OPTI-Prem: Optimising Neonatal Service Provision for Preterm Babies Born Between 27 and 31 Weeks of Gestation in England
OPTI-Prem: Optimising Neonatal Service Provision for Preterm Babies Born Between 27 and 31 Weeks of Gestation in England
Premature babies, born several weeks before their due date, are often very ill in the first
 weeks and months of life, compared with those born at full term. Because babies' brains and
 bodies are still developing at this time, early birth puts them at increased risk of later
 problems with health and development. It is important to do everything possible to try to
 improve the overall health of these children. Not only will this help children and families,
 but it will also help to understand the correct amount and type of care they will need from
 the NHS in the future. At present, England has three types of neonatal units: Neonatal
 Intensive care units (NICUs) that can care for the most sick and most premature babies, Local
 Neonatal Units (LNUs) that generally care for slightly less sick babies, and Special Care
 baby units (SCBU) that care for larger premature babies who are generally well, but need time
 to grow and develop before going home.

 For those premature babies born between 27 and 31 weeks of pregnancy, there is no information
 on whether they benefit from being looked after in one type of unit or another. At present
 there is no guidance, so these babies may be looked after in either LNUs or NICUs. Babies who
 are born at this stage of pregnancy cannot be looked after in a SCBU and sometimes need to be
 moved after birth to either a NICU or LNU. There are 84 LNUs and 45 NICUs in England. In
 2014, about half of these babies were cared for in a NICU and half in a LNU. There is the
 need to know whether babies born between 27 and 31 weeks are best cared for in a NICU or LNU
 or if it does not matter.

 The main things that control where a baby is born are where the mother has her antenatal
 care, and where there is a cot available for the baby. A mother may have antenatal care in a
 hospital that has a NICU, LNU or SCBU. Because it is difficult to predict which mother is
 going to have her baby early, she cannot be directed, at the time of her choosing her
 hospital for antenatal care, where to go to for care. There is uncertainty before birth which
 baby is likely to require intensive care, but usually the less mature babies need more
 intensive care.

 In this study to find out where it is best to care for babies born at 27-31 weeks of
 pregnancy, the study will look at which type of unit: a) leads to the best outcome for babies
 born at each week of pregnancy in this range; b) is most cost-effective for families and the
 NHS and c) best considers views and needs of parents and staff caring for babies.
Mixed methods, longitudinal study; 5 work streams, supported by a Parent Advisory Panel:

 Work stream 1:Clinical Outcomes Study Using routinely collected data from the National
 Neonatal Research Database (NNRD) for babies born at 27-31 weeks of gestation, admitted to
 neonatal units in England 01/01/14-31/12/17.Estimates of differences in mortality and
 specified morbidities between babies cared for in LNUs and NICUs will be obtained Data will
 be linked to Hospital Episode Statistics (morbidity) and ONS(mortality) up to 1 year of age
 for longer term outcomes.

 Work stream 2:Types of clinical care provided Using NNRD, data from a unit questionnaire
 (01/01/017-31/12/2017), and review of guidelines from neonatal units, variation in clinical
 practice in 6 areas will be examined: medical/nurse staffing; policies/practice re
 respiratory support; infection control, feeding and developmental care, discharge and length
 of stay. Where appropriate, outcomes (mortality, chronic lung disease, central line sepsis,
 receipt of breastmilk on discharge and length of stay in hospital) by week of gestational
 age, will be analysed between units with similar practices.

 Work stream 3:Economic analysis A cost-effectiveness study comparing costs and outcomes of
 LNU versus NICU will be conducted.

 Work stream 4:Ethnographic study with a representative group of parents and clinicians
 Observations and interviews will be used to explore factors parents think should guide
 decision making about place of care and how it happens in practice; clinicians'
 perspectives/practices on decision making and place of care; impact on parents/families of
 these decisions and subsequent change in care location; and how parents can best be supported
 at this time. 40 cases from 2 networks [20 real-time, 20 retrospective] will be studied.

 Workstream 5:

 Once the results of the 4 work streams are analysed, and conclusions reached, a working group
 will be set up in collaboration with BAPM to develop recommendations to be made available for
 health service delivery planning.
Inclusion Criteria:

 -  preterm babies born at 27-31 weeks

 Exclusion Criteria:

 -