Notes  Data are presented as a pair of overlying bars, the outer, wider bar representing the period 1st Oct 2007 to 30th September 2008, and the inner, narrower bar the period 1st October 2008 to 30th June  Interpret network analyses with caution; neonatal units commenced participation at different time and all units within a network have not necessarily contributed data for all periods; the reports do not therefore reflect complete network activity, nor are all networks represented in every analysis.  Data need to be interpreted as a guide to potential areas for further investigation and not as evidence of quality of care. There are several reasons why a network may appear as an outlier in the data; these include errors in the data entered, inconsistencies in the type of data entered, missing data, incomplete network- wide participation and inadequate risk adjustment.

© 2008 Imperial College London All Rights Reserved The use of the information provided in this report is welcomed, on the understanding that the Neonatal Data Analysis Unit is acknowledged. The right of the authors and the Neonatal Data Analysis Unit to be identified as the authors of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

Figure 1 Birth weight by gestational age, all infants, all contributing units 1 October June 2009

Figure 2a Admissions by birth weight category, neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009

Figure 2b Admissions by birth weight category, neonatal unit and network Level Two units; 1 October September 2008 and 1 October June 2009

Figure 2c Admissions by birth weight category, neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009

Figure 3a Admissions by gestational age category, neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009

Figure 3b Admissions by gestational age category, neonatal unit and network Level Two Units; 1 October September 2008 and 1 October June 2009

Figure 3c Admissions by gestational age category, neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009

Figure 4a Admissions by reason for admission, neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009

Figure 4b Admissions by reason for admission, neonatal unit and network Level Two Units; 1 October September 2008 and 1 October June 2009

Figure 4c Admissions by reason for admission, neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009 Figure 4d

Reason for admission as a percentage of total admissions by network of admission 1 October September 2008 and 1 October 2008 – 30 June 2009

Figure 5a Babies receiving respiratory support by neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009

Figure 5b Babies receiving respiratory support by neonatal unit and network Level Two Units; 1 October September 2008 and 1 October June 2009

Figure 5c Babies receiving respiratory support by neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009

Figure 6a Care days by neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009

Figure 6b Care days by neonatal unit and network Level Two Units; 1 October September 2008 and 1 October June 2009

Figure 6c Care days by neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009

Figure 6d Levels of care as a percentage of total days of care provided, by network of booking 1 October September 2008 and 1 October June 2009

Figure 7a Admissions by discharge destination, neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009

Figure 7b Admissions by discharge destination, neonatal unit and network Level Two Units; 1 October September 2008 and 1 October June 2009

Figure 7c Admissions by discharge destination, neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009

Figure 8a Admission temperature, babies ≤ weeks gestational age, by neonatal unit and network of first admission Level One Units; 1 October September 2008 and 1 October June 2009 The top and bottom edges of the box represent the 75 th and 25 th centiles; the dots represent temperatures above the 75 th centile or below the 25 th centile; the centre horizontal line represents the median

Figure 8b Admission temperature, babies ≤ weeks gestational age, by neonatal unit and network of first admission Level Two Units; 1 October September 2008 and 1 October June 2009 The top and bottom edges of the box represent the 75 th and 25 th centiles; the dots represent temperatures above the 75 th centile or below the 25 th centile; the centre horizontal line represents the median

Figure 8c Admission temperature, babies ≤ weeks gestational age, by neonatal unit and network of first admission Level Three Units; 1 October September 2008 and 1 October June 2009 The top and bottom edges of the box represent the 75 th and 25 th centiles; the dots represent temperatures above the 75 th centile or below the 25th centile; the centre horizontal line represents the median

Figure 9a Feeding at discharge by neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009

Figure 9b Feeding at discharge by neonatal unit and network Level Two Units; 1 October September 2008 and 1 October June 2009

Figure 9c Feeding at discharge by neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009

Figure 9d Feeding at discharge by network of booking 1 October September 2008 and 1 October June 2009

Figure 10a Admissions by Index of Multiple Deprivation (2007), by neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009 The top and bottom edges of the box represent the 75 th and 25 th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values; the higher the index, the greater the deprivation

Figure 10b Admissions by Index of Multiple Deprivation (2007), by neonatal unit and network Level Two Units 1 October September 2008 and 1 October June 2009 The top and bottom edges of the box represent the 75 th and 25 th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values; the higher the index, the greater the deprivation

