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Last Updated:  Monday, 24 March, 2003, 00:13 GMT
Premature babies 'endangered'
More than 3,500 premature births were studied
Some premature babies may be dying needlessly because of inadequate standards of hospital care, says a major report by paediatric experts.

They found a range of shortcomings which could be contributing to premature baby deaths.

The report, by the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI), concludes that there are too few experienced staff in many units.

Thousands of babies are born prematurely each year, and the report's authors examined the cases of more than 3,500 born after just 27 or 28 weeks or pregnancy.

They found that 88% of these survived.

However, the study found that there were many "deficiencies in care".

Some of these could be attributed to poorly-trained staff. There were problems in the resuscitation of babies who were not breathing when they were born, and some staff were not skilled at inserting breathing and feeding tubes.

First days

However, the overall care of some babies - particularly in the vital first week of life - was lacking in some cases.

Premature baby
I didn't think I'd see them again. It was terrible
Nicci Livesey

Some babies did not receive good "ventilatory and cardiovascular" support, or were not kept at the right temperature.

There were even delays in administering surfactant therapy - a soapy mixture given to improve the working of the immature lung - even though it is well acknowledged that this is the best practice for babies born this early.

There were also problems in arrangements for transferring the sickest babies from delivery rooms into the intensive care unit.

The report's authors noted that these problems were more frequent in babies that did not survive - although they said this did not prove that they contributed to the death.

Dr Mary Macintosh, the director of CESDI, said: "Survival rates have improved substantially over the last decade, but the enquiry concludes that they could improve further.

In terms of survival rates, we are beginning to lag behind Europe
Dr Patricia Hamilton, CESDI
"Better coordination and training is needed within units, and the expertise of neonatal consultant supervision of the care of premature babies in the first week of life is crucial."

Dr Patricia Hamilton, a consultant neonatologist at St George's Hospital in London, described many hospital's approach to neonatal intensive care as "ad hoc".

She told BBC News Online: "Many of the standards that were made in 1996 are still not in place.

"In terms of survival rates, we are beginning to lag behind Europe."

In 1999, Britain had the second highest infant mortality rate in the European Union after Greece.

Change needed

Other experts agreed that change was needed. Many advocate a reorganisation of neonatal intensive care units into a loose network, with certain units specialising in treating the sickest babies.

There are not enough staff or cots to give these babies the best possible care
Dr Evan Harris, Liberal Democrats
Professor David Field, treasurer of the British Association of Perinatal Medicine, told BBC News Online: "It is proving very difficult to find the specialist nursing staff for neonatal intensive care units.

"The service needs to be far better coordinated."

A spokesman for Bliss, the premature baby charity, said: "It is unacceptable that mothers and babies are still being put at risk because the right systems and services are not in place."

Liberal Democrat Health spokesman Dr Evan Harris pointed out that the overall number of intensive care cots had dropped by a fifth since 1997.

He said: "Babies are dying unnecessarily because of sub-standard care.

"This is obviously related to a lack of capacity. There are not enough staff or cots to give these babies the best possible care."

A spokesman for the Department of Health said that it had commissioned new guidelines for the NHS as a result of the CESDI survey.

She said: "The Children's National Service Framework, which includes maternity services will set national standards of care for antenatal, intrapartum and post natal services."

The BBC's Adam Brimelow
"(The report) says there is a need for more specialist consultants and nurses"

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