortality and make other serious complications, such as bleeding into the brain, less likely. The NICE guideline Preterm Labour and Birth¹⁴ details recommendations on the use of antenatal corticosteroids prior to suspected preterm birth.

The NNAP reports the proportion of eligible mothers who received a full course of antenatal corticosteroids within one week of delivery. On time delivery of a full course of antenatal corticosteroids, with 24 hours between doses, is challenging to achieve, due to the complexities of accurately predicting preterm birth. This intervention is likely to be more achievable in some groups of mothers and babies, such as planned deliveries due to preeclampsia, compared to others such as clinical emergencies such as delivery for placental abruption. However, NNAP recognise the importance of describing the use of antenatal steroids in a way that is adherent to national guidance¹⁵, and Table 15 and Table 16 describe the proportions of babies treated with a dosing interval that is guideline adherent.

2.2.1 Results

2.2.1.1 Time series

Figure 51: Antenatal steroids, by year.

2.2.1.2 Network time series

Figure 52: Antenatal steroids, by neonatal network and year.

2.2.1.3 Type time series

Figure 53: Antenatal steroids, by level of neonatal unit and year.

2.2.1.4 Unit type results

Unit Type	Eligible mothers	With outcome	Given	Not given	Missing	Given - appropriate	Given - inappropriate	Given - missing dose
NICU	5,921	5,852	3,070 (52.5%)	2,782	69 (1.2%)	1,472	1,125 (19.2%)	473
LNU	4,200	4,147	2,039 (49.2%)	2,108	53 (1.3%)	864	839 (20.2%)	336
SCU	979	959	406 (42.3%)	553	20 (2.0%)	160	151 (15.7%)	95
Other	32	25	7 (28.0%)	18	7 (21.9%)	2	3 (12.0%)	2
Total	11,132	10,983	5,522 (50.3%)	5,461	149 (1.3%)	2,498	2,118 (19.3%)	906

Table 15: Antenatal steroids, by level of neonatal unit, 2025.

2.2.1.5 Network results

Network	Eligible mothers	With outcome	Given	Not given	Missing	Given - appropriate	Given - inappropriate	Given - missing dose
East Midlands	715	706	341 (48.3%)	365	9 (1.3%)	159	146 (20.7%)	36
East England	966	950	460 (48.4%)	490	16 (1.7%)	150	196 (20.6%)	114
Kent Surrey Sussex	771	763	390 (51.1%)	373	8 (1.0%)	114	157 (20.6%)	119
London NCE	825	816	505 (61.9%)	311	9 (1.1%)	107	199 (24.4%)	199
London NW	483	477	254 (53.2%)	223	6 (1.2%)	85	132 (27.7%)	37
London South	546	519	277 (53.4%)	242	27 (4.9%)	89	84 (16.2%)	104
North West	1,322	1,320	687 (52.0%)	633	2 (0.2%)	290	362 (27.4%)	35
Northern	499	499	232 (46.5%)	267	0 (0.0%)	212	13 (2.6%)	7
South West	717	709	360 (50.8%)	349	8 (1.1%)	212	99 (14.0%)	49
Thames Valley Wsx	817	814	394 (48.4%)	420	3 (0.4%)	191	167 (20.5%)	36
West Midlands	1,157	1,133	551 (48.6%)	582	24 (2.1%)	224	273 (24.1%)	54
Yorkshire Humber	998	991	467 (47.1%)	524	7 (0.7%)	307	128 (12.9%)	32
Scotland	847	826	383 (46.4%)	443	21 (2.5%)	248	78 (9.4%)	57
Wales	434	431	211 (49.0%)	220	3 (0.7%)	106	81 (18.8%)	24
Other	35	29	10 (34.5%)	19	6 (17.1%)	4	3 (10.3%)	3
Total	11,132	10,983	5,522 (50.3%)	5,461	149 (1.3%)	2,498	2,118 (19.3%)	906

Table 16: Antenatal steroids, by neonatal network, 2025.

2.2.1.6 Caterpillar plot

Figure 54: Antenatal steroids, by neonatal unit, 2025.

2.2.1.7 Network caterpillar plot

Figure 55: Antenatal steroids, by neonatal network, 2025.

2.2.1.8 Steroids by dose timing

Figure 56: Antenatal steroid administration timing bar chart, by neonatal network, 2025.

2.2.1.9 Ethnicity bar chart

Figure 57: Antenatal steroids by ethnicity, 2025.

2.2.2 Findings

There has been a reduction in the proportion of mothers receiving a full course of antenatal steroids since 2024, to 50.3% (5,522 of 10,983) (Figure 51). This reduction in adherence does not necessarily reflect poorer care, and may reflect only that teams are focussing on ensuring that the interval between doses of antenatal steroids is appropriate and in line with RCOG guidelines.¹⁶
Table 15 and Table 16 show headline adherence to the measure and also provide a breakdown of the number of mothers given antenatal steroids where dosing was appropriate and inappropriate.
The proportion of antenatal steroids courses given at inappropriate dosing intervals ranges from 2.6% to 27.7% between neonatal networks (Table 16). This represents unwarranted variation in practice, and opportunities for improvement in the delivery of antenatal steroids in line with guidelines.
To support a shift in practice in line with guidelines, the NNAP has introduced supplementary reporting of appropriate and inappropriate dosing into the Restricted Access Dashboard (RAD), with a view to amending the headline NNAP measure in due course. NNAP classification of appropriate and inappropriate dosing is described in the NNAP measures guide.¹⁷
A lower proportion of White mothers received antenatal steroids (48.1% (CI: 47% - 49.2%)) than Asian (55.1% (CI: 53.1% - 57.1%)), Black (56.5% (CI: 53.8% - 59.2%)) and mothers grouped as Mixed/Other ethnicity (53.1% (CI: 49.5% - 56.7%)) (Figure 57). These results are unadjusted for background variables, but standardisation for gestational age does not alter the interpretation.

2.3 Antenatal magnesium sulphate

Measure question

Does a mother who delivers a baby below 30 weeks’ gestational age receive magnesium sulphate in the 24 hours prior to delivery?

Giving magnesium sulphate to women who are at risk of delivering a preterm baby reduces the chance that their baby will develop cerebral palsy by 32%.¹⁸ The NICE quality standard Preterm Labour and Birth recommends that all women who may deliver their baby at less than 30 weeks gestational age are offered magnesium sulphate where possible.¹⁹ The NNAP developmental standard is that ninety percent (90%) of eligible mothers should receive antenatal magnesium sulphate.

2.3.1 Results

2.3.1.1 Time series

Figure 58: Antenatal magnesium sulphate, by year.

2.3.1.2 Network time series

Figure 59: Antenatal magnesium sulphate, by neonatal network and year.

2.3.1.3 Type time series

Figure 60: Antenatal magnesium sulphate, by level of neonatal unit and year.

2.3.1.4 Unit type results

Unit Type	Eligible mothers	With outcome	Given	Not given	Missing
NICU	2,507	2,504	2,254 (90.0%)	250	3 (0.1%)
LNU	1,012	1,010	870 (86.1%)	140	2 (0.2%)
SCU	156	156	121 (77.6%)	35	0 (0.0%)
Other	13	11	6 (54.5%)	5	2 (15.4%)
Total	3,688	3,681	3,251 (88.3%)	430	7 (0.2%)

Table 17: Antenatal magnesium sulphate, by level of neonatal unit, 2025.

2.3.1.5 Network results

Network	Eligible mothers	With outcome	Given	Not given	Missing
East Midlands	235	235	204 (86.8%)	31	0 (0.0%)
East England	299	298	260 (87.2%)	38	1 (0.3%)
Kent Surrey Sussex	257	257	230 (89.5%)	27	0 (0.0%)
London NCE	290	290	254 (87.6%)	36	0 (0.0%)
London NW	169	169	151 (89.3%)	18	0 (0.0%)
London South	205	202	176 (87.1%)	26	3 (1.5%)
North West	440	440	399 (90.7%)	41	0 (0.0%)
Northern	157	157	137 (87.3%)	20	0 (0.0%)
South West	199	199	176 (88.4%)	23	0 (0.0%)
Thames Valley Wsx	294	293	258 (88.1%)	35	1 (0.3%)
West Midlands	411	411	359 (87.3%)	52	0 (0.0%)
Yorkshire Humber	313	313	289 (92.3%)	24	0 (0.0%)
Scotland	267	267	231 (86.5%)	36	0 (0.0%)
Wales	140	140	121 (86.4%)	19	0 (0.0%)
Other	12	10	6 (60.0%)	4	2 (16.7%)
Total	3,688	3,681	3,251 (88.3%)	430	7 (0.2%)

Table 18: Antenatal magnesium sulphate, by neonatal network, 2025.

2.3.1.6 Caterpillar plot

Figure 61: Antenatal magnesium sulphate, by neonatal unit, 2025.

2.3.1.7 Network caterpillar plot

Figure 62: Antenatal magnesium sulphate, by neonatal network, 2025.

2.3.1.8 Ethnicity bar chart

Figure 63: Antenatal magnesium sulphate by ethnicity, 2025.

2.3.2 Findings

There is evidence of a small overall increase in antenatal magnesium sulphate administration in 2025 (88.3%, 3,251 of 3,681), after several years with minimal change in adherence (2024 – 86.7%, 2020 – 86.1%) (Figure 58).
Geographical variation in delivery of magnesium sulphate appears to have reduced over time, with all networks achieving between 86.4% (CI: 80.7 - 92.1%, 121 of 140) to 92.3% (CI: 89.4 - 95.2%, 289 of 313) in 2025 (Figure 59).
Adherence is poorer in SCUs (77.6% (121 of 156)), compared to LNUs (86.1% (870 of 1,010)) and NICUs (90% (2,254 of 2,504)), however most mothers and babies eligible for this intervention are cared for in a NICU or LNU (Table 17).
Lower proportions of mothers of Mixed/other (85.9% (CI: 81.7% - 90.1%)) and White ethnicities (87.3% (CI: 85.9% - 88.7%)) received antenatal magnesium sulphate than Asian (90.8% (CI: 88.9% - 92.7%)) and Black mothers (92.3% (CI: 90.1% - 94.5%)) (Figure 63). These results are unadjusted for background variables, but standardisation for gestational age does not alter the interpretation.

2.4 Birth in a centre with a NICU

Measure question

Is a baby:

born at less than 27 weeks’ gestational age, or
less than 800 grams at birth, or
born as a multiple at less than 28 week’s gestational age

delivered in a maternity service on the same site as a designated neonatal intensive care unit (NICU)?

Babies who are born at less than 27 weeks gestational age are at high risk of death, serious illness, and brain injury. National recommendations in England state that neonatal networks should aim to configure and deliver services to increase the proportion of babies at this gestational age being delivered in a hospital with a neonatal intensive care unit (NICU) on site.²⁰ This is because there is evidence that outcomes improve if such premature babies are cared for in a NICU from birth. The NNAP development standard states that at least 85% of eligible babies should be delivered in a maternity service on the same site as a NICU.

2.4.1 Results

2.4.1.1 Time series

Figure 64: Birth in an NICU, by year.

2.4.1.2 Network time series

Figure 65: Birth in an NICU, by neonatal network and year.

2.4.1.3 Network results

Network	Eligible mothers	With outcome	Born NICU	Not born NICU	Not born NNU
East Midlands	101	101	74 (73.3%)	27	0
East England	132	132	93 (70.5%)	37	2
Kent Surrey Sussex	129	129	109 (84.5%)	18	2
London NCE	170	170	137 (80.6%)	31	2
London NW	84	84	68 (81.0%)	16	0
London South	103	103	86 (83.5%)	16	1
North West	217	217	199 (91.7%)	17	1
Northern	77	77	68 (88.3%)	8	1
South West	96	96	76 (79.2%)	19	1
Thames Valley Wsx	150	150	127 (84.7%)	22	1
West Midlands	219	219	191 (87.2%)	26	2
Yorkshire Humber	166	166	138 (83.1%)	28	0
Scotland	142	142	128 (90.1%)	14	0
Wales	71	71	57 (80.3%)	13	1
Other	2	2	0 (0.0%)	0	2
Total	1,859	1,859	1,551 (83.4%)	292	16

Table 19: Birth in an NICU, by neonatal network, 2025.

2.4.1.4 Network caterpillar plot

Figure 66: Birth in an NICU, by neonatal network, 2025.

2.4.1.5 Ethnicity bar chart

Figure 67: Birth in an NICU by ethnicity, 2025.

2.4.2 Findings

Overall, there continues to be a steady improvement in the proportion of extremely preterm babies born in a centre with a NICU, with an increase from 79.2% in 2024 to 83.4% (1,551 of 1,859) in 2025 (Figure 64).
Improvement has been driven predominantly by changes in two networks; Wales and the East Midlands ODN, both seeing considerable improvement in recent years (Figure 65).
Significant geographical variation does remain between regional networks, from 70.5% (CI: 62.7 - 78.3%, 93 of 132) to 91.7% (CI: 88 - 95.4%, 199 of 217) in 2025 (Figure 66).
A lower proportion of babies born to White mothers are delivered in a centre with an onsite NICU (80.3% (CI: 77.9% - 82.7%)), compared to those born to Black (83.7% (CI: 79.8% - 87.6%)), Asian (86.7% (CI: 83.5% - 89.9%)) and mothers grouped as Mixed Other (88.6% (CI: 83.3% - 93.9%)). However, overlapping confidence intervals suggest this finding could be a chance finding (Figure 67). These results are unadjusted for background variables, however proportions standardised for gestational age are presented.

2.5 Deferred cord clamping

Measure question

Does a baby born at less than 34 weeks’ gestational age have their cord clamped at or after one minute?

Evidence shows that avoiding immediate cord clamping reduces death in preterm babies by nearly a third.²¹ Deferred cord clamping has been shown to be incompletely implemented in the UK and is one of the key optimal perinatal care interventions identified to improve the safety and outcomes of neonatal care. The NNAP developmental standard is that at least 75% of babies born at less than 34 weeks gestational age should have their cord clamped at or after one minute.

2.5.1 Results

2.5.1.1 Time series

Figure 68: Deferred cord clamping, by year.

2.5.1.2 Network time series

Figure 69: Deferred cord clamping, by neonatal network and year.

2.5.1.3 Type time series

Figure 70: Deferred cord clamping, by level of neonatal unit and year.

2.5.1.4 Unit type results

Unit Type	Eligible babies	With outcome	Deferred	Not deferred	Missing	Less than 1 minute	1 - 2 minutes	2 - 3 minutes	3 minutes or more
NICU	6,872	6,699	5,154 (76.9%)	1,545	173 (2.5%)	1,545	4,345	581	228
LNU	4,811	4,801	3,665 (76.3%)	1,136	10 (0.2%)	1,136	3,059	443	163
SCU	1,078	1,074	840 (78.2%)	234	4 (0.4%)	234	704	83	53
Other	126	89	68 (76.4%)	21	37 (29.4%)	21	26	10	32
Total	12,887	12,663	9,727 (76.8%)	2,936	224 (1.7%)	2,936	8,134	1,117	476

Table 20: Deferred cord clamping, by level of neonatal unit, 2025.

2.5.1.5 Network results

Network	Eligible babies	With outcome	Deferred	Not deferred	Missing	Less than 1 minute	1 - 2 minutes	2 - 3 minutes	3 minutes or more
East Midlands	817	810	591 (73.0%)	219	7 (0.9%)	219	479	83	29
East England	1,096	1,090	806 (73.9%)	284	6 (0.5%)	284	693	92	21
Kent Surrey Sussex	876	873	677 (77.5%)	196	3 (0.3%)	196	477	89	111
London NCE	960	809	603 (74.5%)	206	151 (15.7%)	206	576	17	10
London NW	565	564	413 (73.2%)	151	1 (0.2%)	151	405	6	2
London South	738	720	543 (75.4%)	177	18 (2.4%)	177	505	26	12
North West	1,528	1,526	1,225 (80.3%)	301	2 (0.1%)	301	892	297	36
Northern	571	571	429 (75.1%)	142	0 (0.0%)	142	398	18	13
South West	834	831	697 (83.9%)	134	3 (0.4%)	134	550	95	52
Thames Valley Wsx	940	937	711 (75.9%)	226	3 (0.3%)	226	551	125	35
West Midlands	1,319	1,317	1,034 (78.5%)	283	2 (0.2%)	283	876	91	67
Yorkshire Humber	1,138	1,138	850 (74.7%)	288	0 (0.0%)	288	706	89	55
Scotland	974	970	765 (78.9%)	205	4 (0.4%)	205	672	68	25
Wales	479	473	355 (75.1%)	118	6 (1.3%)	118	333	16	6
Other	52	34	28 (82.4%)	6	18 (34.6%)	6	21	5	2
Total	12,887	12,663	9,727 (76.8%)	2,936	224 (1.7%)	2,936	8,134	1,117	476

Table 21: Deferred cord clamping, by neonatal network, 2025.

