6666 Do neonatal quality audit measures actually correlate with trust mortality?

Objectives Neonatal units submit data to NNAP to demonstrate quality neonatal care.1 In theory good quality neonatal care should lead to better survival. We acknowledge that being ranked number one on entry to a tennis tournament does not guarantee a place in the final. We triangulated NNAP data with MBRRACE mortality data for 2019- 2021. Methods NNAP and MBRRACE data is publicly available. We collated NNAP data by hospital trust ranking for: antenatal steroids, magnesium sulphate, DCC (2021 only), admission temperature, positive cultures, NEC, administration of EBM. A summed rank was produced for all trusts across domains. We compared trusts' stabilised neonatal mortality rates against the rank-sum of quality NNAP measures. Results For 2019 there was a statistically significant weak correlation between sum-ranking and neonatal mortality (Rho=0.3836,p=0.000009284) across 126 trusts. There was no statistically significant correlation when looking at SCU, NICU and NICUs with surgery separately, though one was found with respect to LNUs. There remained a statistically significant correlation with MBRRACE mortality group stratifications for those with below and above average mortality, but not those within 5% of average. For 2020 there was a statistically significant weak correlation between sum-ranking and neonatal mortality (Rho=0.3152,p=0.0007) across 112 trusts. There was no statistically significant correlation when looking at SCU, LNU, NICU and NICUs with surgery, separately. There remained a statistically significant correlation with MBRRACE mortality group stratifications for those with below and above average mortality, but not those within 5% of average. For 2021 there was no statistically significant correlation between sum-ranking and neonatal mortality (Rho=0.165,p=0.094) across 104 trusts. This remained the case when looking at SCU, LNU, NICU and NICUs with surgery, separately and when looking at the MBRRACE mortality group stratifications. Conclusion There seems to be inconsistency in whether the quality measures being recorded truly affect outcome. The mortality statistics are adjusted for gestational age, deprivation, ethnicity and maternal age at birth.2 They are not adjusted for the quality measures recorded by NNAP. Therefore, we expected to find that centres ranking highly for quality measures should still have had lower adjusted mortality. This was not uniformly the case across the years. Although statistically significant correlations have been identified in 2019 and 2020, these have been weak correlations only. Are the current quality measures the correct ones? Has the addition of DCC affected the validity of results? Now NNAP are collecting mortality data, will they look at the ranking for quality measures for comparison? References National Neonatal Audit Programme, accessed via: https://nnap.rcpch.ac.uk/default.aspx on 30th October 2023. MBRRACE-UK Perinatal Mortality Surveillance Report Technical document p7, MBRRACE-UK, October 2022.