6








Variation in stillbirth and neonatal mortality rates

 
     

It is standard practice for hospitals in the UK to monitor the number of stillbirths and neonatal deaths and review such cases through regular perinatal mortality meetings. Any increase in the perinatal mortality rate should be a cause of local concern and initiate discussion on the reasons for high rates locally. These might include referral patterns, the case mix of the population served or, on occasions, standards of care.

In addition to reporting on perinatal mortality on a nationwide basis, CEMACH aims to support local processes wherever possible through the provision of timely information. To this end we have provided stillbirth rates and neonatal mortality rates at regional, strategic health authority and trust levels in Sections 6.1, 6.2 and 6.3, respectively. With this report, we have also sent each NHS trust a separate report providing individualised trust-specific summary figures. We hope that this will enable trusts to compare themselves with other trusts and that they will be willing to share their trust-specific reports with other providers and commissioners to assist in benchmarking and local review.

In future years, the provision of this information will become more sophisticated by adjusting for referral patterns and the distribution of risk factors in the population served by individual trusts. Perinatal mortality rates for individual trusts will also be grouped according to organisational facilities available, such as the level of neonatal intensive care provision, to enable appropriate comparisons to be made.

 
 

6.1

 

Variation in mortality by region

Using the postcode of the normal residential address of the mother, stillbirth rates and neonatal mortality rates by the government offices for the regions are shown in Figures 5 and 6. Numbers used for the construction of these figures are shown in Appendix B.

The crude stillbirth rate in London was higher than that observed in England, Wales and Northern Ireland as a whole (Figure 5). The stillbirth rate in the South East and the South West was lower than that of the population of England, Wales and Northern Ireland as a whole. Figure 6 shows a higher crude neonatal mortality rate in the West Midlands and a lower neonatal mortality rate in the South East than that seen in the whole of England, Wales and Northern Ireland.

These mortality rates have not been adjusted for the distribution of risk factors or case mix in the population of the region and are therefore crude measures of mortality. They should not be interpreted as direct indicators of standards of care as there are many factors that can influence outcomes. CEMACH hopes to explore obtaining appropriate data on live births to allow analysis of adjusted mortality rates by region in the future.

 
 

6.2

 

Variation in mortality by strategic health authority

Using the postcode of the normal residential address of the mother, stillbirth rates and neonatal mortality rates by NHS strategic health authority are shown in Figures 7 and 8. Data used to create these figures are shown in Appendix B.

 
 

6.3

 

Variation in mortality by hospital trust

Stillbirth and neonatal mortality rates for trusts with 1000 live births or more in 2004 are presented in Figures 9 and 10. These figures (known as funnel plots) show each individual trust's mortality rate plotted against the number of live births in that trust, the national mortality rate (solid line) and associated 95% confidence intervals (thin dotted lines) dependant on size of trust. Each marker represents one trust.

If a trust lies within the 95% confidence limits, it has a crude mortality rate that is statistically consistent with the national rate. If a trust lies outside the 95% confidence limits, then the trust has a crude rate that is significantly different from the national rate. However, care should be taken in the interpretation of these figures as data displayed are crude mortality rates. They do not take into account the risk factors and case mix of the population served by the individual trust nor the transfer of mothers and babies between hospitals due to medical or other reasons.

From 2005, CEMACH has collected intended place of delivery as well as actual place of delivery and place of death. This will allow more detailed trust specific reports to be produced to take into account the effects of transfers before and after delivery in the future.

In addition, from 2005 onwards, CEMACH will present trust mortality data by type of provider. This will allow organisations to compare their mortality rates with other organisations with similar facilities.