2.5.1.6 Caterpillar plot

Figure 71: Deferred cord clamping, by neonatal unit, 2025.

2.5.1.7 Network caterpillar plot

Figure 72: Deferred cord clamping, by neonatal network, 2025.

2.5.1.8 Ethnicity bar chart

Figure 73: Deferred cord clamping by ethnicity, 2025.

2.5.2 Findings

Ongoing improvement in the delivery of deferred cord clamping continues, with 76.8% (9,727 of 12,663) of eligible babies receiving this important intervention in 2025, compared with 60.6% in 2022 (Figure 68).
Geographical variation appears to have reduced over time, however there is still some evidence of a significant difference between the worst performing network, achieving 73% (CI: 69.9 - 76.1%, 591 of 810) and the best performing network, achieving 83.9% (CI: 81.4 - 86.4%, 697 of 831) in 2025 (Figure 72).
More than 1 in 10 babies (1,593 of 9,727) who had any deferred cord clamping had deferred clamping of two or more minutes, suggesting a rapid adoption of preliminary evidence that longer periods of deferred clamping may be advantageous.²²
There is a recognisable and important difference in unadjusted and adjusted analyses in the proportion of preterm babies who experience deferred cord clamping between Black babies and White babies in the 2025 data (Black - 71.5% (CI: 69.1% - 73.9%), White - 77.5% (CI: 76.6% - 78.4%)), although not in the babies categorised as Asian (77.8% (CI: 76.1% - 79.5%)) (Figure 73). These results are unadjusted for background variables, but standardisation for gestational age does not alter the interpretation, and the reasons for this disparity remain unexplained. National initiatives, such as the Maternity Disparities Taskforce in England, may wish to explore further the mechanisms underpinning this disparity in neonatal care delivery.

2.6 Temperature on admission

Measure question

Does a baby born at less than 34 weeks’ gestational age have a first temperature on admission which is both between 36.5–37.5°C and measured within one hour of birth?

Low admission temperature is associated with an increased risk of illness and death in preterm babies. Low temperature (or hypothermia) is a preventable condition in vulnerable newborn babies. This NNAP measure looks at how successful neonatal units are at achieving a normal first temperature (between 36.5 and 37.5°C) within an hour of birth in very preterm babies. The NNAP developmental standard is that at least 90% of babies should have an admission temperature taken within an hour of birth and measuring within the normal range.

From 2023, the cohort for this measure included babies born at 32 and 33 weeks gestational age, in line with MatNeoSIP measurement. The measurement specifically includes babies whose admission to neonatal units was after an hour of age though these are small in number. This was at the request of audit users, who noted that exclusion of babies admitted after an hour of age risked providing a perverse incentive to delay the admission of already hypothermic moderately preterm infants. National guidance notes the risk of excessive therapeutic optimism in choosing location of care for preterm infants.²³

2.6.1 Results

2.6.1.1 Time series

Figure 74: Normal temperature on admission, by year.

2.6.1.2 Network time series

Figure 75: Normal temperature on admission, by neonatal network and year.

2.6.1.3 Type time series

Figure 76: Normal temperature on admission, by level of neonatal unit and year.

2.6.1.4 Unit type results

Unit Type	Eligible babies	With outcome	Adherent	Not adherent	Missing	Less than 36	36-36.5	>37.5	After 1 hour	Not taken
NICU	6,795	6,771	5,488 (81.1%)	1,283	24 (0.4%)	44	408	467	356	8
LNU	4,794	4,787	3,923 (82.0%)	864	7 (0.1%)	34	274	342	214	0
SCU	1,075	1,072	812 (75.7%)	260	3 (0.3%)	12	79	70	98	1
Other	100	97	11 (11.3%)	86	3 (3.0%)	14	6	1	65	0
Total	12,764	12,727	10,234 (80.4%)	2,493	37 (0.3%)	104	767	880	733	9

Table 22: Normal temperature on admission, by level of neonatal unit, 2025.

2.6.1.5 Network results

Network	Eligible babies	With outcome	Adherent	Not adherent	Missing	Less than 36	36-36.5	>37.5	After 1 hour	Not taken
East Midlands	814	808	629 (77.8%)	179	6 (0.7%)	3	54	48	74	0
East England	1,094	1,093	907 (83.0%)	186	1 (0.1%)	6	51	80	49	0
Kent Surrey Sussex	875	874	688 (78.7%)	186	1 (0.1%)	7	62	62	55	0
London NCE	949	938	718 (76.5%)	220	11 (1.2%)	12	78	52	78	0
London NW	564	564	497 (88.1%)	67	0 (0.0%)	4	26	10	27	0
London South	682	670	500 (74.6%)	170	12 (1.8%)	1	44	34	83	8
North West	1,525	1,525	1,254 (82.2%)	271	0 (0.0%)	10	87	112	62	0
Northern	570	570	458 (80.4%)	112	0 (0.0%)	7	44	45	16	0
South West	834	834	679 (81.4%)	155	0 (0.0%)	7	37	67	44	0
Thames Valley Wsx	939	939	779 (83.0%)	160	0 (0.0%)	9	63	65	23	0
West Midlands	1,310	1,309	1,047 (80.0%)	262	1 (0.1%)	16	91	100	54	1
Yorkshire Humber	1,135	1,135	912 (80.4%)	223	0 (0.0%)	7	70	96	50	0
Scotland	969	966	773 (80.0%)	193	3 (0.3%)	13	41	74	65	0
Wales	476	475	380 (80.0%)	95	1 (0.2%)	2	16	35	42	0
Other	28	27	13 (48.1%)	14	1 (3.6%)	0	3	0	11	0
Total	12,764	12,727	10,234 (80.4%)	2,493	37 (0.3%)	104	767	880	733	9

Table 23: Normal temperature on admission, by neonatal network, 2025.

2.6.1.6 Caterpillar plot

Figure 77: Normal temperature on admission, by neonatal unit, 2025.

2.6.1.7 Network caterpillar plot

Figure 78: Normal temperature on admission, by neonatal network, 2025.

2.6.1.8 Ethnicity bar chart

Figure 79: Normal temperature on admission by ethnicity, 2025.

2.6.2 Findings

There is evidence of continued improvement in the proportion of babies with a normal first measured temperature on admission and within an hour of birth (80.4%, 10,234 of 12,727), continuing an improvement trajectory for this measure, and an increase from 75% in 2023 (Figure 74).
Improvement in normal temperature on admission is seen across most neonatal networks in 2025, ranging between 74.6% (CI: 71.3 - 77.9%, 500 of 670) and 88.1% (CI: 85.4 - 90.8%, 497 of 564) (Figure 75).
Achievement of normal temperature on admission is better in LNUs (82%) and NICUs (81.1%) than SCUs (75.7%) (Table 22).
Normal temperature on admission is achieved for 80.2% (CI: 78.6% - 81.8%)) of babies born to Asian mothers, 80.3% (CI: 78.2% - 82.4%)) of babies born to Black mothers, 81.1% (CI: 80.2% - 82%)) of babies born to White mothers, and 80.9% (CI: 78.1% - 83.7%)) of babies born to mothers of Mixed/Other ethnicity (Figure 79). Overlapping confidence intervals suggest there is no significant difference in the achievement of normal temperature on admission between ethnicities. Results are presented as unadjusted proportions, and as proportions standardised for gestational age.

2.7 Breastmilk feeding by day two

Measure question

Does a baby born at less than 34 weeks’ gestational age receive any of their own mother’s milk in the first 2 days of life?

Expert opinion suggests that very early breastmilk use is both clinically beneficial and also that high rates of usage in a unit are an indication that early postnatal support to the mothers of preterm babies in expressing breastmilk is successful. The NNAP reports breastmilk feeding in the first two days of life because currently data describing breastmilk use within 24 hours of birth are not complete enough to usefully describe early breastmilk feeding.

2.7.1 Results

2.7.1.1 Time series

Figure 80: Breastmilk by day two, by year.

Figure 81: Exclusive breastmilk by day two, by year.

2.7.1.2 Network time series

Figure 82: Breastmilk by day two, by neonatal network and year.

Figure 83: Exclusive breastmilk by day two, by neonatal network and year.

2.7.1.3 Type time series

Figure 84: Breastmilk by day two, by level of neonatal unit and year.

Figure 85: Exclusive breastmilk by day two, by level of neonatal unit and year.

2.7.1.4 Unit type results

Unit Type	Eligible babies	With outcome	Any mother's milk	No mother's milk	Missing	Mother's milk only	Mixed feeding	Other feeding	Nil by mouth
NICU	6,737	6,677	5,128 (76.8%)	1,549	60 (0.9%)	4,012 (60.1%)	1,116	881	668
LNU	4,791	4,780	3,380 (70.7%)	1,400	11 (0.2%)	2,296 (48.0%)	1,084	862	538
SCU	1,073	1,071	700 (65.4%)	371	2 (0.2%)	506 (47.2%)	194	245	126
Other	3	3	1 (33.3%)	2	0 (0.0%)	1 (33.3%)	0	1	1
Total	12,604	12,531	9,209 (73.5%)	3,322	73 (0.6%)	6,815 (54.4%)	2,394	1,989	1,333

Table 24: Breastmilk by day two, by level of neonatal unit, 2025.

2.7.1.5 Network results

Network	Eligible babies	With outcome	Any mother's milk	No mother's milk	Missing	Mother's milk only	Mixed feeding	Other feeding	Nil by mouth
East Midlands	808	805	493 (61.2%)	312	3 (0.4%)	407 (50.6%)	86	131	181
East England	1,079	1,078	729 (67.6%)	349	1 (0.1%)	520 (48.2%)	209	230	119
Kent Surrey Sussex	860	859	579 (67.4%)	280	1 (0.1%)	357 (41.6%)	222	201	79
London NCE	942	908	678 (74.7%)	230	34 (3.6%)	519 (57.2%)	159	79	151
London NW	558	558	395 (70.8%)	163	0 (0.0%)	213 (38.2%)	182	134	29
London South	673	649	475 (73.2%)	174	24 (3.6%)	330 (50.8%)	145	103	71
North West	1,507	1,507	1,166 (77.4%)	341	0 (0.0%)	994 (66.0%)	172	179	162
Northern	565	564	401 (71.1%)	163	1 (0.2%)	351 (62.2%)	50	85	78
South West	829	829	693 (83.6%)	136	0 (0.0%)	475 (57.3%)	218	116	20
Thames Valley Wsx	932	932	719 (77.1%)	213	0 (0.0%)	484 (51.9%)	235	125	88
West Midlands	1,294	1,291	1,028 (79.6%)	263	3 (0.2%)	810 (62.7%)	218	154	109
Yorkshire Humber	1,121	1,119	833 (74.4%)	286	2 (0.2%)	666 (59.5%)	167	153	133
Scotland	958	955	647 (67.7%)	308	3 (0.3%)	399 (41.8%)	248	230	78
Wales	470	469	369 (78.7%)	100	1 (0.2%)	288 (61.4%)	81	66	34
Total	12,596	12,523	9,205 (73.5%)	3,318	73 (0.6%)	6,813 (54.4%)	2,392	1,986	1,332

Table 25: Breastmilk by day two, by neonatal network, 2025.

2.7.1.6 Caterpillar plot

Figure 86: Caterpillar plot of breastmilk by day two, by neonatal unit, 2025.

Figure 87: Caterpillar plot of exclusive breastmilk by day two, by neonatal unit, 2025.

2.7.1.7 Network caterpillar plot

Figure 88: Caterpillar plot of breastmilk by day two, by neonatal network, 2025.

Figure 89: Caterpillar plot of exclusive breastmilk by day two, by neonatal network, 2025.

2.7.1.8 Ethnicity bar chart

Figure 90: Breastmilk by day two, by ethnicity, 2025.

2.7.2 Findings

There has been marked ongoing improvement in the overall proportion of babies receiving any of their mother’s milk by day 2 of life, from 54.3% in 2022 to 73.5% (9,209 of 12,531) in 2025 (Figure 80).
A similar trend is seen in the proportion of babies exclusively receiving breastmilk, from 36.6% in 2022 to 54.4% (6,815 of 12,531 in 2025). This suggests that improvement is not at the expense of exclusive breastmilk feeding (Figure 81).
Over that period, there has been a reduction in regional variation in early breastmilk feeding, ranging from 36% to 79.6% in 2022, and from 61.2% (CI: 57.8 - 64.6%, 493 of 805) to 83.6% (CI: 81.1 - 86.1%, 693 of 829) in 2025 (Figure 82).
Comparing unit types, proportions of any breastmilk by day 2 are higher in NICUs (76.8%), than in LNUs (70.7%) and SCUs (65.4%) (Table 24).
Variation between neonatal units continues to be wide; from 32.4% to 100%, indicating opportunities for local quality improvement (Figure 86).
A lower proportion of babies born to Black mothers received any of their mother’s milk in their first 2 days of life (70.3% (CI: 67.8% - 72.8%)), than babies born to White (73.7% (CI: 72.7% - 74.7%)), Asian (75.2% (CI: 73.4% - 77%)) and mothers of Mixed/Other ethnicity (76.6% (CI: 73.6% - 79.6%)) (Figure 90). These results are unadjusted for background variables, but standardisation for gestational age does not alter the interpretation.

2.8 Non-invasive breathing support

Measure question

What proportion of babies born at less than 32 weeks’ gestation only receive non-invasive breathing (or respiratory) support during the first week of life?

Invasive respiratory support is defined as that delivered through an endotracheal tube.

Bronchopulmonary Dysplasia (BPD) is the most common form of chronic lung disease in infancy associated with preterm birth. Despite the advances in perinatal care such as administration of antenatal corticosteroids, surfactant and gentler ventilation strategies, the proportion of babies with BPD has not decreased, and appears to be rising. However, there is substantial variation in the proportions of BPD among neonatal networks even after comparing the proportions with a matched group of babies with very similar case mix.

One the contributing factors to BPD is the type and duration of respiratory support provided to the babies. Provision of non-invasive respiratory support, to avoid mechanical ventilation through endotracheal tube, and early extubation of very preterm infants onto non-invasive support have been shown to reduce the risk of BPD.²⁴ Variations in respiratory care practices (the type and duration of respiratory support) may contribute to these variations in proportions of BPD.

The NICE guidance (NG 124) recommends provision of non-invasive respiratory support through nasal CPAP or high flow humidified oxygen therapy as primary mode of respiratory support for preterm infants.²⁵ Through the identification of variation in the extent of adoption of NICE guidance between neonatal networks, and units of a similar designation, the NNAP can support quality improvement.

2.8.1 Adjustment for case mix

The non-invasive breathing support measure is adjusted only for gestational age at birth. It is the only process measure to which case mix adjustment is applied.

Further details about the case mix adjustment methodology can be found in Case mix adjustment and the NNAP methodology and statistical analysis plan.

2.8.2 Results

2.8.2.1 Time series

Figure 91: Non-invasive breathing support, by year.

2.8.2.2 Network time series

Figure 92: Non-invasive breathing support, by neonatal network and year.

2.8.2.3 Type time series

Figure 93: Non-invasive breathing support, by level of neonatal unit and year.

