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Maternal, Newborn and Infant Clinical Outcomes Review Programme (MBRRACE-UK) Context Page

MBRRACE-UK (Mothers and Babies – Reducing Risk through Audits and Confidential Enquiries across the UK) runs the national Maternal, Newborn and Infant Clinical Outcomes Review Programme from Oxford University’s National Perinatal Epidemiology Unit (NPEU), UK Obstetric Surveillance System (UKOSS) and the Infant Mortality and Morbidity Studies (TIMMS) group at the University of Leicester. The programme includes the monitoring of still birth and neonatal death rates.

A total of 136/136 (100%)[1] trusts in the UK participated in the 2018 programme for births in 2016.

To view the full audit data set visit the MBRRACE-UK website.

Metrics

1. Stabilised & risk-adjusted, comparative, stillbirth rate

  • Rationale: This metric measures the stillbirth rate for a given organisation. The stillbirth rate is defined as the number of stillbirths deaths per 1,000 total births. Stillbirths are defined as babies delivered at or after 24+0 weeks gestation showing no signs of life, irrespective of when the death occurred. The rate is expressed as a figure (with 95% confidence intervals) per 1,000 total births. Deaths resulting from termination of pregnancy and births <24 +0 weeks gestational age are excluded.  The death of a baby in the time period before, during or shortly after birth is a devastating outcome for families. There is evidence that the UK’s death rate varies across regions, even after taking into account differences in poverty, ethnicity and the age of the mother.
  • Guideline/mapping: Saving Babies’ Lives A care bundle for reducing stillbirth, NHS England, 2016
  • Graph/relative performance: Trusts are compared against other trusts with a similar number of births and similar facilities. Lower figures are better.  There are five comparator groups:
  1. Level 3 NICU and Neonatal Surgery.
  2. Level 3 NICU.
  3. 4,000 or more births per annum at 22 weeks or later.
  4. 2,000-3,999 births per annum at 22 weeks or later.
  5. Under 2,000 births per annum at 22 weeks or later.
  • A trust in the green band means that the trust’s result is more than 10% lower than the comparator aggregate; a yellow circle means that the trust’s result is lower than the comparator aggregate by up to 10%; an orange circle means that the trust’s result is higher by up to 10% than the comparator aggregate; a red circle means that the trust’s result is more than 10% higher than the comparator aggregate. Perinatal mortality rates are likely to be influenced by numerous maternal and foetal factors  (such as maternal age, socio-economic deprivation, ethnicity, birth multiplicity and gestational age at birth) and organisational characteristics (e.g. units with level 3 Neonatal Intensive Care and neonatal surgical capabilities are likely to manage the highest-risk cases); this metric uses adjustment to ensure that hospitals dealing with higher-risk cases are compared fairly against those with less complex cases.
  • Quality improvement prompt question: ‘Red circle’ or ‘orange circle’ status for a hospital should prompt questions about the results of any local case reviews performed to determine possible causes for stillbirths, as recommended by MBRRACE,  and what actions the hospital has taken as a result of the review. Further recommendations are found in the final report, as it is recognised that different organisations will have different aspirations based on the make-up of their local population.

