NNAP Summary Report 2024 data
Source: data.gov.uk (2025-10-20)

National Neonatal Audit Programme annual report on 2024 data. This publication contains data from the National Neonatal Audit Programme annual report on 2024 data. The audit aims to assess whether babies admitted to neonatal units receive consistently high-quality care.

Audits 
RCPCH
NNAP
National Neonatal
Audit Programme
National Neonatal Audit 
Programme (NNAP) 
Summary report on 2024 data
October 2025
Royal College of 
Paediatrics and Child Health
RCPCH
Photo courtesy of Mabel Micah

NNAP
National Neonatal 
Audit Programme
Summary report 
on 2024 data
Introduction	
3
Results at a glance	
4
Key messages & recommendations	
6
1. Mortality to discharge in very preterm babies	
6
2. Outcomes of neonatal care	
8
3. Optimal perinatal care	
10
4. Parental partnership in care	
12
5. On-time screening for retinopathy 
of prematurity (ROP)	
13
6. Neonatal nurse staffing	
13
7. Equity of neonatal care	
14
Further information:
Further information about the background, aims, and scope of 
the NNAP is available at: www.rcpch.ac.uk/about-nnap
NNAP Governance
Details of the NNAP governance structure and membership of 
the NNAP Project Team are available at www.rcpch.ac.uk/work-
we-do/quality-improvement-patient-safety/national-neonatal-
audit-programme/governance-delivery
© 2025 Healthcare Quality Improvement Partnership (HQIP)
Published by RCPCH October 2025.  
Cite as: National Neonatal Audit Programme (NNAP) Summary report on 2024 data. RCPCH: London, 2025.
Royal College of Paediatrics and Child Health. Incorporated by Royal Charter and registered as a Charity in England and Wales: 
1057744 and in Scotland: SCO38299. Registered Office 5-11 Theobalds Road, London WC1X 8SH. Patron HRH The Princess Royal. 
Front cover photo courtesy 
of Mabel Micah
Gracielle needed help 
breathing, but I was still 
able to feed her and give 
her kangaroo care. A few 
weeks later, Gracielle is 
now breathing and feeding 
without support. This is to 
encourage everyone that it 
does get better.
2

Extended analysis report
The NNAP 2024 data extended analysis 
report, available at: www.rcpch.ac.uk/
NNAP-report-2024-data provides results 
by NNAP measure by unit type, by neonatal 
network, and for England, Scotland, Wales 
and the Isle of Man combined. There is also a  
summary of findings for each audit measure, 
recommended next steps for services seeking 
to make improvements and links to further 
resources and case studies. 
NNAP Data Dashboard
The public facing NNAP Data Dashboard 
presents results for each of the 10 key 
performance metrics as annual rolling 
averages, updated monthly. Data in the 
Dashboard are provisional and may be subject 
to change between updates and before the 
publication of the NNAP annual summary 
report. Registered audit participants within 
neonatal networks and units can access a 
restricted version of the dashboard to support 
data cleaning and early quality improvement 
interventions. Access the dashboard at: www.
rcpch.ac.uk/resources/nnap-data-dashboard
Full results
Full annual results at unit and network 
level, interactive reporting tools and 
unit posters are available on NNAP 
Online at: www.rcpch.ac.uk/resources/
nnap-online-report-data
Full results
Full annual results at unit and network level, 
interactive reporting tools and unit posters 
are available on NNAP Online at: www.rcpch.
ac.uk/resources/nnap-online-report-data
A line of sight table describing the evidence 
base for the recommendations made in this 
report is available at: www.rcpch.ac.uk/NNAP-
report-2024-data
Established in 2006, the National 
Neonatal Audit Programme 
(NNAP) is commissioned by the 
Healthcare Quality Improvement 
Partnership (HQIP) and delivered 
by the Royal College of Paediatrics 
and Child Health (RCPCH). 
Introduction
It assesses whether babies admitted to 
neonatal units receive consistent high-quality 
care in relation to the NNAP audit measures 
that are aligned to a set of professionally 
agreed guidelines and standards. The NNAP 
also identifies variation in the provision 
of neonatal care at local unit, regional 
network and national levels and supports 
stakeholders to use audit data to stimulate 
improvement in care delivery and outcomes.
The audit reports key outcomes of neonatal 
care, measures of optimal perinatal care, 
maternal breastmilk feeding, parental 
partnership, neonatal nurse staffing levels, 
and other important care processes.
This report summarises the key messages 
and national recommendations developed 
by consensus by the NNAP Project Board 
and Methodology and Dataset Group, based 
on NNAP data relating to babies admitted 
to neonatal care in England, Scotland, Wales 
and the Isle of Man between 1 January and 31 
December 2024. 
Further data
Further data about maternity and perinatal 
services is available from the National 
Maternity & Perinatal Audit (NMPA) and 
Mothers and Babies: Reducing Risk through 
Audits and Confidential Enquiries across 
the UK (MBRRACE-UK). The NMPA measures 
various aspects of maternity and neonatal 
care provided by NHS maternity services in 
England, Scotland and Wales. MBRRACE-UK 
conducts robust national surveillance and 
investigates the deaths of women and babies 
who die during pregnancy or shortly after 
pregnancy in the UK.
3
National Neonatal Audit Programme Summary report on 2024 data