2.8.2.4 Unit type results

Unit Type	Eligible babies	With outcome	Not ventilated	Ventilated	Missing
NICU	4,005	3,945	1,900 (48.2%)	2,045	60 (1.5%)
LNU	2,262	2,230	1,379 (61.8%)	851	32 (1.4%)
SCU	343	339	164 (48.4%)	175	4 (1.2%)
Other	57	54	24 (44.4%)	30	3 (5.3%)
Total	6,667	6,568	3,467 (52.8%)	3,101	99 (1.5%)

Table 26: Non-invasive breathing support, by level of neonatal unit, 2025.

2.8.2.5 Network results

Network	Eligible babies	With outcome	Not ventilated	Ventilated	Missing	Treatment effect
East Midlands	398	398	169 (42.5%)	229	0 (0.0%)	10.4
East England	560	557	258 (46.3%)	299	3 (0.5%)	9.2
Kent Surrey Sussex	438	433	260 (60.0%)	173	5 (1.1%)	-7.5
London NCE	508	459	207 (45.1%)	252	49 (9.6%)	5.9
London NW	317	317	190 (59.9%)	127	0 (0.0%)	-6.6
London South	374	359	204 (56.8%)	155	15 (4.0%)	-5.8
North West	810	805	418 (51.9%)	387	5 (0.6%)	1.2
Northern	303	303	158 (52.1%)	145	0 (0.0%)	2.8
South West	399	399	234 (58.6%)	165	0 (0.0%)	-4.0
Thames Valley Wsx	516	515	268 (52.0%)	247	1 (0.2%)	-1.4
West Midlands	683	674	407 (60.4%)	267	9 (1.3%)	-8.9
Yorkshire Humber	606	605	310 (51.2%)	295	1 (0.2%)	1.8
Scotland	503	499	272 (54.5%)	227	4 (0.8%)	-2.0
Wales	237	232	105 (45.3%)	127	5 (2.1%)	7.7
Other	15	13	7 (53.8%)	6	2 (13.3%)	NA
Total	6,667	6,568	3,467 (52.8%)	3,101	99 (1.5%)	0.0

Table 27: Non-invasive breathing support, by neonatal network, 2025.

2.8.2.6 Caterpillar plot

Figure 94: Non-invasive breathing support observed proportion, by neonatal unit, 2025.

2.8.2.7 Caterpillar plot - adjusted

Figure 95: Non-invasive breathing support treatment effect, by neonatal unit, 2025.

2.8.2.8 Network caterpillar plot

Figure 96: Non-invasive breathing support observed proportion, by neonatal network, 2025.

2.8.2.9 Network Caterpillar plot - adjusted

Figure 97: Non-invasive breathing support treatment effect, by neonatal network, 2025.

2.8.2.10 Ethnicity bar chart

Figure 98: Non-invasive breathing support by ethnicity, 2025.

2.8.3 Findings

There has been a continued increase, overall, in the proportion of babies born at less than 32 weeks gestational age who only receive non-invasive breathing support in their first week of life, from 47.8% in 2022 to 52.8% in 2025 (Figure 91). This reflects wider adoption of less invasive approaches to respiratory support, as recommended in NICE guidance.²⁶
However, there is wide regional variation in practice, even after considering the impact of gestational age, with treatment effects ranging from -8.9 to 10.4 (Figure 97). Observed proportions range from 42.5% (CI: 37.6 - 47.4%, 169 of 398) to 60.4% (CI: 56.7 - 64.1%, 407 of 674) (Figure 96).
Unit level variation in treatment effect demonstrates that there are opportunities for local improvement; NICU level treatment effect ranges from -34.4 to 19.8 (Figure 95).
Non-invasive breathing support in the first 7 days is delivered for 54.6% (CI: 51.8% - 57.4%)) of babies born to Asian mothers, 51.4% (CI: 48% - 54.8%)) of babies born to Black mothers, 52.7% (CI: 51.1% - 54.3%)) of babies born to White mothers, and 54.4% (CI: 49.5% - 59.3%)) of babies born to mothers of Mixed/Other ethnicity (Figure 98). Overlapping confidence intervals suggest there is no significant difference in the delivery of non-invasive breathing support between ethnicities. These results are unadjusted for background variables, however proportions standardised for gestational age are presented.

2.9 On time screening for retinopathy of prematurity (ROP)

Measure question

Does a baby born at less than 31 weeks’ gestational age, or weighing less than 1501g at birth undergo the first ROP screening according to the guideline?

Retinopathy of prematurity (ROP) is a complication of prematurity which is largely treatable. If left undetected and untreated, severe disease can result in visual impairment. Babies at risk of developing severe ROP should be screened according to the UK screening of retinopathy of prematurity guideline.²⁷

The NNAP reports whether the time of first examination recommendation is met:

For infants born before 31+0 weeks’ gestational age, the first ROP examination should be performed between 31+0 and 31+6 weeks’ postmenstrual age, or at 4 completed weeks’ postnatal age (28-34 days), whichever is later.
For infants born from 31+0 weeks’ gestational age, the first ROP examination should be performed at 36 weeks’ postmenstrual age or 4 completed weeks’ postnatal age (28-34 days), whichever is sooner.

The guideline recommends that all eligible babies should receive screening according to the guideline; the NNAP has set a developmental standard of 80%.

2.9.1 Results

2.9.1.1 Time series

Figure 99: Retinopathy of prematurity screening, by year.

2.9.1.2 Network time series

Figure 100: Retinopathy of prematurity screening, by neonatal network and year.

2.9.1.3 Type time series

Figure 101: Retinopathy of prematurity screening, by level of neonatal unit and year.

2.9.1.4 Unit type results

Unit Type	Eligible babies	With outcome	Screened on time	Not screened on time	Screened on time - before discharge	Screened on time - after discharge	Screened early	Screened late	No screen
NICU	3,424	3,424	2,966 (86.6%)	458	2,868	98	164	266	28
LNU	2,565	2,565	2,149 (83.8%)	416	2,040	109	187	209	20
SCU	529	529	385 (72.8%)	144	359	26	66	73	5
Total	6,518	6,518	5,500 (84.4%)	1,018	5,267	233	417	548	53

Table 28: Retinopathy of prematurity screening, by level of neonatal unit, 2025.

2.9.1.5 Network results

Network	Eligible babies	With outcome	Screened on time	Not screened on time	Screened on time - before discharge	Screened on time - after discharge	Screened early	Screened late	No screen
East Midlands	436	436	372 (85.3%)	64	359	13	32	29	3
East England	551	551	459 (83.3%)	92	447	12	34	53	5
Kent Surrey Sussex	387	387	316 (81.7%)	71	295	21	27	41	3
London NCE	514	514	467 (90.9%)	47	447	20	15	31	1
London NW	325	325	296 (91.1%)	29	277	19	10	17	2
London South	358	358	260 (72.6%)	98	251	9	38	42	18
North West	779	779	705 (90.5%)	74	669	36	20	51	3
Northern	308	308	261 (84.7%)	47	251	10	22	22	3
South West	381	381	315 (82.7%)	66	299	16	26	38	2
Thames Valley Wsx	478	478	419 (87.7%)	59	406	13	22	35	2
West Midlands	657	657	530 (80.7%)	127	501	29	71	53	3
Yorkshire Humber	605	605	518 (85.6%)	87	501	17	42	43	2
Scotland	479	479	387 (80.8%)	92	373	14	30	59	3
Wales	258	258	195 (75.6%)	63	191	4	26	34	3
Total	6,516	6,516	5,500 (84.4%)	1,016	5,267	233	415	548	53

Table 29: Retinopathy of prematurity screening, by neonatal network, 2025.

2.9.1.6 Caterpillar plot

Figure 102: Retinopathy of prematurity screening, by neonatal unit, 2025.

2.9.1.7 Network caterpillar plot

Figure 103: Retinopathy of prematurity screening, by neonatal network, 2025.

2.9.1.8 Ethnicity bar chart

Figure 104: Retinopathy of prematurity screening by ethnicity, 2025.

2.9.2 Findings

Overall adherence to the national ROP screening guideline²⁸ continues to increase, from 66.4% in 2022 to 84.4% (5,500 of 6,518) in 2025 (Figure 99).
There are further opportunities for improvement in on-time screening which could potentially prevent irreversible sight loss, particularly for the 8.4% of babies who were screened late (548 of 6,518) or the 0.8% who were not screened at all (53 of 6,518).
Network adherence to the screening recommendation ranges from 72.6% (CI: 68 - 77.2%, 260 of 358) to 91.1% (CI: 88 - 94.2%, 296 of 325), with an apparent reduction in variation between networks since 2022 (Figure 100).
NICUs achieve better adherence to the recommendation (86.6%), than LNUs (83.8%) and SCUs (72.8%) (Table 28). There are practical challenges to the delivery of ROP screening, particularly in Special Care Units, and known challenges in recruiting paediatric ophthalmologists.²⁹
On-time screening for ROP is acheived for 83.9% (CI: 81.9% - 85.9%)) of babies born to Asian mothers, 87% (CI: 84.7% - 89.3%)) of babies born to Black mothers, 84% (CI: 82.8% - 85.2%)) of babies born to White mothers, and 87.1% (CI: 83.8% - 90.4%)) of babies born to mothers of Mixed/Other ethnicity (Figure 104). Overlapping confidence intervals suggest there is no significant difference in the delivery of ROP screening between ethnicities, however it is important to note that these results are unadjusted for background variables.

2.10 Summary

2.10.1 Recommendations

Recommendation

So that preterm babies’ crucial first few days more commonly lead to the best outcomes after optimal perinatal care and stabilisation at birth, national governments in England, Scotland, Wales and the Isle of Man should consider describing a national ambition to double the proportion of very preterm babies exposed to all relevant measured perinatal optimisation interventions over the next five years.

2.10.2 Actions for local quality improvement

Neonatal networks should ensure that their constituent units are using the NNAP restricted access dashboard to regularly review their rates of optimal perinatal care delivery, identifying instances of non-adherence, and implementing quality improvement activities in response to them. (Action repeated from the 2024 extended analysis report.)
Neonatal units with low and outlying rates of delivery of perinatal interventions should work with those with high rates of delivery to explore opportunities to improve, and to develop and implement improvement plans.
- For non-invasive breathing support, data should be reviewed alongside local BPD rates.
Neonatal networks should undertake exception reporting activities to understand why any preterm babies who delivered in centres not designated to undertake their ongoing care were delivered there. Findings should be shared at regional learning events and, where appropriate, result in changes to clinical management and pathways.
Neonatal networks should provide support to improve rates of timely ROP screening and consider alternative models of delivery such using a hub and spoke model, and training other professionals to deliver elements of the screening.
Every neonatal unit should ensure multi-disciplinary leadership for optimal perinatal care to ensure strong and consistent messaging. Perinatal teams can use NNAP frequent reporting tools and quality improvement methodology to understand the proportion of babies receiving perinatal care interventions in their service and network, to identify opportunities for improvement to maximise quality of care, and the delivery of interventions identified by national improvement initiatives. (Action repeated from the 2024 extended analysis report.)
Perinatal teams should work on building their perinatal culture, to develop a fully collaborative multi-disciplinary approach, with high quality communication habits, joint decision making and agreement of shared goals to improve outcomes for preterm babies and their families. The following resources can be used to support these efforts:
- BAPM QI toolkits and resources:
- Scottish Patient Safety Programme Perinatal
- West of England Academic Health Sciences Network, PERIPrem
- PERIPrem Cymru
- Maternity Transformation Programme, NHS England (Action repeated from the 2024 extended analysis report.)

2.10.3 Improvement case studies and useful resources

Perinatal optimisation

Perinatal optimisation bundle metric improvement in a District General Hospital. Dr D. Thakkar et al., Hillingdon Hospital, The Hillingdon Hospitals NHS Foundation Trust.

Deferred cord clamping

Golden Early Minutes (GEM), Improving cord management in preterm infants: A multidisciplinary quality improvement project. Dr L. Macaskill et al., Walsall Manor Hospital, Walsall Healthcare NHS Trust.

Temperature on admission

Neonatal Early Stabilisation Team: Optimising perinatal wellbeing package. Dr K. Brown & Dr L. Shaw, NHS Tayside.
Use game theory to drive improvement: The normothermia grand prix!. Dr R. Banerjee & Dr D. Winderbank-Scott, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust.

Breastmilk feeding by day two

Improving the delivery of breastmilk in the first two days of life Dr R. Garr et al., Perinatal Team, Whiston Hospital, Mersey & West Lancashire Teaching Hospitals NHS Trust.

Retinopathy of prematurity

Retinopathy of prematurity (ROP) screening project. A. M. Anthony et al., Salisbury NHS Foundation Trust.
Royal College of Paediatrics and Child Health. UK Screening of Retinopathy of Prematurity Guideline
ROP Screening Calculator

3 Workstream three: Outcomes of neonatal care

3.1 Complications of prematurity

Measure question

What proportion of babies born between 24 and 31 weeks’ gestation inclusive did not have a reported serious complication of prematurity (late onset infection, NEC, BPD, serious preterm brain injury or mortality)?

The NNAP outcomes composite measure is designed to provide a single, high-level indicator of clinical outcomes for very preterm babies, and is an area of focus in the NNAP Quality Improvement Strategy. It reports the proportion of babies born between 24 and 31 weeks’ gestation who did not experience any serious complications of prematurity. These complications include late-onset infection, necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD), serious preterm brain injury, or mortality.

The composite measure applies to babies admitted to neonatal units who meet the gestational age criteria and have reached 44 weeks’ postmenstrual age within the reporting period. Each baby is assessed against the component measures for which they are eligible, meaning not all babies are evaluated on all six measures. Results are reported by hospital and network of birth.

3.1.1 Results

3.1.1.1 Time series

Figure 105: Complications of prematurity composite, by year.

3.1.1.2 Network time series

Figure 106: Complications of prematurity composite, by neonatal network and year.

3.1.1.3 Type time series

Figure 107: Complications of prematurity composite, by level of neonatal unit and year.

3.1.1.4 Unit type results

Unit Type	Eligible babies	With outcome	No complications	Complications	Missing
NICU	3,984	3,861	1,966 (50.9%)	2,018	123 (3.1%)
LNU	2,269	2,213	1,529 (69.1%)	740	56 (2.5%)
SCU	352	324	213 (65.7%)	139	28 (8.0%)
Other	72	58	28 (48.3%)	44	14 (19.4%)
Total	6,677	6,456	3,736 (57.9%)	2,941	221 (3.3%)

Table 30: Complications of prematurity composite, by level of neonatal unit, 2025.

3.1.1.5 Network results

Network	Eligible babies	With outcome	No complications	Complications	Missing
East Midlands	422	407	232 (57.0%)	190	15 (3.6%)
East England	595	551	316 (57.4%)	279	44 (7.4%)
Kent Surrey Sussex	419	410	259 (63.2%)	160	9 (2.1%)
London NCE	472	421	232 (55.1%)	240	51 (10.8%)
London NW	306	304	178 (58.6%)	128	2 (0.7%)
London South	389	347	187 (53.9%)	202	42 (10.8%)
North West	778	776	458 (59.0%)	320	2 (0.3%)
Northern	325	320	185 (57.8%)	140	5 (1.5%)
South West	382	378	237 (62.7%)	145	4 (1.0%)
Thames Valley Wsx	488	486	285 (58.6%)	203	2 (0.4%)
West Midlands	711	693	393 (56.7%)	318	18 (2.5%)
Yorkshire Humber	602	590	342 (58.0%)	260	12 (2.0%)
Scotland	506	502	295 (58.8%)	211	4 (0.8%)
Wales	254	253	130 (51.4%)	124	1 (0.4%)
Other	28	18	7 (38.9%)	21	10 (35.7%)
Total	6,677	6,456	3,736 (57.9%)	2,941	221 (3.3%)

Table 31: Complications of prematurity composite, by neonatal network, 2025.

3.1.1.6 Caterpillar plot

Figure 108: Complications of prematurity composite, by neonatal unit, 2025.

3.1.1.7 Network caterpillar plot

Figure 109: Complications of prematurity composite by ethnicity, unadjusted for background variables, 2025.

