1. Dr. Arun Ramachandran Consultant Neonatologist Singleton Hospital Quality group, Wales Neonatal Network

2.  Important cause of morbidity and mortality in preterm babies  Reviews in Canada, England and USA have shown wide variations between hospitals (3- 11%) which can be improved by QI initiatives  Current incidence in Wales is unknown  Need to measure baseline incidence for QI

3. Anonymised data from Badgernet All babies admitted to neonatal units in Wales included NEC confirmed/ suspected as per hospital discharge summary NEC confirmed in Wales in 2013 - 39 babies (< 1500 g - 30 babies) NEC suspected in Wales in 2013 - 129 babies

4. Incidence Wales (2013) ( 12 units) VON (2013) (1000 units) Canadian Neonatal Network ( 25 units) (2003 – 2008) UK ( From VON for 2013) All babies1.37 % (39/2835) 1.2 % Birth weight 501 – 1500 g 9 % (30/331) 5.1 %6.7 % Birth weight 501 – 1000 g 16.6 % (21/126) Gestation ≤ 32 weeks 5.9 % ( 31/518)5.1% (858/16669) QI launched

5. Mortality Wales (2013) ( 12 units) Canadian Neonatal Network ( 25 units) (2003 – 2008) All babies 25. 6% (10/39) 501 - 1500 g 33.3% (10/30) Gestation ≤ 32 weeks29% (9/31)25% (215/858)

18.  Improve our ability to monitor morbidity Build better case definitions into Badgernet Welsh morbidity dashboard in Badgernet ?? Universal data entry into VON  Reduce incidence and severity of NEC - Early initiation and increased use of breast milk - Antibiotic governance - Probiotics ?? - QI initiative by Health Boards - Yearly outcome review by network - ? CQUIN

19. 1. Fanaroff AA, Stoll BJ, Wright LL, et al; NICHDNeonatal Research Network. Trends in neonatal morbidity and mortality for verylow birthweight infants. Am J Obstet Gynecol. 2007;196(2):147–148, e1–e85. 2. Incidence and timing of presentation of necrotising enterocolitis in preterm infants. Wendy H.Yee, Shoo K. Lee et al and the Canadian Neonatal Network. Paediatrics;J an 2012.DOI:10.1542/peds.2011-2022. 3. Stoll BJ, Hansen NI, Bell EF, et al; EuniceKennedy Shriver National Institute of Child Health and Human Development NeonatalResearch Network. Neonatal outcomes of extremely preterm infants from the NICHDNeonatal Research Network. Pediatrics. 2010;126(3):443–456. 4. Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr.2010;156(4):562–567, e1