Figure 10c Admissions by Index of Multiple Deprivation (2007), by neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009 The top and bottom edges of the box represent the 75 th and 25 th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values; the higher the index, the greater the deprivation

Figure 11a Multiple births by neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009

Figure 11b Multiple births by neonatal unit and network Level Two Units; 1 October September 2008 and 1 October June 2009

Figure 11c Multiple births by neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009

Figure 11d Multiple births as a percentage of total admissions by network of booking 1 October September 2008 and 1 October 2008 to 30 June 2009

Figure 12a Post-menstrual age at discharge by neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009 The top and bottom edges of the box represent the 75 th and 25 th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values

Figure 12b Post-menstrual age at discharge by neonatal unit and network Level Two Units; 1 October September 2008 and 1 October June 2009 The top and bottom edges of the box represent the 75 th and 25 th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values

Figure 12c Post-menstrual age at discharge by neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009 The top and bottom edges of the box represent the 75 th and 25 th centiles; the centre horizontal line represents the median; the whiskers extend to the highest and lowest recorded values

Figure 13a Admissions by maternal ethnicity, neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009

Figure 13b Admissions by maternal ethnicity, neonatal unit and network Level Two Units; 1 October September 2008 and 1 October June 2009

Figure 13c Admissions by maternal ethnicity, neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009

Figure 13d Maternal ethnicity by network of booking 1 October September 2008 and 1 October June 2009

Figure 14a Major morbidities by neonatal unit and network Level One Units; 1 October September 2008 and 1 October June 2009

Figure 14b Major morbidities by neonatal unit and network Level Two Units; 1 October September 2008 and 1 October June 2009

Figure 14c Major morbidities by neonatal unit and network Level Three Units; 1 October September 2008 and 1 October June 2009

Figure 14d Major morbidities by network of booking 1 October September 2008 and 1 October June 2009

Figure 15 Babies born out of network, by network of booking 1 October September 2008 and 1 October June 2009

Figure 16 Babies receiving some care outside booked network 1 October September 2008 and 1 October June 2010

Figure 17 Babies ≥36 weeks gestational age with recorded convulsions by network of admission 1 October September 2008 and 1 October June 2009

Figure 18a Standardised mortality ratio, unadjusted for case-mix, for babies born ≤32 +6 weeks gestational age by neonatal network of booking (1 January 2008 to 31 December 2008) Figure 18b Standardised mortality ratio (adjusted for gestational age at birth, birth weight, gender, antenatal steroids, and multiple birth) for babies born ≤32 +6 weeks gestational age by Network of Booking (1 January 2008 to 31 December 2008) Mortality by Network Two plots of estimated mortality ratios (observed deaths/expected deaths) for networks are reported. For the unadjusted outcome the expected number of deaths is the number of deaths that would have occurred in the network if its overall death rate had been the same as the overall rate in the other networks. The adjusted expected number of deaths is that which would be expected if the unit had the same death rates as the other networks combined, based on the gestational age at birth, birth weight, sex, antenatal steroid use and multiplicity of pregnancy of the infants. A value for the ratio greater than 1 indicates an observed number of deaths greater than the expected and a value of less than 1 indicates an observed number of deaths less than the expected number. The mortality ratios are shown on funnel plots with the ratio plotted against the expected number of deaths. On the plots 95% and 99.8% confidence intervals are drawn for reference. These lines fall approximately two and three standard deviations respectively from the average and can be used to assess the statistical significance of any extreme observations.

Final Outcome Gestational Age (weeks) Died01/10/ /09/ /10/ /06/ Total Home01/10/ /09/ /10/ /06/ Total Unknown01/10/ /09/ /10/ /06/ Total Ward01/10/ /09/ /10/ /06/ Total All recorded outcomes 01/10/ /09/ Total Table 1 - Final outcome by gestational age - 1 October June 2009

Final Outcome Gestational Age (weeks) Total Died01/10/ /09/ /10/ /06/ Total Home01/10/ /09/ /10/ /06/ Total Unknown01/10/ /09/ /10/ /06/ Total Ward01/10/ /09/ /10/ /06/ Total All recorded outcomes01/10/ /09/ /10/ /06/ Total