3.1.2 Findings

There has been an increase in the proportion of babies with no reported serious complication of prematurity, from 51.7% in 2022, to 57.9% (3,736 of 6,456) in 2025 (Figure 105).
However, it should be noted that missing data has been historically high for this composite measure, and there has been no notable decline in the component measures (BPD, NEC, bloodstream infection, preterm brain injury and mortality), and so this temporal change should be interpreted with caution.
It should be noted that the measure is dominated by BPD, given the more frequent occurrence of this outcome in comparison to NEC, bloodstream infection, brain injury and death.

3.2 Mortality to discharge home

Measure question

Does a baby born between 24 weeks’ and 31 weeks’ gestational age inclusive die before discharge home, or 44 weeks’ post-menstrual age (whichever occurs sooner)?

The NNAP reports mortality until discharge, or 44 weeks post-menstrual age (whichever occurs sooner), for a one-year cohort of babies born at 24 to 31 weeks gestational age inclusive who turned, or would have turned, 44 weeks post-menstrual age between 1st of January 2024 and the 31st of December 2024. Results are reported by neonatal network, with babies attributed to the unit of birth. When the place of birth is listed as home or transit, babies will be attributed to the network containing the unit of first admission.

This measure of mortality supplements other measures of mortality, such as that reported by Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries in the UK (MBRRACE-UK). The NNAP measure only includes very preterm babies because they experience higher mortality and is limited to babies born alive and admitted to neonatal units, describing mortality up to the point of hospital discharge. MBRRACE-UK report neonatal mortality, defined as that occurring before 28 days of age, by centre, for all gestational ages. There is evidence that notable numbers of babies die after 28 days.³⁰ MBRRACE-UK have published data showing national rates of infant mortality (death before a year of age for babies born before 27 weeks gestational age).³¹

NNAP mortality reporting currently excludes admissions of babies born at 22 and 23 weeks’ gestational age. However, in this extended analysis we report separately the proportion of admitted babies born at 22 and 23 weeks gestational age who do not survive to 44 weeks PMA or discharge home.

3.2.1 Adjustment for case mix

The mortality measure is adjusted for: gestational age at birth, ethnicity, deprivation quintile, sex, birthweight, pregnancy complications, mother medical problems, mother age, smoking status, previous pregnancies and multiplicity.

Further details about the case mix adjustment methodology can be found in Case mix adjustment and the NNAP methodology and statistical analysis plan.

3.2.2 Results

3.2.2.1 Time series

Figure 110: Mortality to discharge home, babies born at 24-31 weeks gestational age, by year.

Figure 111: Mortality to discharge home, babies born at 24-27 weeks gestational age, by year.

Figure 112: Mortality to discharge home, babies born at 28-31 weeks gestational age, by year.

3.2.2.2 Network time series

Figure 113: Mortality to discharge home, babies born at 24-31 weeks gestational age, by neonatal network and year.

Figure 114: Mortality to discharge home, babies born at 24-27 weeks gestational age, by neonatal network and year.

Figure 115: Mortality to discharge home, babies born at 28-31 weeks gestational age, by neonatal network and year.

3.2.2.3 Type time series

Figure 116: Mortality to discharge home, babies born at 24-31 weeks gestational age, by unit type and year.

Figure 117: Mortality to discharge home, babies born at 24-27 weeks gestational age, by unit type and year.

Figure 118: Mortality to discharge home, babies born at 28-31 weeks gestational age, by unit type and year.

3.2.2.4 Unit type results

Unit Type	Eligible babies	With outcome	Died	Survived
NICU	3,984	3,984	282 (7.1%)	3,702
LNU	2,269	2,269	79 (3.5%)	2,190
SCU	352	352	14 (4.0%)	338
Other	72	72	4 (5.6%)	68
Total	6,677	6,677	379 (5.7%)	6,298

Table 32: Mortality to discharge home, babies born at 24-31 weeks gestational age, by level of neonatal unit, 2025.

Unit Type	Eligible babies	With outcome	Died	Survived
NICU	1,570	1,570	227 (14.5%)	1,343
LNU	335	335	41 (12.2%)	294
SCU	67	67	9 (13.4%)	58
Other	17	17	1 (5.9%)	16
Total	1,989	1,989	278 (14.0%)	1,711

Table 33: Mortality to discharge home, babies born at 24-27 weeks gestational age, by level of neonatal unit, 2025.

Unit Type	Eligible babies	With outcome	Died	Survived
NICU	2,414	2,414	55 (2.3%)	2,359
LNU	1,934	1,934	38 (2.0%)	1,896
SCU	285	285	5 (1.8%)	280
Other	55	55	3 (5.5%)	52
Total	4,688	4,688	101 (2.2%)	4,587

Table 34: Mortality to discharge home, babies born at 28-31 weeks gestational age, by level of neonatal unit, 2025.

3.2.2.5 Network results

Network	Eligible babies	With outcome	Died	Survived	Treatment effect
East Midlands	422	422	29 (6.9%)	393	1.4
East England	595	595	35 (5.9%)	560	0.9
Kent Surrey Sussex	419	419	24 (5.7%)	395	0.6
London NCE	472	472	21 (4.4%)	451	-1.7
London NW	306	306	19 (6.2%)	287	0.3
London South	389	389	23 (5.9%)	366	0.2
North West	778	778	54 (6.9%)	724	1.2
Northern	325	325	15 (4.6%)	310	-0.9
South West	382	382	13 (3.4%)	369	-1.1
Thames Valley Wsx	488	488	18 (3.7%)	470	-2.3
West Midlands	711	711	62 (8.7%)	649	2.4
Yorkshire Humber	602	602	27 (4.5%)	575	-1.5
Scotland	507	507	28 (5.5%)	479	-0.2
Wales	254	254	10 (3.9%)	244	-2.0
Other	27	27	1 (3.7%)	26	NA
Total	6,677	6,677	379 (5.7%)	6,298	0.0

Table 35: Mortality to discharge home, babies born at 24-31 weeks gestational age, by neonatal network, 2025.

Network	Eligible babies	With outcome	Died	Survived
East Midlands	126	126	25 (19.8%)	101
East England	145	145	23 (15.9%)	122
Kent Surrey Sussex	119	119	19 (16.0%)	100
London NCE	145	145	15 (10.3%)	130
London NW	102	102	17 (16.7%)	85
London South	123	123	14 (11.4%)	109
North West	222	222	36 (16.2%)	186
Northern	91	91	10 (11.0%)	81
South West	91	91	8 (8.8%)	83
Thames Valley Wsx	166	166	13 (7.8%)	153
West Midlands	239	239	50 (20.9%)	189
Yorkshire Humber	188	188	16 (8.5%)	172
Scotland	152	152	25 (16.4%)	127
Wales	72	72	7 (9.7%)	65
Other	8	8	0 (0.0%)	8
Total	1,989	1,989	278 (14.0%)	1,711

Table 36: Mortality to discharge home, babies born at 24-27 weeks gestational age, by neonatal network, 2025.

Network	Eligible babies	With outcome	Died	Survived
East Midlands	296	296	4 (1.4%)	292
East England	450	450	12 (2.7%)	438
Kent Surrey Sussex	300	300	5 (1.7%)	295
London NCE	327	327	6 (1.8%)	321
London NW	204	204	2 (1.0%)	202
London South	266	266	9 (3.4%)	257
North West	556	556	18 (3.2%)	538
Northern	234	234	5 (2.1%)	229
South West	291	291	5 (1.7%)	286
Thames Valley Wsx	322	322	5 (1.6%)	317
West Midlands	472	472	12 (2.5%)	460
Yorkshire Humber	414	414	11 (2.7%)	403
Scotland	355	355	3 (0.8%)	352
Wales	182	182	3 (1.6%)	179
Other	19	19	1 (5.3%)	18
Total	4,688	4,688	101 (2.2%)	4,587

Table 37: Mortality to discharge home, babies born at 28-31 weeks gestational age, by neonatal network, 2025.

3.2.2.6 Babies born at 22 and 23 weeks gestational age

Report Year	22 week babies	22 week mortality	23 week babies	23 week mortality
2018	15	10 (66.7%)	253	139 (54.9%)
2019	14	11 (78.6%)	258	135 (52.3%)
2020	52	37 (71.2%)	271	142 (52.4%)
2021	81	59 (72.8%)	228	120 (52.6%)
2022	104	81 (77.9%)	293	150 (51.2%)
2023	112	81 (72.3%)	245	132 (53.9%)
2024	107	75 (70.1%)	264	133 (50.4%)
2025	83	63 (75.9%)	291	156 (53.6%)

Table 38: Mortality to discharge home, babies born at 22-23 weeks gestational age, by year

3.2.2.7 Network caterpillar plot

Figure 119: Mortality observed proportion, babies born at 24-31 weeks gestational age, by neonatal network, 2025.

Figure 120: Mortality observed proportion, babies born at 24-27 weeks gestational age, by neonatal network, 2025.

Figure 121: Mortality observed proportion, babies born at 28-31 weeks gestational age, by neonatal network, 2025.

3.2.2.8 Network Caterpillar plot - adjusted

Figure 122: Mortality treatment effect, babies born at 24-31 weeks gestational age, by neonatal network, 2025.

3.2.3 Findings

Overall, there is an apparent reduction in the proportion of mortality to discharge home (or 44 weeks PMA) in babies born between 24 and 31 weeks gestational age; to 5.7% (379 of 6,677) in 2025.³² Between 2018 and 2024, mortality ranged between 6.2% and 6.4% (Figure 110).
Mortality continues to vary by region, ranging from 3.4% (CI: 1.6 - 5.2%, 13 of 382) to 8.7% (CI: 6.6 - 10.8%, 62 of 711) (Figure 119). Treatment effects range from -2.3 to 2.4, indicating that variation in mortality is not explained by differences in the background characteristics of the babies cared for by the networks (Figure 122).
The apparent improvement in overall mortality does not appear to be driven by a reduction in mortality in the worst performing network, but rather by reductions in several other networks (Figure 113). This indicates continued unwarranted geographical variation, which is targeted by one of the NNAP Quality Improvement Strategy improvement goals.³³
Overall, the proportion of babies born between 24 and 27 weeks gestational age who died was 14% (278 of 1,989. In 2024, the proportion was 15.8 (Figure 111).
The proportion of babies born between 28 and 31 weeks gestational age who died was 2.2% (101 of 4,688. In 2024, the proportion was 2.3 (Figure 112).
The number of babies born at 22 weeks and admitted to neonatal care appears to have peaked, and rates of mortality among admitted babies remain similar, ranging between 66.7% and 78.6% over the period 2018-2025. The number of babies admitted at 23 weeks remains relatively stable, as does the mortality rate for admitted babies (50.4 - 54.9% between 2018 and 2025) (Table 38).

3.3 Bronchopulmonary dysplasia

Measure question

Does an admitted baby born at less than 32 weeks’ gestational age develop bronchopulmonary dysplasia (BPD) or die?

Babies born very preterm typically have incompletely developed lungs and usually need support with their breathing. Simply being born early can cause some ongoing breathing difficulty. Being on a ventilator can cause damage to the lungs, exacerbate breathing problems later in life and put babies at risk of chest infections. This condition is known as bronchopulmonary dysplasia (BPD) and is sometimes called chronic lung disease.

The NNAP reports on the proportion of babies born very preterm who are receiving help with their breathing or extra oxygen four weeks before their term due date. Only babies who survive their early course can develop BPD, and therefore it is important that we consider rates of BPD alongside rates of death before 36 weeks postmenstrual age. For this reason, we report the combined outcome of BPD or death.

Differing proportions of BPD or death between units and networks could be the result of differing treatment or might partially result from differences in the readiness of clinicians to administer oxygen to very preterm infants, although a recent paper shows no evidence of such a phenomenon.³⁴

3.3.1 Adjustment for case mix

The BPD or death measure is adjusted for: gestational age at birth, ethnicity, deprivation quintile, sex, birthweight, pregnancy complications, mother medical problems, mother age, smoking status, previous pregnancies and multiplicity

Further details about the case mix adjustment methodology can be found in Case mix adjustment chapter and the NNAP methodology and statistical analysis plan.

3.3.2 Results

3.3.2.1 Time series

Figure 123: Bronchopulmonary dysplasia or death, by year.

3.3.2.2 Network time series

Figure 124: Bronchopulmonary dysplasia or death, by neonatal network and year.

3.3.2.3 Type time series

Figure 125: Bronchopulmonary dysplasia or death, by level of neonatal unit and year.

3.3.2.4 Unit type results

Unit Type	Eligible babies	With outcome	BPD or death	No BPD or death	Missing	BPD	Early death
NICU	4,278	4,249	2,049 (48.2%)	2,229	29 (0.7%)	1,611	438
LNU	2,320	2,305	631 (27.4%)	1,689	15 (0.6%)	522	109
SCU	363	359	115 (32.0%)	248	4 (1.1%)	96	19
Other	74	73	34 (46.6%)	40	1 (1.4%)	24	10
Total	7,035	6,986	2,829 (40.5%)	4,206	49 (0.7%)	2,253	576

Table 39: Bronchopulmonary dysplasia or death, by level of neonatal unit, 2025.

3.3.2.5 Network results

Network	Eligible babies	With outcome	BPD or death	No BPD or death	Missing	BPD	Early death	Treatment effect
East Midlands	440	435	173 (39.8%)	267	5 (1.1%)	133	40	0.7
East England	616	607	237 (39.0%)	379	9 (1.5%)	188	49	1.7
Kent Surrey Sussex	448	445	163 (36.6%)	285	3 (0.7%)	121	42	-3.4
London NCE	519	512	218 (42.6%)	301	7 (1.3%)	178	40	0.6
London NW	315	314	130 (41.4%)	185	1 (0.3%)	106	24	0.5
London South	403	386	157 (40.7%)	246	17 (4.2%)	133	24	0.2
North West	834	833	333 (40.0%)	501	1 (0.1%)	253	80	-0.2
Northern	340	340	147 (43.2%)	193	0 (0.0%)	122	25	2.4
South West	395	394	142 (36.0%)	253	1 (0.3%)	125	17	0.0
Thames Valley Wsx	513	513	207 (40.4%)	306	0 (0.0%)	177	30	-2.7
West Midlands	758	755	313 (41.5%)	445	3 (0.4%)	216	97	-0.9
Yorkshire Humber	633	633	260 (41.1%)	373	0 (0.0%)	214	46	0.5
Scotland	528	527	213 (40.4%)	315	1 (0.2%)	173	40	-0.1
Wales	269	269	124 (46.1%)	145	0 (0.0%)	105	19	3.8
Other	24	23	12 (52.2%)	12	1 (4.2%)	9	3	NA
Total	7,035	6,986	2,829 (40.5%)	4,206	49 (0.7%)	2,253	576	0.0

Table 40: Bronchopulmonary dysplasia or death, by neonatal network, 2025.

3.3.2.6 Caterpillar plot

Figure 126: Bronchopulmonary dysplasia or death observed proportion, by neonatal unit, 2025.

3.3.2.7 Caterpillar plot - adjusted

Figure 127: Bronchopulmonary dysplasia or death treatment effect, by neonatal unit, 2025.

3.3.2.8 Network caterpillar plot

Figure 128: Bronchopulmonary dysplasia or death observed proportion, by neonatal network, 2025.

3.3.2.9 Network Caterpillar plot - adjusted

Figure 129: Bronchopulmonary dysplasia or death treatment effect, by neonatal network, 2025.

3.3.3 Findings

Overall, there has been a further small increase in 2025 in the proportion of babies born at less than 32 weeks gestational age who experience BPD or death; from 39.8% in 2024, to 40.5% (2,829 of 6,986) in 2025, despite a reduction in deaths over this period. This is consistent with the longer term trend in the proportion of babies experiencing BPD or death since 2017, when the proportion was 36.7% (Figure 123).
This trend could represent a worsening of this outcome, possibly influenced by the same factors which led to a fall in mortality in 2025, or could simply indicate a growing willingness to administer oxygen to preterm infants whose underlying physiology does not differ from that in previous years.
Neonatal networks range in their observed proportions of BPD or death from 36% (CI: 31.3 - 40.7%, 142 of 394) to 46.1% (CI: 40.1 - 52.1%, 124 of 269 (Figure 128). Neonatal network treatment effect ranges from -3.4 to 3.8 (Figure 129). This suggests that the variation in this outcome is unwarranted and a suitable area for clinical improvement.
Among NICUs, there is wide variation in observed proportions of BPD or death; from 32.7% (17/52) to 73.3% (66/90) (Figure 126). NICU treatment effects range from 15.3% to -11% (Figure 127).

