BMJ Medicine (Jul 2023)

Effect of national guidance on survival for babies born at 22 weeks’ gestation in England and Wales: population based cohort study

  • ,
  • Bradley N Manktelow,
  • Stavros Petrou,
  • Jennifer J Kurinczuk,
  • Richard Lindley,
  • Victoria Nesbitt,
  • Alan C Fenton,
  • Sanjay Salgia,
  • Sarah E Seaton,
  • Matthew Babirecki,
  • Anita Mittal,
  • Ahmed Hassan,
  • Karin Schwarz,
  • Stephen Brearey,
  • Mehdi Garbash,
  • David Gibson,
  • Pauline Adiotomre,
  • Cath Seagrave,
  • Hilary Dixon,
  • Narendra Aladangady,
  • Hassan Gaili,
  • Matthew James,
  • M Lal,
  • Khalid Mannan,
  • Dhaval Dave,
  • Jennifer Birch,
  • I Misra,
  • Richard Nicholl,
  • Charlotte Groves,
  • Christos Zipitis,
  • Joanne Fedee,
  • Richa Gupta,
  • Salim Yasin,
  • Carrie Heal,
  • Chris Knight,
  • Hari Kumar,
  • Delyth Webb,
  • Sankara Narayanan,
  • Elizabeth Eyre,
  • Caroline Sullivan,
  • Wynne Leith,
  • Megan Eaton,
  • Ambalika Das,
  • Andrew Powls,
  • Sanjeev Bali,
  • Katharine Mcdevitt,
  • Anna Gregory,
  • Donovan Duffy,
  • Shu-Ling Chuang,
  • Lucy K Smith,
  • Amit Gupta,
  • Cheryl Battersby,
  • Imran Ahmed,
  • Chris Warren,
  • Laura Stewart,
  • Igor Fierens,
  • Tristan Bate,
  • Mark Johnson,
  • Rashmi Gandhi,
  • Nitin Goel,
  • Artur Abelian,
  • Shakir Saeed,
  • Cheentan Singh,
  • Hilary Conetta,
  • Faith Emery,
  • Vineet Gupta,
  • Yee Aung,
  • Vennila Ponnusamy,
  • Pinki Surana,
  • Caroline Delahunty,
  • Anand Kamalanathan,
  • Kavi Aucharaz,
  • Matt Nash,
  • Alex Allwood,
  • Nigel Brooke,
  • Jennifer Holman,
  • Sobia Balal,
  • Savi Sivashankar,
  • Michael Grosdenier,
  • Prakash Thiagarajan,
  • Lidia Tyszcuzk,
  • Bushra Abdul-Malik,
  • Dominic Muogbo,
  • Chrissie Oliver,
  • Lucinda Winckworth,
  • Naveen Athiraman,
  • Jim Baird,
  • Akinsola Ogundiya,
  • Pamela Cairns,
  • Porus Bastani,
  • Giles Kendall,
  • Puneet Nath,
  • Yee Mon Aung,
  • Ros Garr,
  • Sundeep Sandhu,
  • Anitha James,
  • S Kinmond,
  • Ruchika Gupta,
  • Rebecca Winterson,
  • Nick Barnes,
  • AM Heuchan,
  • Hannah Shore,
  • Archana Mishra,
  • DAMIEN ARMSTRONG,
  • Oluseun Tayo,
  • Carolina Zorro,
  • J Coutts,
  • Karen Turnock,
  • David Deekollu,
  • Victoria Sharp,
  • Rajiv Chaudhary,
  • Sam Wallis,
  • Stan Craig,
  • Lee Abbott,
  • Shaveta Mulla,
  • Penny Broggio,
  • Peter McEwan,
  • Divyen Shah,
  • Grenville Fox,
  • Alison Verner,
  • Clare Cane,
  • Clare Irving,
  • Shelagh Parkinson,
  • Ghada Ramadan,
  • Ruth J Matthews,
  • Ian Gallimore,
  • Nigel Ruggins,
  • Emily van Blankenstein,
  • Penelope Young,
  • Ramona Onita,
  • Toria Klutse,
  • Sonia Spathis,
  • Sathish Krishnan,
  • Samar Sen,
  • Prem Pitchaikani,
  • Jonathan Filkin,
  • Ashok Karupaiah,
  • Richard Heaver,
  • Mohammad Alam,
  • Patricia Cowley,
  • Shilpa Ramesh,
  • Julia Croft,
  • Soma Sengupta,
  • Anitha Vayalakkad,
  • Arun Ramachandran,
  • Se-Yeon Park,
  • Bharath Gowda,
  • Eleanor Bond,
  • Daniel Dogar,
  • Rebecca Kettle,
  • Rathod Poorva,
  • Maninder Bal,
  • Mani Kandasamy,
  • Claire Hollinsworh,
  • Alaa Ghoneem,
  • Girish Gowda,
  • Abraham Isaac,
  • Jo Behrsin,
  • Ather Ahmed,
  • Surendran Chandrasekaran,
  • Tiziana Fragapane Muthukumar,
  • Bivan Saha,
  • Sangeeta Tiwary,
  • Dush Batra,
  • Sanath Reddy,
  • Aesha Mohammedi,
  • Salamatu Jalloh,
  • Kemy Naidoo,
  • Anjali Pektar,
  • Adedayo Owoeye,
  • Umapathee Majuran,
  • Helen Purves,
  • Esther Morris,
  • Peter Curtis,
  • Tayyaba Aamir,
  • Angela Yannoulias,
  • Edward Yates,
  • Abijeet Godhamgaonkar,
  • Abby Parish,
  • Mario Martínez-Jiménez,
  • LM Wong,
  • Dr Morris,
  • Dr Siramhatia,
  • Nim Subhedar,
  • Jo MacLeod,
  • Arin Mukherjee,
  • Dr Bird,
  • Saulius Satas,
  • Andrew Eccleston,
  • Dominic O'Reilly,
  • Dr Bhushan,
  • P Van Der Heide,
  • Helen Rhodes Ben Stenson,
  • Ambrose Onibere,
  • Nita Saxena

DOI
https://doi.org/10.1136/bmjmed-2023-000579
Journal volume & issue
Vol. 2, no. 1

Abstract

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Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks’ gestation in England and Wales.Design Population based cohort study.Setting England and Wales, comprising routine data for births and hospital records.Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021.Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21.Results For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at <500g weight; 19% to 31% at 22 weeks+0 days to 22 weeks+3 days).Conclusions A change in national guidance to recommend a risk based approach was associated with a threefold increase in 22 weeks’ gestation babies receiving survival focused care. The number of babies being admitted to neonatal units and those surviving to discharge increased.