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National Incidence of Brain Injuries occurring at or soon after Birth in England: a report of work undertaken for the Department of Health National Maternity Ambition

Presented at the Neonatal Society 2017 Spring Meeting.

Gale C, Statnikov E, Jawad S, Uthaya S, Modi N

Section of Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital campus, SW10 9NH

Background: In November 2015, the Secretary of State for Health announced a national ambition to halve the annual rates brain injuries occurring during or soon after birth in England, by 2030, with a reduction of 20% by 2020 (1). The reference year, 2010. Here we describe how a consensus working definition for brain injuries occurring during or soon after birth, based on existing, routinely recorded data was developed. We use this definition of calculate national incidence rates for England over the period 2010-2015.

Methods: An expert group of neonatologists, obstetricians, policy and other health professionals was convened by the Department of Health to agree a working definition for brain injuries occurring during or soon after birth. To calculate national incidence rates, we extracted data from the National Neonatal Research Database (NNRD) in England for the period 2010-2015. The NNRD contains data from clinician-entered, point-of-care electronic patient records. The NNRD did not receive data from all NHS neonatal units in England in 2010-2011, so upper and lower incidence rates were estimated for these years as the NNRD did not receive data from all NHS neonatal units in England for these years. We estimated lower and upper margins of increase based on 2012- 2015 data, and estimated the upper and lower incidence rates using a two standard deviation range above and below estimated incidence values to account for uncertainty. Denominator data was all live births in England (2).

Results: The agreed consensus definition for brain injuries occurring during or soon after birth comprised infants of all gestational ages with the following conditions: seizures, hypoxic ischaemic encephalopathy, stroke, intracranial haemorrhage, central nervous system infection and kernicterus, and preterm infants with white matter disease (periventricular leucomalacia). Annual incidence figures and rates are shown in the table below.

National Incidence of Brain Injuries occurring at or soon after Birth in England: a report of work undertaken for the Department of Health National Maternity Ambition

Conclusion: Annual incidence figures for brain injuries occurring during or soon after birth can be obtained from data held in the NNRD; annual incidence rates for individual conditions are consistent with published rates from similar settings. Routinely recorded data, captured as part of clinical care, can be used for national surveillance and to support quality improvement, offering efficiencies over traditional approaches.

Corresponding author: christopher.gale@imperial.ac.uk

References
1. https://www.gov.uk/government/news/new-ambition-to-halve-rate-of-stillbirths-and-infant-deaths
2. Office for National Statistics (ONS) Birth Summary Tables – England and Wales

This work was commissioned and funded by the Department of Health in England; we thank them for permission to submit this work for presentation at the Neonatal Society Spring Meeting

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