3.4 Necrotising enterocolitis

Measure question

Does an admitted baby born at less than 32 weeks’ gestational age meet the NNAP surveillance definition for necrotising enterocolitis (NEC) on one or more occasion?

Necrotising enterocolitis (NEC) is a serious condition which can follow preterm birth. Bowel inflammation prevents milk feeding and surgery may be needed. Babies who develop NEC tend to stay in hospital for a long time. Rates of mortality in babies with NEC are high, at over 20%.³⁵ Babies who survive NEC can have developmental as well as long-term feeding and bowel problems. Reporting of NEC is based on a surveillance definition, and cases are attributed to the unit caring for the baby at 48 hours of age.

3.4.1 Adjustment for case mix

The NEC measure is adjusted for: gestational age at birth and birthweight.

Further details about the case mix adjustment methodology can be found in Case mix adjustment chapter and the NNAP methodology and statistical analysis plan.

3.4.2 Quality and accuracy of NEC reporting

NNAP clinical leads are asked to provide assurance of the accuracy of their NEC data. 92% (164 of 179) of units gave assurance in 2025 (in 2024 the proportion was also 92%). Results are presented based on all units’ data, and on data from those providing assurance only. An indication of whether a unit provided assurance is given alongside unit results on NNAP Online. Units which did not assure their data are omitted from the treatment effect analysis and outlier analysis, if applicable.

3.4.3 Results

3.4.3.1 Time series

Figure 130: Necrotising enterocolitis, by year.

3.4.3.2 Network time series

Figure 131: Necrotising enterocolitis, by neonatal network and year.

3.4.3.3 Type time series

Figure 132: Necrotising enterocolitis, by level of neonatal unit and year.

3.4.3.4 Unit type results

Unit Type	Eligible babies	With outcome	NEC	No NEC	Missing	No NEC died	No NEC survived
NICU	4,658	4,519	278 (6.2%)	4,241	139 (3.0%)	338	3,903
LNU	2,082	2,065	46 (2.2%)	2,019	17 (0.8%)	12	2,007
SCU	108	106	0 (0.0%)	106	2 (1.9%)	0	106
Total	6,848	6,690	324 (4.8%)	6,366	158 (2.3%)	350	6,016

Table 41: Necrotising enterocolitis - all data, by level of neonatal unit, 2025.

Unit Type	Eligible babies	With outcome	NEC	No NEC	Missing
NICU	4,396	4,364	266 (6.1%)	4,098	32 (0.7%)
LNU	1,982	1,968	43 (2.2%)	1,925	14 (0.7%)
SCU	88	87	0 (0.0%)	87	1 (1.1%)
Total	6,466	6,419	309 (4.8%)	6,110	47 (0.7%)

Table 42: Necrotising enterocolitis - validated data, by level of neonatal unit, 2025.

3.4.3.5 Network results

Network	Eligible babies	With outcome	NEC	No NEC	Missing	No NEC died	No NEC survived	Treatment effect
East Midlands	413	413	20 (4.8%)	393	0 (0.0%)	24	369	0.2
East England	575	564	30 (5.3%)	534	11 (1.9%)	26	508	1.2
Kent Surrey Sussex	447	444	11 (2.5%)	433	3 (0.7%)	31	402	-2.6
London NCE	517	428	22 (5.1%)	406	89 (17.2%)	25	381	-0.2
London NW	322	322	18 (5.6%)	304	0 (0.0%)	11	293	0.7
London South	380	355	20 (5.6%)	335	25 (6.6%)	16	319	0.6
North West	851	850	41 (4.8%)	809	1 (0.1%)	59	750	-0.1
Northern	319	319	8 (2.5%)	311	0 (0.0%)	17	294	-2.1
South West	389	389	15 (3.9%)	374	0 (0.0%)	13	361	-0.3
Thames Valley Wsx	506	506	18 (3.6%)	488	0 (0.0%)	22	466	-1.8
West Midlands	742	722	57 (7.9%)	665	20 (2.7%)	47	618	2.7
Yorkshire Humber	612	612	20 (3.3%)	592	0 (0.0%)	26	566	-1.4
Scotland	518	509	23 (4.5%)	486	9 (1.7%)	25	461	-0.4
Wales	256	256	21 (8.2%)	235	0 (0.0%)	8	227	3.6
Total	6,847	6,689	324 (4.8%)	6,365	158 (2.3%)	350	6,015	0.0

Table 43: Necrotising enterocolitis - all data, by neonatal network, 2025.

Network	Eligible babies	With outcome	NEC	No NEC	Missing
East Midlands	394	394	18 (4.6%)	376	0 (0.0%)
East England	511	504	30 (6.0%)	474	7 (1.4%)
Kent Surrey Sussex	444	441	11 (2.5%)	430	3 (0.7%)
London NCE	404	400	20 (5.0%)	380	4 (1.0%)
London NW	240	240	13 (5.4%)	227	0 (0.0%)
London South	344	339	18 (5.3%)	321	5 (1.5%)
North West	851	850	41 (4.8%)	809	1 (0.1%)
Northern	319	319	8 (2.5%)	311	0 (0.0%)
South West	389	389	15 (3.9%)	374	0 (0.0%)
Thames Valley Wsx	506	506	18 (3.6%)	488	0 (0.0%)
West Midlands	741	721	57 (7.9%)	664	20 (2.7%)
Yorkshire Humber	611	611	20 (3.3%)	591	0 (0.0%)
Scotland	455	448	19 (4.2%)	429	7 (1.5%)
Wales	256	256	21 (8.2%)	235	0 (0.0%)
Total	6,465	6,418	309 (4.8%)	6,109	47 (0.7%)

Table 44: Necrotising enterocolitis - validated data, by neonatal network, 2025.

3.4.3.6 Caterpillar plot

Figure 133: Necrotising enterocolitis observed proportion - all data, by neonatal unit, 2025.

Figure 134: Necrotising enterocolitis observed proportion - validated data, by neonatal unit, 2025.

3.4.3.7 Caterpillar plot - adjusted

Figure 135: Necrotising enterocolitis treatment effect - validated data, by neonatal unit, 2025.

3.4.3.8 Network caterpillar plot

Figure 136: Necrotising enterocolitis observed proportion - all data, by neonatal network, 2025.

Figure 137: Necrotising enterocolitis observed proportion - validated data, by neonatal network, 2025.

3.4.3.9 Network Caterpillar plot - adjusted

Figure 138: Necrotising enterocolitis treatment effect - all data, by neonatal network, 2025.

3.4.4 Findings

There is some evidence of a fall in the overall proportion of NEC over the last three years; 4.8% (324 of 6,690) in 2025, 5% in 2024, and 5.5% in 2023.³⁶ Between 2017 and 2022, the proportion ranged between 5.9% and 6.6% (Figure 130).
Among neonatal networks, observed proportions of babies with NEC range from 2.5% (CI: 1.1 - 3.9%, 11 of 444) to 8.2% (CI: 4.8 - 11.6%, 21 of 256) (Figure 136).
Neonatal network treatment effect, ranging from -2.6 to 3.6, indicates that variation in NEC cannot be fully explained by differences in the background characteristics of the babies cared for by the networks (Figure 138).
Among the 92% of neonatal units who provided assurance that their NEC data was complete in 2025, the proportion of babies with NEC ranges from 0% to 50% (Figure 134). Treatment effect ranged from -9.2 to 48.7 (Figure 135).
These findings should continue to be interpreted with caution and alongside rates of missing data for a given network or unit.
There is evidence that breastmilk feeding can reduce the risk of developing NEC.³⁷ While the NNAP has demonstrated improvements in the proportion of babies receiving any of their mother’s milk, the reasons for the apparent fall in NEC are not known.

3.5 Late onset bloodstream infection

Measure question

Does an admitted baby born at less than 32 weeks’ have one or more episodes of bloodstream infection, characterised by one or more positive blood cultures taken with a clearly pathogenic organism, after 72 hours of age?

Sick and premature babies are prone to infection by a variety of germs, including some that are normally harmless to healthy people. Infections increase the risk of death, can lengthen the stay in the neonatal unit and may worsen the long-term developmental outlook for babies.³⁸ Those caring for babies can reduce the risk of infection by following good infection prevention and control practice in the neonatal unit.

To look for infection in babies, neonatal staff usually take blood cultures to check whether bacteria or other organisms are present in their blood. Units are encouraged to report all positive blood cultures: we accept that under-reporting of negative cultures is likely. The NNAP reports the proportion of babies with one or more blood cultures positive for a pure growth of bacteria, fungi or yeasts.

In this report, we focus only on very preterm infants (born at less than 32 weeks gestation) because these are the babies at highest risk of infection and because bloodstream infections in more mature babies may occur more in some units than others depending on the case mix of babies cared for.

3.5.1 Adjustment for case mix

The bloodstream infection measure is adjusted for: gestational age at birth and unit level.

Further details about the case mix adjustment methodology can be found in Case mix adjustment chapter and the NNAP methodology and statistical analysis plan.

3.5.2 Quality and accuracy of bloodstream infection reporting

NNAP clinical leads are asked to provide assurance of the accuracy of their bloodstream infection data. 89% (159 of 179) of units gave assurance in 2025 (in 2024 the proportion was 90%). Results are presented based on all units’ data, and on data from those providing assurance only. An indication of whether a unit provided assurance is given alongside unit level [measure] results on NNAP Online. Units which did not assure their data are omitted from the treatment effect analysis and outlier analysis, if applicable.

3.5.3 Results

Some organisms grown may represent either a true bloodstream infection or contamination of the blood culture sample with skin organisms. For this reason, results for bloodstream infection are presented in two columns. One column presents the number of babies for whom at least one culture grew either a mixed organism or an organism of unclear pathogenicity. The other column presents the number of babies for whom one or more cultures grew a pure organism of clear pathogenicity. Clearly pathogenic organisms are those for which a pure growth indicates a significant (true) infection, regardless of whether clinical confirmation is also present. A list of such organisms is provided in the NNAP 2025 Audit Measures Guide.

363 very preterm babies (less than 32 weeks gestation) had a pure growth of a clearly pathogenic organism. Babies contribute to the denominator for this measure for all units to which they were admitted, therefore babies can be counted twice in the analysis conducted for units and networks (if cared for in more than one unit or network). At an overall audit level, babies are only counted once.

3.5.3.1 Time series

Figure 139: Late onset bloodstream infection, by year.

3.5.3.2 Network time series

Figure 140: Late onset bloodstream infection, by neonatal network and year.

3.5.3.3 Type time series

Figure 141: Late onset bloodstream infection, by level of neonatal unit and year.

3.5.3.4 Unit type results

Table 45: Late onset bloodstream infection - all data, by level of neonatal unit, 2025.

Unit Type	All episodes	All babies	BSI with clearly pathogenic organism	No BSI	BSI with organism of unclear pathogenicity
NICU	6,224	4,886	316 (6.5%)	4,570	999
LNU	3,779	3,310	47 (1.4%)	3,263	173
SCU	946	876	1 (0.1%)	875	10
Total	10,949	9,072	364 (4.0%)	8,708	1,182

Table 46: Late onset bloodstream infection - validated data, by level of neonatal unit, 2025.

Unit Type	All episodes	All babies	BSI with clearly pathogenic organism	No BSI	BSI with organism of unclear pathogenicity
NICU	5,695	4,475	297 (6.6%)	4,178	938
LNU	3,432	3,010	42 (1.4%)	2,968	168
SCU	774	716	0 (0.0%)	716	7
Total	9,901	8,201	339 (4.1%)	7,862	1,113

3.5.3.5 Network results

Network	All episodes	All babies	BSI with clearly pathogenic organism	No BSI	BSI with organism of unclear pathogenicity	Treatment effect
East Midlands	846	483	20 (4.1%)	463	78	-0.9
East England	955	649	23 (3.5%)	626	84	-0.8
Kent Surrey Sussex	721	485	17 (3.5%)	468	51	-1.5
London NCE	819	577	42 (7.3%)	535	111	1.5
London NW	527	346	13 (3.8%)	333	39	-1.2
London South	557	426	28 (6.6%)	398	58	1.3
North West	1,395	879	39 (4.4%)	840	147	-0.6
Northern	505	320	13 (4.1%)	307	42	-0.6
South West	635	410	10 (2.4%)	400	45	-1.8
Thames Valley Wsx	785	530	37 (7.0%)	493	89	1.5
West Midlands	1,032	766	40 (5.2%)	726	167	0.0
Yorkshire Humber	1,010	656	27 (4.1%)	629	104	-0.6
Scotland	753	521	34 (6.5%)	487	97	1.7
Wales	405	272	21 (7.7%)	251	58	3.1
Total	10,945	7,320	364 (5.0%)	6,956	1,170	0.0

Table 47: Late onset bloodstream infection - all data, by neonatal network, 2025.

Network	All episodes	All babies	BSI with clearly pathogenic organism	No BSI	BSI with organism of unclear pathogenicity
East Midlands	788	452	19 (4.2%)	433	77
East England	615	428	14 (3.3%)	414	66
Kent Surrey Sussex	697	472	17 (3.6%)	455	51
London NCE	647	461	35 (7.6%)	426	82
London NW	348	245	12 (4.9%)	233	30
London South	512	388	28 (7.2%)	360	58
North West	1,335	847	39 (4.6%)	808	147
Northern	505	320	13 (4.1%)	307	42
South West	630	407	10 (2.5%)	397	45
Thames Valley Wsx	755	507	37 (7.3%)	470	89
West Midlands	1,000	751	39 (5.2%)	712	165
Yorkshire Humber	996	646	27 (4.2%)	619	104
Scotland	664	464	28 (6.0%)	436	88
Wales	405	272	21 (7.7%)	251	58
Total	9,897	6,660	339 (5.1%)	6,321	1,102

Table 48: Late onset bloodstream infection - validated data, by neonatal network, 2025.

3.5.3.6 Caterpillar plot

Table 49: Late onset bloodstream infection observed proportion - all data, by neonatal unit, 2025.

Figure 142: Late onset bloodstream infection observed proportion - validated data, by neonatal unit, 2025.

3.5.3.7 Caterpillar plot - adjusted

Table 50: Late onset bloodstream infection treatment effect - all data, by neonatal unit, 2025.

3.5.3.8 Network caterpillar plot

Figure 143: Late onset bloodstream infection observed proportion - all data, by neonatal network, 2025.

Figure 144: Late onset bloodstream infection observed proportion - validated data, by neonatal network, 2025.

3.5.3.9 Network Caterpillar plot - adjusted

Figure 145: Late onset bloodstream infection treatment effect - all data, by neonatal network, 2025.

3.5.4 Findings

The overall proportion of babies born at less than 32 weeks who experienced late onset bloodstream infection was 5.3% (363 of 6,804). In previous years, proportions ranged between 4.4% and 5.8% from 2018 to 2024 (Figure 139).³⁹
Observed proportions vary approximately threefold between neonatal networks, from 2.4% (CI: 0.9 - 3.9%, 10 of 410) to 7.7% (CI: 4.5 - 10.9%, 21 of 272) (Figure 143).
Neonatal network treatment effects range from -1.8 to 3.1, suggesting that opportunities may exist to reduce unwarranted regional variation in proportions of bloodstream infection (Figure 145).
Among the 89% of neonatal units who provided assurance that their bloodstream infection data was complete in 2025, the proportion of babies experiencing bloodstream infection ranged from 0% to 14.8% (Figure 142).
Neonatal unit treatment effects ranged from -6.2 to 10.1 (Figure 145).
Following an agreement with the UKHSA to link infection data from the Second Generation Surveillance System (SGSS) with neonatal data, the NNAP expects to be able to validate historical NNAP infection reporting and to use the linked data to strengthen future reporting of this measure.

