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Neonatal mortality and stillbirths

Independently assured by the Information Governance Board (IGB)


Published by
NHS Digital
Assurance Date
07 May 2015
Reporting level
CCG and National
Reporting period
Annual
Review date
07 May 2016
Based on data from
Office for National Statistics (ONS). CCG level extract of the Childhood, Infant and Perinatal Mortality in England and Wales publication.

Purpose

The number of stillbirths and neonatal deaths is influenced by a number of maternal health factors, including obesity, smoking and a range of chronic diseases. The treatment/support for many of these fall within Clinical Commissioning Group (CCG) responsibilities.

Even where the relevant service is not commissioned by a CCG, for example smoking cessation, the identification and referral of women with a need for such support falls within the role of maternity services commissioned by CCGs. The number is also influenced by effective support during the birth process and the postnatal period in services mainly commissioned by CCGs.

Where the number of local stillbirths and neonatal deaths is disproportionately high, CCGs should consider the reasons for this and take appropriate action.

Definition

This indicator measures the proportion of live and stillbirths which were stillborn or died within 28 days, per 1,000 live and stillbirths that occur in a calendar year. The indicator will be reported at the national level, disaggregated by Clinical Commissioning Group (CCG) of residence.

This indicator will use the same definitions as used in the Office for National Statistics (ONS) publication. The ONS defines a stillbirth as “born after 24 or more weeks completed gestation and which did not, at any time, breathe or show signs of life”. Neonatal mortality is defined as “deaths under 28 days”.

CCG level data will be aggregated from the Lower Super Output Area (LSOA) of the mother’s home postcode. This will result in the distribution of activity being aggregated based on the resident population of the CCG, as opposed to the usual convention in the CCG Outcomes Indicator Set (OIS) of using the registered population, which is based on GP Practice.

How this indicator is calculated

Data Source

Office for National Statistics (ONS). Clinical Commissioning Group (CCG) level extract of the Childhood, Infant and Perinatal Mortality in England and Wales publication.

The data is taken from an extract of data held by ONS, where birth registration and death registration data have been linked. This data is used by ONS to publish live birth, stillbirth, and neonatal mortality figures as part of the Childhood, Infant and Perinatal Mortality in England and Wales statistical bulletin.

Numerator

Of the denominator, the number of stillbirths and neonatal deaths.

Denominator

The number of live births and stillbirths that occur during a calendar year, by Clinical Commissioning Group (CCG) of residence.

Calculation

This indicator is calculated by dividing the numerator by the denominator and multiplying by 100 to provide a percentage indicator value. 95% confidence intervals are calculated using the Wilson Score method.

Caveats

When the extract of data occurs, not all deaths may have been registered There is, therefore, a chance that this indicator may omit a small proportion of activity.

The neonatal mortality and stillbirth rate may be influenced by the number of multiple births. However, overall in England and Wales in 2011, there were 22,796 multiple births, compared to 696,828 singleton births. Of the 2,116 neonatal deaths in England and Wales in 2011, 1,761 (83.2%) were singleton births, and 355 (16.8%) were multiple births. Data on multiplicity of births and stillbirths is not available without an extract. As the number of multiple births is only a small proportion of the total, it is recommended to retain these cases in the indicator. This will allow for consistency with the source publication and the NHS Outcomes Framework (OF) indicator on which this is based.

Interpretation Guidelines

A low proportion of stillbirths and deaths under 28 days is desirable.

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