Does neonatal care delivery in England and Wales vary by deprivation and ethnicity: a retrospective cohort study.

Abstract

Objective: To investigate whether perinatal care delivery in England and Wales varies by ethnicity and socio-economic deprivation, using National Neonatal Audit Programme (NNAP) measures.

Design: Retrospective observational study using NNAP (2017-2023) data.

Setting: Neonatal units in England and Wales participating in the NNAP.

Participants: Admitted infants born at ≥22 weeks with recorded data on ethnicity, deprivation and relevant NNAP measures.

Outcome measures: Fourteen NNAP measures covering perinatal optimisation, neonatal care, breastfeeding and parental partnership were explored by ethnicity (White, Black, Asian, Mixed and Other) and deprivation.

Results: Ethnicity and deprivation were associated with several measures of care. Compared with White infants, Black, Asian, Mixed and 'Other' ethnicity babies had lower odds of receiving deferred cord clamping (adjusted ORs (aOR) 0.76 (95% CI 0.70 to 0.84), 0.88 (95% CI 0.82 to 0.95), 0.79 (0.68 to 0.92) and 0.75 (0.64 to 0.88), respectively) and had higher odds of abnormal admission temperature. White infants had higher odds of receiving early breastmilk compared with infants from minority ethnic groups, but had lower odds of receiving it at 14 days or at discharge. Compared with the least deprived, the most deprived infants had lower odds of receiving breastmilk, within 48 hours (aOR: 0.58 (95% CI 0.54 to 0.63)) and at discharge (aOR: 0.39 (95% CI 0.36 to 0.43)). There were lower odds of early parental updates and involvement in ward rounds for minoritised ethnic groups (compared with White families) and most deprived (compared with least deprived) families.

Conclusions: Disparities exist in the delivery of perinatal care by ethnicity and deprivation. There are opportunities to improve equity, particularly around deferred cord clamping, breastfeeding support and parental partnership.