3.6 Preterm brain injury

Measure question

What proportion of babies born at less than 32 weeks’ gestational age experience preterm brain injury (intraventricular haemorrhage 3 or 4, post-haemorrhagic ventricular dilation or cystic periventricular leukomalacia cPVL)?

The NNAP reports proportions of the more serious grades of intraventricular/ periventricular haemorrhagic brain injury, proportions of cystic periventricular leukomalacia (cPVL) and the proportions of experience post haemorrhagic ventricular dilatation (PVHD).

Very preterm infants may experience brain injury, either from bleeding or consequent to cystic periventricular leukomalacia. The consequences of such injury vary, in part depending on the severity of the injury. In the NNAP, we assess the proportion of babies in whom these types of brain injury occur. For intraventricular haemorrhage (IVH), we concentrate only on the more severe grades of injury. We appreciate that within these grade 3 and 4 haemorrhages the clinical sequalae may vary sigificantly depending on the laterality and size of injury. However, where the survelliance case definition, as set out in the NNAP measures guide, is consistently applied by neonatal units, we believe it will form the basis for appropriate comparisons of rates of adverse outcome between neonatal services.

The NNAP is also reporting proportions of cystic periventricular leukomalaicia (cPVL) based on the published surveillance case definition. Similarly to IVH, cases identified with cPVL will experience heterogenous outcome, but one that on average is much more likely to be characterised by disability than in babies without cPVL. It is not the case that all IVH or cPVL outcomes are known to be, or likely to be, preventable. However, these forms of brain injury are reasonably common and regarded as clinically important, with increased risk of adverse neurodevelopmental outcomes.⁴⁰ Care bundles targetting reduction in their incidence are described, which may be of interest to units experiencing high rates of preterm brain injury.⁴¹,⁴²

3.6.1 Quality and accuracy of preterm brain injury reporting

NNAP clinical leads are asked to provide assurance of the accuracy of their preterm brain injury data. 90% (161 of 179) of units gave assurance in 2025 (in 2024 the proportion was 89.4%). Results are presented based on all units’ data, and on data from those providing assurance only. An indication of whether a unit provided assurance is given alongside unit results on NNAP Online. Note that case mix adjustment is not yet conducted for preterm brain injury. Outlier analysis is conducted on the proportion of missing data for the IVH 3 or 4 measure.

3.6.2 Results

3.6.2.1 Time series

Figure 146: Intraventricular haemorrhage (IVH) grades 3 and 4 or death, by year.

Figure 147: Cystic periventricular leukomalacia (cPVL) or death, by year.

Figure 148: Posthaemorrhagic ventricular dilatation (PHVD) or death, by year.

3.6.2.2 Network time series

Figure 149: Intraventricular haemorrhage (IVH) grades 3 and 4 or death, by neonatal network and year.

Figure 150: Cystic periventricular leukomalacia (cPVL) or death, by neonatal network and year.

Figure 151: Posthaemorrhagic ventricular dilatation (PHVD) or death, by neonatal network and year.

3.6.2.3 Type time series

Figure 152: Intraventricular haemorrhage (IVH) grades 3 and 4 or death, by level of neonatal unit and year.

Figure 153: Cystic periventricular leukomalacia (cPVL) or death, by level of neonatal unit and year.

Figure 154: Posthaemorrhagic ventricular dilatation (PHVD) or death, by level of neonatal unit and year.

3.6.2.4 Unit type results

Unit Type	Eligible babies	With outcome	IVH 3/4 or death	No IVH 3/4 or death	Missing	Died	IVH 3/4
NICU	4,287	4,132	639 (15.5%)	3,493	155 (3.6%)	345	294
LNU	2,321	2,264	192 (8.5%)	2,072	57 (2.5%)	83	109
SCU	363	339	30 (8.8%)	309	24 (6.6%)	16	14
Other	80	60	12 (20.0%)	48	20 (25.0%)	7	5
Total	7,051	6,795	873 (12.8%)	5,922	256 (3.6%)	451	422

Table 51: Intraventricular haemorrhage (IVH) grades 3 and 4 or death - all data, by level of neonatal unit, 2025.

Unit Type	Eligible babies	With outcome	cPVL or death	No cPVL or death	Missing	Died	cPVL
NICU	4,287	4,145	520 (12.5%)	3,625	142 (3.3%)	404	116
LNU	2,321	2,257	135 (6.0%)	2,122	64 (2.8%)	81	54
SCU	363	340	15 (4.4%)	325	23 (6.3%)	9	6
Other	80	65	9 (13.8%)	56	15 (18.8%)	5	4
Total	7,051	6,807	679 (10.0%)	6,128	244 (3.5%)	499	180

Table 52: Cystic periventricular leukomalacia (cPVL) or death - all data, by level of neonatal unit, 2025.

Unit Type	Eligible babies	With outcome	PHVD or death	No PHVD or death	Missing	Died	PHVD
NICU	4,287	4,142	589 (14.2%)	3,553	145 (3.4%)	376	213
LNU	2,321	2,258	141 (6.2%)	2,117	63 (2.7%)	74	67
SCU	363	342	23 (6.7%)	319	21 (5.8%)	6	17
Other	80	65	8 (12.3%)	57	15 (18.8%)	4	4
Total	7,051	6,807	761 (11.2%)	6,046	244 (3.5%)	460	301

Table 53: Posthaemorrhagic ventricular dilatation (PHVD) or death - all data, by level of neonatal unit, 2025.

Unit Type	Eligible babies	With outcome	IVH 3/4 or death	No IVH 3/4 or death	Missing	Died	IVH 3/4
NICU	3,862	3,826	596 (15.6%)	3,230	36 (0.9%)	320	276
LNU	2,169	2,131	182 (8.5%)	1,949	38 (1.8%)	77	105
SCU	305	288	27 (9.4%)	261	17 (5.6%)	14	13
Total	6,336	6,245	805 (12.9%)	5,440	91 (1.4%)	411	394

Table 54: Intraventricular haemorrhage (IVH) grades 3 and 4 or death - validated data, by level of neonatal unit, 2025.

Unit Type	Eligible babies	With outcome	cPVL or death	No cPVL or death	Missing	Died	cPVL
NICU	3,862	3,795	484 (12.8%)	3,311	67 (1.7%)	379	105
LNU	2,169	2,122	126 (5.9%)	1,996	47 (2.2%)	76	50
SCU	305	287	14 (4.9%)	273	18 (5.9%)	8	6
Total	6,336	6,204	624 (10.1%)	5,580	132 (2.1%)	463	161

Table 55: Cystic periventricular leukomalacia (cPVL) or death - validated data, by level of neonatal unit, 2025.

Unit Type	Eligible babies	With outcome	PHVD or death	No PHVD or death	Missing	Died	PHVD
NICU	3,862	3,793	538 (14.2%)	3,255	69 (1.8%)	357	181
LNU	2,169	2,123	131 (6.2%)	1,992	46 (2.1%)	69	62
SCU	305	289	22 (7.6%)	267	16 (5.2%)	5	17
Total	6,336	6,205	691 (11.1%)	5,514	131 (2.1%)	431	260

Table 56: Posthaemorrhagic ventricular dilatation (PHVD) or death - validated data, by level of neonatal unit, 2025.

3.6.2.5 Network results

Network	Eligible babies	With outcome	IVH 3/4 or death	No IVH 3/4 or death	Missing	Died	IVH 3/4
East Midlands	440	426	56 (13.1%)	370	14 (3.2%)	33	23
East England	616	579	69 (11.9%)	510	37 (6.0%)	33	36
Kent Surrey Sussex	450	444	57 (12.8%)	387	6 (1.3%)	26	31
London NCE	519	435	58 (13.3%)	377	84 (16.2%)	37	21
London NW	315	311	30 (9.6%)	281	4 (1.3%)	18	12
London South	409	355	46 (13.0%)	309	54 (13.2%)	24	22
North West	834	831	130 (15.6%)	701	3 (0.4%)	58	72
Northern	340	335	36 (10.7%)	299	5 (1.5%)	24	12
South West	395	391	37 (9.5%)	354	4 (1.0%)	15	22
Thames Valley Wsx	513	510	58 (11.4%)	452	3 (0.6%)	21	37
West Midlands	759	749	132 (17.6%)	617	10 (1.3%)	72	60
Yorkshire Humber	633	621	71 (11.4%)	550	12 (1.9%)	38	33
Scotland	529	526	57 (10.8%)	469	3 (0.6%)	32	25
Wales	269	267	33 (12.4%)	234	2 (0.7%)	17	16
Other	30	15	3 (20.0%)	12	15 (50.0%)	3	0
Total	7,051	6,795	873 (12.8%)	5,922	256 (3.6%)	451	422

Table 57: Intraventricular haemorrhage (IVH) grades 3 and 4 or death - all data, by neonatal network, 2025.

Network	Eligible babies	With outcome	cPVL or death	No cPVL or death	Missing	Died	cPVL
East Midlands	440	429	51 (11.9%)	378	11 (2.5%)	38	13
East England	616	568	45 (7.9%)	523	48 (7.8%)	33	12
Kent Surrey Sussex	450	440	51 (11.6%)	389	10 (2.2%)	37	14
London NCE	519	460	42 (9.1%)	418	59 (11.4%)	33	9
London NW	315	311	24 (7.7%)	287	4 (1.3%)	20	4
London South	409	378	36 (9.5%)	342	31 (7.6%)	22	14
North West	834	822	102 (12.4%)	720	12 (1.4%)	74	28
Northern	340	328	25 (7.6%)	303	12 (3.5%)	20	5
South West	395	391	25 (6.4%)	366	4 (1.0%)	16	9
Thames Valley Wsx	513	507	41 (8.1%)	466	6 (1.2%)	28	13
West Midlands	759	747	107 (14.3%)	640	12 (1.6%)	87	20
Yorkshire Humber	633	612	48 (7.8%)	564	21 (3.3%)	34	14
Scotland	529	525	51 (9.7%)	474	4 (0.8%)	37	14
Wales	269	268	29 (10.8%)	239	1 (0.4%)	18	11
Other	30	21	2 (9.5%)	19	9 (30.0%)	2	0
Total	7,051	6,807	679 (10.0%)	6,128	244 (3.5%)	499	180

Table 58: Cystic periventricular leukomalacia (cPVL) or death - all data, by neonatal network, 2025.

Network	Eligible babies	With outcome	PHVD or death	No PHVD or death	Missing	Died	PHVD
East Midlands	440	430	53 (12.3%)	377	10 (2.3%)	38	15
East England	616	569	54 (9.5%)	515	47 (7.6%)	28	26
Kent Surrey Sussex	450	440	57 (13.0%)	383	10 (2.2%)	33	24
London NCE	519	460	52 (11.3%)	408	59 (11.4%)	34	18
London NW	315	311	26 (8.4%)	285	4 (1.3%)	16	10
London South	409	377	50 (13.3%)	327	32 (7.8%)	16	34
North West	834	822	113 (13.7%)	709	12 (1.4%)	66	47
Northern	340	329	27 (8.2%)	302	11 (3.2%)	19	8
South West	395	391	33 (8.4%)	358	4 (1.0%)	16	17
Thames Valley Wsx	513	507	48 (9.5%)	459	6 (1.2%)	25	23
West Midlands	759	745	114 (15.3%)	631	14 (1.8%)	80	34
Yorkshire Humber	633	612	49 (8.0%)	563	21 (3.3%)	32	17
Scotland	529	525	50 (9.5%)	475	4 (0.8%)	38	12
Wales	269	268	32 (11.9%)	236	1 (0.4%)	17	15
Other	30	21	3 (14.3%)	18	9 (30.0%)	2	1
Total	7,051	6,807	761 (11.2%)	6,046	244 (3.5%)	460	301

Table 59: Posthaemorrhagic ventricular dilatation (PHVD) or death - all data, by neonatal network, 2025.

Network	Eligible babies	With outcome	IVH 3/4 or death	No IVH 3/4 or death	Missing	Died	IVH 3/4
East Midlands	414	403	53 (13.2%)	350	11 (2.7%)	31	22
East England	509	489	62 (12.7%)	427	20 (3.9%)	29	33
Kent Surrey Sussex	385	381	46 (12.1%)	335	4 (1.0%)	20	26
London NCE	417	410	57 (13.9%)	353	7 (1.7%)	36	21
London NW	237	235	21 (8.9%)	214	2 (0.8%)	11	10
London South	250	241	24 (10.0%)	217	9 (3.6%)	13	11
North West	832	829	130 (15.7%)	699	3 (0.4%)	58	72
Northern	339	334	36 (10.8%)	298	5 (1.5%)	24	12
South West	392	390	37 (9.5%)	353	2 (0.5%)	15	22
Thames Valley Wsx	508	506	58 (11.5%)	448	2 (0.4%)	21	37
West Midlands	745	735	130 (17.7%)	605	10 (1.3%)	72	58
Yorkshire Humber	621	610	70 (11.5%)	540	11 (1.8%)	38	32
Scotland	421	419	51 (12.2%)	368	2 (0.5%)	28	23
Wales	265	263	30 (11.4%)	233	2 (0.8%)	15	15
Other	1	0	0 (NaN%)	0	1 (100.0%)	0	0
Total	6,336	6,245	805 (12.9%)	5,440	91 (1.4%)	411	394

Table 60: Intraventricular haemorrhage (IVH) grades 3 and 4 or death - validated data, by neonatal network, 2025.

Network	Eligible babies	With outcome	cPVL or death	No cPVL or death	Missing	Died	cPVL
East Midlands	414	404	48 (11.9%)	356	10 (2.4%)	36	12
East England	509	479	41 (8.6%)	438	30 (5.9%)	31	10
Kent Surrey Sussex	385	378	41 (10.8%)	337	7 (1.8%)	30	11
London NCE	417	409	42 (10.3%)	367	8 (1.9%)	33	9
London NW	237	234	17 (7.3%)	217	3 (1.3%)	14	3
London South	250	244	19 (7.8%)	225	6 (2.4%)	12	7
North West	832	820	101 (12.3%)	719	12 (1.4%)	74	27
Northern	339	327	25 (7.6%)	302	12 (3.5%)	20	5
South West	392	389	25 (6.4%)	364	3 (0.8%)	16	9
Thames Valley Wsx	508	503	41 (8.2%)	462	5 (1.0%)	28	13
West Midlands	745	733	105 (14.3%)	628	12 (1.6%)	85	20
Yorkshire Humber	621	601	47 (7.8%)	554	20 (3.2%)	34	13
Scotland	421	418	45 (10.8%)	373	3 (0.7%)	33	12
Wales	265	265	27 (10.2%)	238	0 (0.0%)	17	10
Other	1	0	0 (NaN%)	0	1 (100.0%)	0	0
Total	6,336	6,204	624 (10.1%)	5,580	132 (2.1%)	463	161

Table 61: Cystic periventricular leukomalacia (cPVL) or death - validated data, by neonatal network, 2025.

Network	Eligible babies	With outcome	PHVD or death	No PHVD or death	Missing	Died	PHVD
East Midlands	414	405	50 (12.3%)	355	9 (2.2%)	36	14
East England	509	480	48 (10.0%)	432	29 (5.7%)	26	22
Kent Surrey Sussex	385	378	48 (12.7%)	330	7 (1.8%)	27	21
London NCE	417	409	47 (11.5%)	362	8 (1.9%)	34	13
London NW	237	234	19 (8.1%)	215	3 (1.3%)	11	8
London South	250	244	21 (8.6%)	223	6 (2.4%)	10	11
North West	832	820	113 (13.8%)	707	12 (1.4%)	66	47
Northern	339	328	27 (8.2%)	301	11 (3.2%)	19	8
South West	392	389	33 (8.5%)	356	3 (0.8%)	16	17
Thames Valley Wsx	508	503	48 (9.5%)	455	5 (1.0%)	25	23
West Midlands	745	731	112 (15.3%)	619	14 (1.9%)	79	33
Yorkshire Humber	621	601	49 (8.2%)	552	20 (3.2%)	32	17
Scotland	421	418	46 (11.0%)	372	3 (0.7%)	34	12
Wales	265	265	30 (11.3%)	235	0 (0.0%)	16	14
Other	1	0	0 (NaN%)	0	1 (100.0%)	0	0
Total	6,336	6,205	691 (11.1%)	5,514	131 (2.1%)	431	260

Table 62: Posthaemorrhagic ventricular dilatation (PHVD) or death - validated data, by neonatal network, 2025.

