Introduction Preterm birth is a major public health concern with lifelong consequences. National policies in England and Wales aim to reduce deaths, improve outcomes and address disparities. We examined changes in admissions, care processes and outcomes among extremely (EPT) and very preterm (VPT) infants overall and by maternal ethnicity. Methods We conducted a retrospective, population-based cohort study using the National Neonatal Research Database and Office for National Statistics data, covering all National Health Service neonatal units from 2013 to 2023. Temporal trends in care processes and clinical outcomes were estimated using modified Poisson regression. Models were adjusted for gestational age, sex, multiplicity and birth weight z-score. Results are presented as adjusted risk ratios with 95% CIs. Results There were 26 132 EPT and 55 789 VPT admissions, with no significant change in overall admission rates. Admissions of babies born below 24 weeks gestation almost doubled. Mothers of black ethnicity consistently had the highest rates of EPT and VPT admissions. Deliveries by emergency caesarean section increased (EPT: 1.04, 1.03 to 1.04; VPT: 1.02, 1.01 to 1.02). Delivery room intubation (EPT: 0.96, 0.96 to 0.97; VPT: 0.93, 0.93 to 0.93), intubated respiratory support (EPT: 0.99, 0.99 to 0.99; VPT: 0.96, 0.96 to 0.97), and surgical or device closure of patent ductus arteriosus closure (EPT: 0.82, 0.80 to 0.84; VPT: 0.86, 0.81 to 0.92) decreased. In EPT infants, maternal milk uses at discharge (1.01, 1.01 to 1.02) and late-onset bloodstream infection increased (1.03, 1.02 to 1.04) and early postnatal transfers (0.98, 0.97 to 0.99) and mortality decreased (0.98, 0.97 to 0.99). In VPT infants, severe necrotising enterocolitis (0.96, 0.94 to 0.98) and survival without major morbidity decreased (0.99, 0.99 to 0.99). Conclusions Over the last decade, EPT and VPT admission rates in England and Wales have not changed and ethnic disparities remain evident. Delivery of some evidence-based care processes improved, but clinical outcomes showed only modest gains.
Chehrazi et al. (2026) studied this question.