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Survival of very preterm infants admitted to neonatal care in England 2008–2014: time trends and regional variation
  1. Shalini Santhakumaran1,2,
  2. Yevgeniy Statnikov1,2,
  3. Daniel Gray1,3,
  4. Cheryl Battersby1,2,
  5. Deborah Ashby2,
  6. Neena Modi1,2
  7. on behalf of the Medicines for Neonates Investigator Group
  1. 1 Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
  2. 2 Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
  3. 3 Royal College of Paediatrics and Child Health, National Neonatal Audit Programme, London, UK
  1. Correspondence to Professor Neena Modi; n.modi{at}


Objective To analyse survival trends and regional variation for very preterm infants admitted to neonatal care.

Setting All neonatal units in England.

Patients Infants born at 22+0–31+6 weeks+daysgestational age (GA) over 2008–2014 and admitted to neonatal care; published data for admitted infants 22+0–25+6 weeks+days GA in 1995 and 2006, and for live births at 22+0–31+6 weeks+days GA in 2013.

Methods We obtained data from the National Neonatal Research Database. We used logistic regression to model survival probability with birth weight, GA, sex, antenatal steroid exposure and multiple birth included in the risk adjustment model and calculated annualpercentage change (APC) for trends using joinpoint regression. We evaluated survival over a 20-year period for infants <26 weeks’ GA using additional published data from the EPICure studies.

Results We identified 50 112 eligible infants. There was an increase in survival over 2008–2014 (2008: 88.0%; 2014: 91.3%; adjusted APC 0.46% (95% CI 0.30 to 0.62) p<0.001). The greatest improvement was at 22+0–23+6 weeks (APC 6.03% (95% CI 2.47 to 3.53) p=0.002). Improvement largely occurred in London and South of England (APC: London 1.26% (95% CI 0.60 to 1.96); South of England 1.09% (95% CI 0.36 to 1.82); Midlands and East of England 0.15% (95% CI −0.56 to 0.86); and North of England 0.26% (95% CI −0.54 to 1.07)). Survival at the earliest gestations improved at a similar rate over 1995–2014 (22+0–25+6 weeks, APC 2.73% (95% CI 2.35 to 3.12), p value for change=0.25).

Conclusions Continued national improvement in the survival of very preterm admissions masks important regional variation. Timely assessment of preterm survival is feasible using electronic records.

  • neonatology
  • data collection
  • epidemiology
  • health services research

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  • Contributors All authors contributed to study design and analysis. SS and NM are the guarantors for the study. SS, YS, DG, CB and NM had full access to the NNRD data. All authors had full access to the summary data presented in this paper (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding SS, YS and CB were funded by the National Institute for Health Research under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0707-10010) held by NM. DG receives salary support through the Royal College of Paediatrics and Child Health National Neonatal Audit Programme that is commissioned by the Healthcare Quality Improvement Partnership and funded by the Department of Health. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the RCPCH, or the Department of Health. Neither the study sponsor, Imperial College London, nor the study funder, the National Institute for Health Research, had any role in in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

  • Ethics approval National Research Ethics Service (16/LO/1093).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data from this study are available for prespecified purposes subject to approval from the Neonatal Data Analysis Unit Steering Board.

  • Press Release Please contact the press offices of Imperial College London, Chelsea and Westminster Hospital and Royal College of Paediatrics and Child Health

  • Collaborators *Members of the Medicines for Neonates Investigator Group: Neena Modi,1 Jane Abbott,2 Deborah Ashby,3 Peter Brocklehurst,4 Kate Costeloe,5 Elizabeth Draper,6 Jacquie Kemp,7 Azeem Majeed,8 Stavros Petrou,9 Alys Young10. 1Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, 369 Fulham Road, London SW10 9NH, UK. 2Bliss, 2nd Floor, Chapter House, 18C20 Crucifix Lane, London SE1 3JW, UK. 3Imperial Clinical Trials Unit, 1st Floor, Stadium House, 68 Wood Lane, London W12 7RH, UK. 4UCL EGA Institute for Women’s Health, Medical School Building, 74 Huntley Street, London WC1E 6AU, UK. 5Blizard Institute, Barts and the London School of Medicine and Dentistry, 4 Newark Street, London E12AT, UK. 6Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester LE1 7RH, UK. 7London Specialised Commissioning Group, London, UK. 8Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, Charing Cross campus, Reynolds Building, St Dunstans Road, London W6 8RP, UK. 9Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. 10Manchester Academic Health Sciences Centre, Core Technology Facility, The University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK.

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