3.6.2.6 Caterpillar plot

Figure 155: Intraventricular haemorrhage (IVH) grades 3 and 4 or death observed proportion - all data, by neonatal unit, 2025.

Figure 156: Cystic periventricular leukomalacia (cPVL) or death observed proportion - all data, by neonatal unit, 2025.

Figure 157: Posthaemorrhagic ventricular dilatation (PHVD) or death observed proportion - all data, by neonatal unit, 2025.

Figure 158: Intraventricular haemorrhage (IVH) grades 3 and 4 or death observed proportion - validated data, by neonatal unit, 2025.

Figure 159: Cystic periventricular leukomalacia (cPVL) or death observed proportion - validated data, by neonatal unit, 2025.

Figure 160: Posthaemorrhagic ventricular dilatation (PHVD) or death observed proportion - validated data, by neonatal unit, 2025.

3.6.2.7 Network caterpillar plot

Figure 161: Intraventricular haemorrhage (IVH) grades 3 and 4 or death observed proportion - all data, by neonatal network, 2025.

Figure 162: Cystic periventricular leukomalacia (cPVL) or death observed proportion - all data, by neonatal network, 2025.

Figure 163: Posthaemorrhagic ventricular dilatation (PHVD) or death observed proportion - all data, by neonatal network, 2025.

Figure 164: Intraventricular haemorrhage (IVH) grades 3 and 4 or death observed proportion - validated data, by neonatal network, 2025.

Figure 165: Cystic periventricular leukomalacia (cPVL) or death observed proportion - validated data, by neonatal network, 2025.

Figure 166: Posthaemorrhagic ventricular dilatation (PHVD) or death observed proportion - validated data, by neonatal network, 2025.

3.6.3 Findings

Over the past few years, NNAP reporting of preterm brain injury has focussed on reducing rates of missing data and driving improvements in data quality. Data completeness continues to improve year on year; for IVH grades 3 or 4, from 26.% in 2021, to 3.6% in 2025 (Figure 146).
However, network level variation in missing data remains; between 0.4% and 16.2% for IVH 3 or 4 (Table 57).
The overall proportion of IVH grades 3 or 4 or death is 12.8% (Figure 146). The apparent fall over time in the proportion of IVH 3 or 4 should not confidently be interpreted as a real reduction given the historically high rates of missing data, and the number of neonatal units who have not been able to assure their data in 2025.
The overall proportion of CPVL or death is 10% (Figure 147). Changes in this proportion over time should not be over-interpreted given the historically high rates of missing data, and the number of neonatal units who have not been able to assure their data in 2025.
The overall proportion of PHVD or death is 11.2% (Figure 148). Changes in this proportion over time should not be over-interpreted given the historically high rates of missing data, and the number of neonatal units who have not been able to assure their data in 2025.

3.7 Summary

3.7.1 Recommendations

Recommendations

As recommended in the NNAP 2024 data report, Neonatal networks should:

Review mortality data and, where rates are higher than expected, develop locally prioritised improvement plans. Quality improvement activity should focus on best practices identified in Neonatal Networks with low mortality, with particular attention to differences in network structure, staffing, clinical governance, and clinical practice. (Recommendation repeated from the 2023 data report.)
With their constituent units, undertake reviews of deaths in accordance with the BAPM Framework for Practice: Neonatal Mortality Governance and engage with statutory death review processes. Shared learning from these reviews should inform network governance and unit level clinical practice.

In line with the recommendation made in the NNAP 2024 data report, NHS England⁴³ and health departments in Devolved Governments should work together to:

issue clear, UK-wide guidance to neonatal services around the correct reporting of preterm brain injury including PHVD, so that robust data collection can support the achievement of the national ambition to reduce neonatal brain injury.
develop a mandated, UK-wide NHS neonatal information standard to ensure that clinical reporting systems are interoperable, ensuring robust data collection to support effective measurement and reporting of all neonatal processes and outcomes.

3.7.2 Actions for local quality improvement

Neonatal units without assured data entry for outcomes such as NEC, bloodstream infection and preterm brain injury should develop and implement plans to deliver enhanced completeness and quality of data, using the Restricted Access Dashboard to support frequent review and to address quality issues in a timely manner. Where data quality is affected by interoperability of EPR systems, this should be identified as a barrier to quality improvement and raised as a risk within Trust governance structures. (Action repeated and adapted from the 2024 extended analysis report.)
Neonatal units with higher rates of bronchopulmonary dysplasia (BPD) and a positive treatment effect, should review the NICE guideline and use the BAPM QI Toolkit to carry out a gap analysis and implement quality improvement programmes. (Action repeated from the 2024 extended analysis report.)
Neonatal units and networks with higher rates of necrotising enterocolitis (NEC) and a positive treatment effect should seek to learn from units with validated low rates of NEC, and consider introducing a single cross-network probiotic and feeding guideline. (Action repeated from the 2024 extended analysis report.)
Neonatal networks with high levels of incomplete preterm brain injury data should take urgent action in the short term to address this to ensure that local and regional and national rates of preterm brain injury can be confidently described. (Action repeated from the 2024 extended analysis report.)

3.7.3 Improvement case studies and useful resources

Reducing bloodstream infection in babies born under 32 weeks of gestation: From outlier to outstanding. Dr A. Paria et al., Lancashire Women & Newborn Centre, Burnley General Hospital, East Lancashire Hospitals NHS Trust.

Quality improvement vignette: Sharing learning from neonatal mortality reviews in Wales

Dr Jennifer Calvert, Clinical Lead, Wales Maternity and Neonatal Strategic Clinical Network

Neonatal units across Wales are required to review every neonatal death using the Perinatal Mortality Review Tool (PMRT) as part of a consistent approach to learning and quality improvement. Following local review, cases are presented to the monthly Neonatal Mortality Shared Learning Forum (NMSLF), hosted by the Maternity and Neonatal Strategic Network.

The forum brings together a broad multidisciplinary team, including all members of the perinatal team, ambulance service colleagues, other clinical specialists, and, where relevant, colleagues from outside Wales. Using a recently updated standardised PMRT-based template, unit representatives present anonymised summaries of local reviews, highlighting examples of good practice, lessons learned, and actions arising from Health Board reviews.

By sharing learning across organisations, the forum enables participants to identify recurring themes that may not be apparent from individual cases alone and to develop wider recommendations for service improvement. Learning points are collated after each meeting and circulated across the network, supporting the spread of good practice and continuous improvement in neonatal care throughout Wales.

