The aim of this audit was to compare neonatal admissions in the South West of England during 2020 to previous years to determine whether staff perceptions of NNUs being less busy were corroborated by admission data. We found a decrease in NNU admissions from 2018–2020, confirming neonatal staff perceptions. However interestingly the decrease between 2018 and 2019 was larger than the difference between 2019 and 2020, implying that the COVID-19 lockdown was not necessarily implicated. Additionally, we found no significant difference in admissions across gestational groups, similar to a single-site UK-based study [3] and data from Philadelphia and Israel [7, 8]. However, these findings are in disagreement with data from other developed countries such as Italy, Ireland and the Netherlands [6, 9–11].
Between 2010–2019 the rate of preterm live births in the UK has been between 7%- 8%. Reducing preterm birth is a national health priority in the UK, with an aim to reduce rates from 8–6% by 2025 [12]. The current strategy to improve preterm birth rates focus on three key areas of care provision: prediction, prevention and preparation of women at high-risk preterm birth. As most morbidity and mortality is associated with births < 34 weeks gestation, even extending gestation for a few further weeks and reducing a relatively small number of preterm births, could have demonstrable impact on health outcomes, as well as cost and resource savings. The drop in NNU admissions in our audit is already evident from 2018 to 2019 and may be reflective of organisational and policy changes to improve preterm rates, in advance of any potential impact of national lockdown restrictions due to the COVID-19 pandemic.
We recognise that the limitation of our observations is reliant on a crude analysis of retrospective data and do not include possible explanatory factors, including induction of labour and/or other obstetric complications. Additionally, we did not include COVID-19 infection rates in our analysis. The UK incidence admission rate with confirmed SARS-CoV-2-infection in pregnancy has been recorded at 4.9/1000 [13]. However, overall COVID-19 infection rates in the South West of England have been relatively low compared to the rest of the UK, concurring the hypothesis that infection is not implicated in our observed trends.
We chose to include a full 12 months of data during the COVID-19 pandemic (January –December 2020), unlike other studies, as there is now emerging evidence that COVID-19 infection is likely to have been circulating prior to the official lockdown in March 2020. Data from years prior to 2018 were not included to enable us to demonstrate a long-term trend, however other studies examined a similar timeframe [7, 9, 10]. It is unclear without nationwide data whether the trends observed in our audit are generalisable. The South West of England has a predominantly white ethnic population, so does not necessarily reflect the more diverse population of the UK.
We aim to monitor the data of 2021 and beyond to understand and investigate possible effects of the extended lockdown period during the COVID-19 pandemic. However, our data have clinical significance and revisiting clinical practices like organisational and workforce issues is warranted. Future research exploring the impact of lockdowns on behaviour change during pregnancy is required to understand the reality of pregnancy and preterm birth.