1. 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 2009.  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.

2. © 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.

3. Figure 1 Birth weight by gestational age, all infants, all contributing units 1 October 2007 - 30 June 2009

4. Figure 2a Admissions by birth weight category, neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

5. Figure 2b Admissions by birth weight category, neonatal unit and network Level Two units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

6. Figure 2c Admissions by birth weight category, neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

7. Figure 3a Admissions by gestational age category, neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

8. Figure 3b Admissions by gestational age category, neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

9. Figure 3c Admissions by gestational age category, neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

10. Figure 4a Admissions by reason for admission, neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

11. Figure 4b Admissions by reason for admission, neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

12. Figure 4c Admissions by reason for admission, neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009 Figure 4d

13. Reason for admission as a percentage of total admissions by network of admission 1 October 2007 - 30 September 2008 and 1 October 2008 – 30 June 2009

14. Figure 5a Babies receiving respiratory support by neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

15. Figure 5b Babies receiving respiratory support by neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

16. Figure 5c Babies receiving respiratory support by neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

17. Figure 6a Care days by neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

18. Figure 6b Care days by neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

19. Figure 6c Care days by neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

20. Figure 6d Levels of care as a percentage of total days of care provided, by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

21. Figure 7a Admissions by discharge destination, neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

22. Figure 7b Admissions by discharge destination, neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

23. Figure 7c Admissions by discharge destination, neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

24. Figure 8a Admission temperature, babies ≤ 32 +6 weeks gestational age, by neonatal unit and network of first admission Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 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

25. Figure 8b Admission temperature, babies ≤ 32 +6 weeks gestational age, by neonatal unit and network of first admission Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 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

26. Figure 8c Admission temperature, babies ≤ 32 +6 weeks gestational age, by neonatal unit and network of first admission Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 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

27. Figure 9a Feeding at discharge by neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

28. Figure 9b Feeding at discharge by neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

29. Figure 9c Feeding at discharge by neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

30. Figure 9d Feeding at discharge by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

31. Figure 10a Admissions by Index of Multiple Deprivation (2007), by neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 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

32. Figure 10b Admissions by Index of Multiple Deprivation (2007), by neonatal unit and network Level Two Units 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 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

33. Figure 10c Admissions by Index of Multiple Deprivation (2007), by neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 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

34. Figure 11a Multiple births by neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

35. Figure 11b Multiple births by neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

36. Figure 11c Multiple births by neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

37. Figure 11d Multiple births as a percentage of total admissions by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 to 30 June 2009

38. Figure 12a Post-menstrual age at discharge by neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 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

39. Figure 12b Post-menstrual age at discharge by neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 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

40. Figure 12c Post-menstrual age at discharge by neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 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

41. Figure 13a Admissions by maternal ethnicity, neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

42. Figure 13b Admissions by maternal ethnicity, neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

43. Figure 13c Admissions by maternal ethnicity, neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

44. Figure 13d Maternal ethnicity by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

45. Figure 14a Major morbidities by neonatal unit and network Level One Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

46. Figure 14b Major morbidities by neonatal unit and network Level Two Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

47. Figure 14c Major morbidities by neonatal unit and network Level Three Units; 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

48. Figure 14d Major morbidities by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

49. Figure 15 Babies born out of network, by network of booking 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

50. Figure 16 Babies receiving some care outside booked network 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2010

51. Figure 17 Babies ≥36 weeks gestational age with recorded convulsions by network of admission 1 October 2007 - 30 September 2008 and 1 October 2008 - 30 June 2009

52. 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.

53. Final Outcome Gestational Age (weeks) 22232425262728293031323334 Died01/10/2007-31/09/2008 8627253454031131612 419 01/10/2008-30/06/2009 2395650323624178910 11 Total 10101128103777655302421221430 Home01/10/2007-31/09/2008.25115162236319385492668771107115081968 01/10/2008-30/06/2009.15599615222429740446265086811201540 Total.4017425838854368289611301421193926283508 Unknown01/10/2007-31/09/2008.61013152219161715111936 01/10/2008-30/06/2009 26312928372420222124 31 Total 2124142435943363936354367 Ward01/10/2007-31/09/2008 138781061113102294392 01/10/2008-30/06/2009.37511 1361252180299 Total 16151219211917251543174691 All recorded outcomes 01/10/2007-31/09/2008 996205235304391441532714808111616252415 46315318022330835844750468592312341881 Total 1315935841552769979997912181493203928594296 Table 1 - Final outcome by gestational age - 1 October 2007 - 30 June 2009

54. Final Outcome Gestational Age (weeks) Total 3536373839404142434445 Died01/10/2007-31/09/2008 101517262521242...527 01/10/2008-30/06/2009 81315241625121...418 Total 182832504146363...945 Home01/10/2007-31/09/2008 144813771214151415361922129822181.18259 01/10/2008-30/06/2009 1073112797111591219151610502115..14218 Total 2521250421852673275534382348432131.32477 Unknown01/10/2007-31/09/2008 315066139961177214...784 01/10/2008-30/06/2009 33326489921084811...776 Total 648213022818822512025...1560 Ward01/10/2007-31/09/2008 5917658661203 1759114222711..8352 01/10/2008-30/06/2009 50962876410241064141689218711116970 Total 1100139316302227226731752034414221115322 All recorded outcomes01/10/2007-31/09/2008 2080220721632882286038192536464191.27922 01/10/2008-30/06/2009 1623180018142296239130652002410161122382 Total 3703400739775178525168844538874352150304