4 Appendix

4.1 Unit participation table

Unit Name	Network	Unit type	IC days	HD days	SC days	All days	Validated BSI data	Validated NEC data	Validated brain injury data
St Marys Manchester	North West	NICU	5,797	5,355	6,034	17,186	Yes	Yes	Yes
The Royal London	London NCE	NICU	4,466	4,250	4,761	13,477	Yes	Yes	Yes
Royal Childrens Glasgow	Scotland	NICU	4,108	4,737	4,607	13,452	Yes	Yes	Yes
Leicester Neonatal	East Midlands	NICU	2,628	2,620	7,821	13,069	Yes	Yes	Yes
Rosie Addenbrookes	East England	NICU	3,675	4,533	4,646	12,854	No	Yes	Yes
John Radcliffe Hospital	Thames Valley Wsx	NICU	3,640	3,806	5,384	12,830	Yes	Yes	Yes
Homerton	London NCE	NICU	3,524	4,242	4,729	12,495	Yes	Yes	Yes
Leeds Neonatal	Yorkshire Humber	NICU	3,272	3,273	5,648	12,193	Yes	Yes	Yes
St Georges Hospital	London South	NICU	3,734	3,738	3,729	11,201	Yes	Yes	No
Jessop Wing Sheffield	Yorkshire Humber	NICU	2,991	2,697	5,230	10,918	Yes	Yes	Yes
Liverpool Womens	North West	NICU	3,232	2,620	4,737	10,589	Yes	Yes	Yes
Chelsea and Westminster	London NW	NICU	3,133	3,097	3,959	10,189	No	No	No
Royal Victoria Infirmary	Northern	NICU	2,059	3,700	4,230	9,989	Yes	Yes	Yes
University Hospital Wales	Wales	NICU	3,014	3,288	3,162	9,464	Yes	Yes	Yes
Queen Alexandra Hospital	Thames Valley Wsx	NICU	2,585	2,169	4,703	9,457	Yes	Yes	Yes
Bradford Royal Infirmary	Yorkshire Humber	NICU	1,670	2,709	4,955	9,334	Yes	Yes	Yes
Kings College Hospital	London South	NICU	3,370	3,216	2,742	9,328	Yes	Yes	Yes
Lancs W and N Centre	North West	NICU	1,602	2,979	4,415	8,996	Yes	Yes	Yes
Royal Bolton Hospital	North West	NICU	1,433	3,345	4,188	8,966	Yes	Yes	Yes
St Michaels Hospital	South West	NICU	3,822	2,450	2,589	8,861	Yes	Yes	Yes
Simpson Centre	Scotland	NICU	2,239	3,296	3,320	8,855	Yes	Yes	Yes
Birmingham Heartlands	West Midlands	NICU	1,439	2,048	5,266	8,753	Yes	Yes	Yes
Princess Anne Hospital	Thames Valley Wsx	NICU	3,289	2,477	2,914	8,680	Yes	Yes	Yes
Nottingham QMC	East Midlands	NICU	3,090	2,222	3,293	8,605	Yes	Yes	Yes
Royal Oldham Hospital	North West	NICU	1,592	3,327	3,646	8,565	Yes	Yes	Yes
Luton and Dunstable	East England	NICU	2,431	2,974	3,156	8,561	Yes	Yes	Yes
Royal Sussex	Kent Surrey Sussex	NICU	2,321	2,405	3,651	8,377	Yes	Yes	Yes
James Cook	Northern	NICU	1,466	2,952	3,737	8,155	Yes	Yes	Yes
Coventry	West Midlands	NICU	2,079	1,888	3,991	7,958	Yes	Yes	Yes
Royal Stoke	West Midlands	NICU	1,462	2,130	3,940	7,532	Yes	Yes	Yes
Norfolk and Norwich	East England	NICU	2,212	2,265	3,015	7,492	Yes	Yes	Yes
Aberdeen Maternity	Scotland	NICU	1,489	2,813	3,188	7,490	Yes	Yes	Yes
New Cross Hospital	West Midlands	NICU	1,796	2,246	3,398	7,440	Yes	Yes	Yes
UCLH*	London NCE	NICU	1,864	2,426	3,123	7,413	No	No	No
The Grange	Wales	NICU	1,650	2,441	3,299	7,390	Yes	Yes	Yes
Southmead Hospital	South West	NICU	1,557	2,249	3,506	7,312	Yes	Yes	Yes
Medway Maritime Hospital	Kent Surrey Sussex	NICU	1,453	2,926	2,877	7,256	Yes	Yes	Yes
Hull Royal Infirmary	Yorkshire Humber	NICU	2,361	2,590	2,280	7,231	Yes	Yes	Yes
Royal Preston Hospital	North West	NICU	1,404	2,188	2,858	6,450	Yes	Yes	Yes
Queen Charlotte	London NW	NICU	1,798	2,577	1,913	6,288	Yes	Yes	Yes
Singleton Hospital	Wales	NICU	1,663	2,631	1,771	6,065	Yes	Yes	Yes
Birmingham Womens	West Midlands	NICU	1,462	1,450	2,697	5,609	Yes	Yes	Yes
Evelina London	London South	NICU	1,882	2,007	1,570	5,459	No	No	No
Princess Royal Glasgow	Scotland	NICU	917	1,849	2,622	5,388	No	No	No
St Peters Hospital	Kent Surrey Sussex	NICU	1,678	1,915	1,670	5,263	Yes	Yes	Yes
William Harvey Hospital	Kent Surrey Sussex	NICU	945	1,303	2,961	5,209	Yes	Yes	No
UH Wishaw	Scotland	NICU	1,144	1,629	2,385	5,158	Yes	Yes	Yes
Derriford Hospital	South West	NICU	1,403	1,725	1,759	4,887	Yes	Yes	Yes
Sunderland Royal	Northern	NICU	851	1,324	2,380	4,555	Yes	Yes	Yes
Ninewells	Scotland	NICU	937	1,336	2,267	4,540	Yes	Yes	Yes
Arrowe Park Hospital	North West	NICU	1,074	1,333	1,171	3,578	Yes	Yes	Yes
Alder Hey	North West	NICU	473	1,325	426	2,224	Yes	Yes	Yes
Queens Romford	London NCE	LNU	530	1,549	5,247	7,326	Yes	Yes	Yes
Midland Met	West Midlands	LNU	564	1,982	3,553	6,099	Yes	Yes	Yes
Royal Derby Hospital	East Midlands	LNU	738	1,609	3,707	6,054	Yes	Yes	Yes
Newham University	London NCE	LNU	519	1,398	3,896	5,813	Yes	Yes	Yes
Gloucestershire	South West	LNU	443	1,860	3,109	5,412	Yes	Yes	Yes
Barnet Hospital	London NCE	LNU	423	1,784	3,195	5,402	Yes	Yes	Yes
Princess Royal Telford	West Midlands	LNU	352	1,247	3,542	5,141	Yes	Yes	Yes
North Middlesex	London NCE	LNU	335	1,501	3,028	4,864	Yes	No	Yes
Whittington Hospital	London NCE	LNU	335	1,291	3,168	4,794	Yes	Yes	Yes
Nottingham City Hospital	East Midlands	LNU	412	903	3,424	4,739	Yes	Yes	Yes
Northwick Park Hospital	London NW	LNU	172	1,067	3,451	4,690	Yes	Yes	Yes
Stoke Mandeville	Thames Valley Wsx	LNU	325	1,299	3,035	4,659	Yes	Yes	Yes
Tunbridge Wells Hospital	Kent Surrey Sussex	LNU	322	1,740	2,590	4,652	Yes	Yes	Yes
St Marys London	London NW	LNU	324	1,326	2,965	4,615	Yes	Yes	Yes
Basildon	East England	LNU	584	1,833	2,185	4,602	Yes	Yes	Yes
Wythenshawe Hospital	North West	LNU	238	1,182	3,160	4,580	Yes	Yes	Yes
Great Western Hospital	South West	LNU	264	1,201	3,024	4,489	Yes	Yes	Yes
Croydon University	London South	LNU	342	1,349	2,742	4,433	Yes	Yes	Yes
Calderdale Royal	Yorkshire Humber	LNU	334	980	3,057	4,371	Yes	Yes	Yes
Northampton	East Midlands	LNU	362	1,287	2,698	4,347	Yes	Yes	Yes
Russells Hall Hospital	West Midlands	LNU	330	873	3,103	4,306	Yes	Yes	Yes
Milton Keynes	Thames Valley Wsx	LNU	252	1,287	2,754	4,293	Yes	Yes	Yes
North Manchester	North West	LNU	148	924	3,205	4,277	No	Yes	Yes
Pinderfields	Yorkshire Humber	LNU	479	1,106	2,662	4,247	Yes	Yes	Yes
Peterborough City	East England	LNU	383	1,278	2,529	4,190	Yes	Yes	Yes
Worcestershire Royal	West Midlands	LNU	303	969	2,918	4,190	Yes	Yes	Yes
Lister Hospital	East England	LNU	217	999	2,942	4,158	Yes	Yes	Yes
UHD Bournemouth	Thames Valley Wsx	LNU	235	1,064	2,808	4,107	Yes	Yes	Yes
Queen Elizabeth Woolwich	London South	LNU	416	912	2,770	4,098	Yes	Yes	Yes
Manor Hospital	West Midlands	LNU	255	888	2,943	4,086	Yes	Yes	Yes
Musgrove Park Hospital	South West	LNU	277	1,111	2,607	3,995	Yes	Yes	Yes
Doncaster Royal	Yorkshire Humber	LNU	292	987	2,696	3,975	Yes	Yes	Yes
Princess Alexandra	East England	LNU	284	937	2,685	3,906	No	No	No
Royal United Hospital	South West	LNU	223	1,251	2,385	3,859	Yes	Yes	Yes
Lewisham	London South	LNU	267	1,017	2,541	3,825	Yes	Yes	Yes
Ayrshire Maternity Unit	Scotland	LNU	286	981	2,523	3,790	Yes	Yes	No
Rotherham	Yorkshire Humber	LNU	195	790	2,631	3,616	Yes	Yes	Yes
Whipps Cross	London NCE	LNU	220	802	2,573	3,595	No	Yes	Yes
East Surrey Hospital	Kent Surrey Sussex	LNU	315	1,147	2,093	3,555	Yes	Yes	Yes
Wexham Park Hospital	Thames Valley Wsx	LNU	241	992	2,286	3,519	Yes	Yes	Yes
Royal Devon Exeter	South West	LNU	238	1,499	1,717	3,454	Yes	Yes	Yes
Ipswich Hospital	East England	LNU	290	1,001	2,069	3,360	Yes	Yes	Yes
Royal Berkshire Hospital	Thames Valley Wsx	LNU	236	1,226	1,878	3,340	Yes	Yes	Yes
Hillingdon Hospital	London NW	LNU	211	1,116	1,970	3,297	Yes	Yes	Yes
Frimley Park Hospital	Kent Surrey Sussex	LNU	309	933	2,014	3,256	Yes	Yes	Yes
Broomfield	East England	LNU	251	1,122	1,869	3,242	No	No	No
Kingston Hospital	London South	LNU	293	826	2,118	3,237	Yes	Yes	Yes
Whiston Hospital	North West	LNU	113	710	2,345	3,168	Yes	Yes	Yes
Barnsley	Yorkshire Humber	LNU	224	516	2,358	3,098	Yes	Yes	Yes
Kettering General	East Midlands	LNU	214	681	2,191	3,086	No	No	No
Victoria Kirkcaldy	Scotland	LNU	288	1,319	1,446	3,053	Yes	Yes	Yes
Kings Mill Hospital	East Midlands	LNU	284	714	2,005	3,003	Yes	Yes	Yes
Glan Clwyd Hospital	Wales	LNU	394	1,137	1,467	2,998	Yes	Yes	Yes
St Helier Hospital	London South	LNU	142	769	2,078	2,989	Yes	Yes	Yes
Royal Alexandra Paisley	Scotland	LNU	211	883	1,876	2,970	Yes	Yes	Yes
Royal Cornwall Hospital	South West	LNU	285	1,087	1,588	2,960	Yes	Yes	Yes
Warrington Hospital	North West	LNU	186	634	2,038	2,858	Yes	Yes	Yes
Watford General Hospital	East England	LNU	141	1,180	1,527	2,848	No	Yes	No
Royal Albert Edward	North West	LNU	145	557	2,022	2,724	Yes	Yes	Yes
Colchester General	East England	LNU	177	1,083	1,441	2,701	Yes	Yes	Yes
Chesterfield Royal	Yorkshire Humber	LNU	112	622	1,967	2,701	Yes	Yes	Yes
Diana PoW Hospital	Yorkshire Humber	LNU	302	699	1,676	2,677	Yes	Yes	Yes
Lincoln County Hospital	East Midlands	LNU	221	784	1,663	2,668	Yes	Yes	Yes
Scunthorpe General	Yorkshire Humber	LNU	194	761	1,627	2,582	Yes	Yes	Yes
Victoria Blackpool	North West	LNU	202	533	1,765	2,500	Yes	Yes	Yes
Forth Valley Royal	Scotland	LNU	141	656	1,641	2,438	Yes	Yes	Yes
Ormskirk	North West	LNU	85	391	1,940	2,416	Yes	Yes	Yes
Stepping Hill Hospital	North West	LNU	175	724	1,501	2,400	Yes	Yes	Yes
Southend Hospital	East England	LNU	166	652	1,475	2,293	Yes	Yes	Yes
Tameside General	North West	LNU	117	563	1,601	2,281	Yes	Yes	Yes
Princess Royal Uni	London South	LNU	105	587	1,535	2,227	Yes	Yes	Yes
York District Hospital	Yorkshire Humber	LNU	187	642	1,327	2,156	Yes	Yes	Yes
Raigmore Inverness	Scotland	LNU	143	677	1,313	2,133	Yes	Yes	Yes
Salisbury District	Thames Valley Wsx	LNU	99	582	1,431	2,112	No	Yes	Yes
Leighton Hospital	North West	LNU	118	441	1,518	2,077	Yes	Yes	Yes
Queen Elizabeth KL	East England	LNU	131	611	1,124	1,866	Yes	Yes	Yes
Royal Lancaster	North West	LNU	109	546	1,114	1,769	Yes	Yes	Yes
Countess of Chester	North West	LNU	24	303	791	1,118	Yes	Yes	Yes
Noble's Hospital	NO RECORD	LNU	27	41	490	558	Yes	Yes	Yes
West Middlesex	London NW	SCBU	68	616	2,988	3,672	No	No	No
Darent Valley Hospital	Kent Surrey Sussex	SCBU	52	792	2,722	3,566	Yes	Yes	Yes
Good Hope Hospital	West Midlands	SCBU	22	162	2,431	2,615	No	No	No
Bedford Hospital	East England	SCBU	57	441	2,029	2,527	Yes	Yes	Yes
West Suffolk Hospital	East England	SCBU	66	689	1,457	2,212	Yes	Yes	Yes
Northumbria SEC	Northern	SCBU	33	160	1,836	2,029	Yes	Yes	Yes
Wrexham Maelor Hospital	Wales	SCBU	34	212	1,702	1,948	Yes	Yes	Yes
Glangwili General	Wales	SCBU	37	465	1,366	1,868	Yes	Yes	Yes
Basingstoke and NH	Thames Valley Wsx	SCBU	113	528	1,211	1,852	Yes	Yes	Yes
St Richards Hospital	Thames Valley Wsx	SCBU	35	287	1,519	1,841	Yes	Yes	Yes
Royal Hampshire	Thames Valley Wsx	SCBU	126	449	1,179	1,754	Yes	Yes	Yes
Princess Royal HH	Kent Surrey Sussex	SCBU	21	340	1,369	1,730	Yes	Yes	Yes
Queen Elizabeth QM	Kent Surrey Sussex	SCBU	27	277	1,412	1,716	Yes	Yes	Yes
Prince Charles Hospital	Wales	SCBU	72	451	1,156	1,679	Yes	Yes	Yes
North Durham	Northern	SCBU	31	102	1,505	1,638	Yes	Yes	Yes
North Tees	Northern	SCBU	27	178	1,431	1,636	Yes	Yes	Yes
James Paget Hospital	East England	SCBU	38	338	1,219	1,595	Yes	Yes	Yes
Hinchingbrooke Hospital	East England	SCBU	58	456	1,059	1,573	No	No	No
Worthing Hospital	Kent Surrey Sussex	SCBU	11	222	1,253	1,486	Yes	Yes	Yes
Conquest Hospital	Kent Surrey Sussex	SCBU	21	315	1,144	1,480	No	No	No
St Johns Livingston	Scotland	SCBU	41	411	1,016	1,468	Yes	Yes	Yes
QE Gateshead	Northern	SCBU	7	120	1,335	1,462	Yes	Yes	Yes
Warwick Hospital	West Midlands	SCBU	38	101	1,296	1,435	Yes	Yes	Yes
George Eliot Hospital	West Midlands	SCBU	23	75	1,317	1,415	Yes	Yes	Yes
PoW Bridgend	Wales	SCBU	59	392	951	1,402	Yes	Yes	Yes
Royal Free Hospital	London NCE	SCBU	33	106	1,254	1,393	No	No	No
Queens Burton on Trent	East Midlands	SCBU	30	42	1,299	1,371	Yes	Yes	Yes
Royal Surrey	Kent Surrey Sussex	SCBU	28	378	855	1,261	Yes	Yes	Yes
Airedale General	Yorkshire Humber	SCBU	14	98	1,079	1,191	Yes	Yes	Yes
Hereford County Hospital	West Midlands	SCBU	27	177	906	1,110	Yes	Yes	Yes
Darlington Memorial	Northern	SCBU	44	132	789	965	Yes	Yes	Yes
North Devon	South West	SCBU	14	107	834	955	Yes	Yes	Yes
Cumberland Infirmary	Northern	SCBU	23	160	764	947	Yes	Yes	Yes
Scarborough	Yorkshire Humber	SCBU	24	94	826	944	No	No	No
Pilgrim General Hospital	East Midlands	SCBU	23	87	775	885	Yes	Yes	Yes
Dumfries and Galloway RI	Scotland	SCBU	5	143	729	877	No	Yes	Yes
Dorset County Hospital	Thames Valley Wsx	SCBU	16	327	506	849	Yes	Yes	Yes
West Cumberland Hospital	Northern	SCBU	10	104	721	835	Yes	Yes	Yes
Torbay Hospital	South West	SCBU	38	214	579	831	Yes	Yes	Yes
Epsom General Hospital	London South	SCBU	6	87	735	828	Yes	Yes	Yes
Bassetlaw	Yorkshire Humber	SCBU	2	51	755	808	Yes	Yes	Yes
Ysbyty Gwynedd	Wales	SCBU	33	219	552	804	Yes	Yes	Yes
Borders General Melrose	Scotland	SCBU	5	50	638	693	Yes	Yes	Yes
Harrogate District	Yorkshire Humber	SCBU	15	63	588	666	Yes	Yes	Yes
Macclesfield District	North West	SCBU	16	45	542	603	Yes	Yes	Yes
St Marys Hospital IOW	Thames Valley Wsx	SCBU	7	91	423	521	Yes	Yes	Yes
Furness General Hospital	North West	SCBU	10	22	470	502	Yes	Yes	Yes
Yeovil District Hospital**	South West	SCBU	10	37	177	224	No	No	No
*Unit has known data interface issues
**Unit closed for part of the year

Table 63: Unit participation table

Footnotes

Cochran-Armitage test for trend, p<0.01.↩︎
NICE. NICE Guideline NG72: Developmental follow-up of children and young people born preterm. 2017.↩︎
NHS England. Neonatal Critical Care Service Specification. 2016.↩︎
Department of Health. Toolkit for high quality neonatal services. 2009.↩︎
British Association of Perinatal Medicine. Service Standards for Hospitals Providing Neonatal Care (3rd edition). 2010.↩︎
NHS England. Three Year Delivery Plan for Maternity and Neonatal Services. March 2023.↩︎
Scottish Government. Maternity and neonatal care - Best Start five-year plan 2017-2024: report. May 2025.↩︎
Health Education and Improvement Wales. Strategic perinatal workforce plan. July 2025.↩︎
NHS England. Maternity and Neonatal Safety Improvement Programme ↩︎
NHS Scotland Scottish Patient Safety Programme Perinatal.↩︎
NHS Wales. PERIPrem Cymru ### Results↩︎
Antenatal steroids, antenatal magnesium sulphate, birth in a centre with a NICU, deferred cord clamping, temperature on admission, breastmilk feeding by day 2.↩︎
Stock SJ, Thomson AJ, Papworth S; the Royal College of Obstetricians, Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG2022;129:e35–e60.↩︎
NICE. NICE Guideline NG25 Preterm labour and birth.2015↩︎
Stock SJ, Thomson AJ, Papworth S; the Royal College of Obstetricians, Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG 2022;129: e35–e60.↩︎
Stock SJ, Thomson AJ, Papworth S; the Royal College of Obstetricians, Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG 2022;129: e35–e60.↩︎
National Neonatal Audit Programme. 2025 NNAP Audit Measures Guide. February 2026.↩︎
Oddie S., Tuffnell D. J., McGuire W.Antenatal magnesium sulfate: Neuro-protection for preterm infants. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2025; 100:F553-F557↩︎
NICE. NICE Guideline NG25 Preterm labour and birth.2015↩︎
NHS England. Neonatal Critical Care Service Specification. 2024↩︎
Fogarty, M. et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and metaanalysis. Am J Obstet Gynecol. 2018 Jan;218(1):1-18.↩︎
Seidler A L et al., Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth: a systematic review and network meta-analysis with individual participant data. Lancet. 2023 Dec 9;402(10418):2223-2234. doi: 10.1016/S0140-6736(23)02469-8. Epub 2023 Nov 14. Erratum in: Lancet. 2023 Dec 9;402(10418):2196. doi: 10.1016/S0140-6736(23)02710-1. PMID: 37977170.↩︎
British Association of Perinatal Medicine. Framework: Early Postnatal Care of the Moderate-Late Preterm Infant. 2023↩︎
Jensen, E.A.Prevention of bronchopulmonary dysplasia: A summary of evidence-based strategies. NeoReviews 2019 Apr;20(4):e189-e201↩︎
National Institute for Health and Care Excellence (NICE). NG124: Specialist neonatal respiratory care for babies born preterm. April 2019↩︎
National Institute for Health and Care Excellence (NICE). NG124: Specialist neonatal respiratory care for babies born preterm. April 2019↩︎
Royal College of Paediatrics and Child Health. UK Screening of Retinopathy of Prematurity Guideline. 2022↩︎
Royal College of Paediatrics and Child Health. UK Screening of Retinopathy of Prematurity Guideline. 2022↩︎
Clough N, Magan T, Jain S. The UK paediatric ophthalmology workforce crisis - a national perspective. Eye (Lond). 2025 Jun;39(9):1793-1796. doi: 10.1038/s41433-025-03755-9. Epub 2025 Mar 18. PMID: 40102569; PMCID: PMC12130465.↩︎
Berrington, J.B., et al. Deaths in Preterm Infants: Changing Pathology Over 2 Decades. J Peds;160(1):49-53.↩︎
Smith, L., et al. on behalf of the MBRRACE-UK collaboration. MBRRACE-UK Supplementary report on survival up to one year of age for babies born before 27 weeks gestational age. 2019↩︎
Cochran-Armitage test for trend between 2024 and 2025, p=0.067.↩︎
Burgess-Shannon J., Briggs S., Oddie S., Mactier H. Variation in use of extended pulse oximetry testing to guide decisions around home oxygen provision for ex-preterm infants; A nationwide survey of UK neonatal units. Respir Med Res 2023 Apr 7;83:101005.↩︎
Burgess-Shannon J., Briggs S., Oddie S., Mactier H. Variation in use of extended pulse oximetry testing to guide decisions around home oxygen provision for ex-preterm infants; A nationwide survey of UK neonatal units. Respir Med Res 2023 Apr 7;83:101005.↩︎
Jones, I. H., Hall, N. J. Contemporary Outcomes for Infants with Necrotizing Enterocolitis-A Systematic Review. J Pediatr. 2020 May;220:86-92.e3.↩︎
Cochran-Armitage test for trend over 3 years, p = 0.068.↩︎
Margaret G. Parker, Lisa Stellwagen, Emily R. Miller, Lawrence Noble, Mark R. Corkins, Mark L. Hudak, Committee on Fetus and Newborn, Section on Breastfeeding, Committee on Nutrition; Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant: Clinical Report. Pediatrics February 2026; 157 (2): e2025073625.↩︎
Stoll, B. J. et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants With neonatal infection. JAMA 2004 Nov 17;292(19):2357-65.↩︎
Cochran-Armitage test for trend over 3 years, p = 0.632.↩︎
NHS England, or the succeeding responsible organisation in England.↩︎
Murthy et. Al., Neuroprotection Care Bundle Implementation to Decrease Acute Brain Injury in Preterm Infants. Pediatr Neurol. 2020 Sep;110:42-48.↩︎
Gross et. Al., Evaluating the Effect of a Neonatal Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants. Children (Basel). 2021 Mar 25;8(4):257.↩︎
NHS England, or the succeeding responsible organisation in England.↩︎