2. Stabilised & risk-adjusted, comparative, neonatal mortality rate

  • Rationale: This metric measures neonatal mortality rate for a given organisation. The neonatal mortality rate is defined as the number of neonatal deaths per 1,000 total births. Neonatal deaths which are defined as the death, within 28 days of birth, of any baby born alive at 20+0 weeks (or greater) gestation or with a birthweight of 400g (or more) where gestation cannot be accurately estimated. The rate is expressed as a figure (with 95% confidence intervals) per 1,000 total births. Deaths resulting from termination of pregnancy and births <24 +0 weeks gestational age are excluded.  The death of a baby in the time period before, during or shortly after birth is a devastating outcome for families. There is evidence that the UK’s death rate varies across regions, even after taking into account differences in poverty, ethnicity and the age of the mother.
  • Guideline/mapping: Each Baby Counts, Royal College of Obstetricians & Gynaecologists, 2017, https://www.rcog.org.uk/globalassets/documents/guidelines/research–audit/each-baby-counts-2015-summary-report-june-2017.pdf
  • Graph/relative performance: Trusts are compared against other trusts with a similar number of births and similar facilities. Lower figures are better.  There are five comparator groups:
  1. Level 3 NICU and Neonatal Surgery.
  2. Level 3 NICU.
  3. 4,000 or more births per annum at 22 weeks or later.
  4. 2,000-3,999 births per annum at 22 weeks or later.
  5. Under 2,000 births per annum at 22 weeks or later.
  • A trust in the green band means that the trust’s result is more than 10% lower than the comparator aggregate; a yellow circle means that the trust’s result is lower than the comparator aggregate by up to 10%; an orange circle means that the trust’s result is higher by up to 10% than the comparator aggregate; a red circle means that the trust’s result is more than 10% higher than the comparator aggregate. Perinatal mortality rates are likely to be influenced by numerous maternal and foetal factors  (such as maternal age, socio-economic deprivation, ethnicity, birth multiplicity and gestational age at birth) and organisational characteristics (e.g. units with level 3 Neonatal Intensive Care and neonatal surgical capabilities are likely to manage the highest-risk cases); this metric uses adjustment to ensure that hospitals dealing with higher-risk cases are compared fairly against those with less complex cases.
  • Quality improvement prompt question: ‘Red circle’ or ‘orange circle’ status for a hospital should prompt questions about the results of any local case reviews performed to determine possible causes for neonatal deaths, as recommended by MBRRACE,  and what actions the hospital has taken as a result of the review. Further recommendations are found in the final report, as it is recognised that different organisations will have different aspirations based on the make-up of their local population.

3. Stabilised & risk-adjusted, comparative, extended perinatal mortality rate

  • Rationale: This metric measures the ‘extended perinatal mortality rate’ for a given organisation. The extended perinatal mortality rate is defined as the number of deaths per 1,000 total births. Deaths are defined as stillbirths (see below)  and neonatal deaths (see below). The rate is expressed as a figure (with 95% confidence intervals) per 1,000 total births. Deaths resulting from termination of pregnancy and births <24 +0 weeks gestational age are excluded.  The death of a baby in the time period before, during or shortly after birth is a devastating outcome for families. There is evidence that the UK’s death rate varies across regions, even after taking into account differences in poverty, ethnicity and the age of the mother.
  • Guideline/mapping: Each Baby Counts, Royal College of Obstetricians & Gynaecologists, 2017
  • Graph/relative performance: Trusts are compared against other trusts with a similar number of births and similar facilities. Lower figures are better.  There are five comparator groups:
  1. Level 3 NICU and Neonatal Surgery.
  2. Level 3 NICU.
  3. 4,000 or more births per annum at 22 weeks or later.
  4. 2,000-3,999 births per annum at 22 weeks or later.
  5. Under 2,000 births per annum at 22 weeks or later.
  • A trust in the green band means that the trust’s result is more than 10% lower than the comparator aggregate; a yellow circle means that the trust’s result is lower than the comparator aggregate by up to 10%; an orange circle means that the trust’s result is higher by up to 10% than the comparator aggregate; a red circle means that the trust’s result is more than 10% higher than the comparator aggregate. Perinatal mortality rates are likely to be influenced by numerous maternal and foetal factors  (such as maternal age, socio-economic deprivation, ethnicity, birth multiplicity and gestational age at birth) and organisational characteristics (e.g. units with level 3 Neonatal Intensive Care and neonatal surgical capabilities are likely to manage the highest-risk cases); this metric uses adjustment to ensure that hospitals dealing with higher-risk cases are compared fairly against those with less complex cases.
  • Quality improvement prompt question: ‘Red circle’ or ‘orange circle’ status for a hospital should prompt questions about the results of any local case reviews performed to determine possible causes for the high mortality rates, as recommended by MBRRACE,  and what actions the hospital has taken as a result of the review. Further recommendations are found in the final report, as it is recognised that different organisations will have different aspirations based on the make-up of their local population.

[1] MBRRACE-UK, 2017

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