6244 Understanding inequalities in neonatal intensive care. Analysis of data on more than 1 million babies in England and Wales, 2012–2022

Objectives Babies born to mothers living in more deprived areas are at a higher risk of dying during the neonatal period.1 Pre-term and unwell term babies are cared for in neonatal intensive units (NICU) and this population contributes significantly to the overall neonatal mortality rate.2 The extent and reasons for any socio-economic and ethnic inequalities in neonatal intensive care outcomes are unclear. Here we present preliminary analyses of inequalities in both admission and mortality in this population. Methods For this retrospective analysis we analysed data on 1,005,114 individual babies born between 1st January 2012 and 31st December 2022 in the National Neonatal Research Database (NNRD) for England and Wales. We linked these data to information on small area deprivation of residence and undertook descriptive analyses, to understand inequalities in admission to neonatal intensive care units over time. To explore inequalities in mortality, we assessed inequalities in important risk factors, such as gestational age and maternal ethnicity by index of multiple deprivation (IMD) deciles. Results Preliminary results show that 13.7% of babies in NICUs were born to women from the most deprived decile, while only 5.6% were born to women from the least deprived decile, with a clear social gradient evident. 2.6% were extremely preterm, 5.6% were very preterm, 29.1% were moderate to late preterm and 62.6% were term. Babies from more disadvantaged areas were more likely to be born preterm and to die prior to discharge. The dataset captured 11,302 deaths (1.1%), with evidence of a social gradient, whereby 1.5% of babies in the most deprived decile died compared to 1.0% of babies in the least deprived decile. 1.2% of babies from a white ethnic background died, whilst 2.1% and 1.6% of babies from Black and Asian ethnicities died. Conclusion There are stark inequalities in the number of babies admitted to and who die in neonatal intensive care units in England and Wales. Ongoing analyses are exploring the intersection of ethnicity and deprivation on outcomes, and the extent to which inequalities can be explained by differences in case mix on admission. References Draper ES, Gallimore ID, Smith LK, Fenton AC, Kurinczuk JJ, Smith PW, et al. Perinatal Mortality Surveillance Report. 2019;64. Child and infant mortality in England and Wales – Office for National Statistics Internet. cited 2022 Apr 29. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodinfantandperinatalmortalityinenglandandwales/2016#infant-mortality-rates-increase-in-england-and-wales-in-2016