The National Neonatal Audit Programme (NNAP) assesses whether babies admitted to 
neonatal units receive consistent high-quality care and identiﬁ es areas for improvement.
This poster summarises both the combined national and network level results based on NNAP 
data relating to babies admitted to neonatal care between January and December 2024, unless 
otherwise stated. Results displayed in the horizontal pink bars show the range of neonatal 
network proportions (lowest and highest) and the pink circles shows the overall audit results. 
A green arrow, whether pointing up or down denotes a positive change, whereas a red arrow, 
pointing up or down denotes a negative change. An amber arrow denotes no change.
Outcomes of neonatal care
Optimal perinatal care
8.1%
4.1%
6.4%
9.2%
1.7%
5.1%
9.4%
3.6%
6.4%
60.5%
46.4%
51.8%
80.4%
66.8%
73.5%
90.4%
83.1%
86.7%
44.8%
33.1%
39.8%
6.7%
2.3%
5.1%
4.6%
1.2%
3%
91.3%
71%
80.7%
82.2%
69.1%
77.6%
82.8%
45.8% 66.8%
WITHIN
DAYS2
NICU
Note that all previous years’ results in the 2024 report use the latest metric deﬁ nitions, methodology and data (as of March 2025) to ensure that ﬁ gures are comparable between years. For this reason, results from previous years will not always 
match previously published NNAP annual results. The total number of babies included differs between measures because of differences in inclusion criteria and missing data. Babies with missing outcomes are not included in the total.
Mortality
6.4% of 7,038 babies born at 
less than 32 weeks died before 
discharge home. 
0% change from previous year 
(2023: 6.4%)
Necrotising enterocolitis
5.1% of 6,909 babies born at 
less than 32 weeks developed 
necrotising enterocolitis.
0.4% decrease from previous year 
(2023: 5.5%)
Preterm brain injury – Intraventricular 
haemorrhage (IVH)
6.4% of 6,880 babies born at less 
than 32 weeks experienced IVH.
0.2% decrease from previous year 
(2023: 6.6%)
Antenatal steroids
51.8% of 11,321 mothers of babies 
born at less than 34 weeks’ were 
given a full course of antenatal 
steroids in the week prior to delivery.
1.2% decrease from previous year 
(2023: 53%)
Deferred cord clamping
73.5% of 12,894 babies born at 
less than 34 weeks’ had their cord 
clamped at or after one minute.  
5% increase from previous year 
(2023: 68.5%)
Bloodstream infection
5.1% of 7,063 babies born at less 
than 32 weeks had growth of 
a clearly pathogenic organism.
0.5% increase from previous year 
(2023: 4.6%)
Born in a centre with a NICU
80.7% of 1,920 babies born at 
less than 27 weeks’ were born 
in a centre with a NICU on site. 
1.1% increase from previous year 
(2023: 79.6%)
Temperature on admission
77.6% of 13,077 babies born at less 
than 34 weeks’ were admitted 
with a temperature within the 
recommended range of 36.5°C-37.5°C.
2.6% increase from previous year 
(2023: 75%)
Breastmilk feeding in 
ﬁ rst 2 days of life
66.8% of 12,874 babies born at 
less than 34 weeks’ received their 
mother’s milk in the ﬁ rst 2 days of life.
4.7% increase from previous year 
(2023: 62.1%)
Preterm brain injury – 
cystic periventricular 
leukomalacia (cPVL)
3% of 6,871 babies born at less 
than 32 weeks experienced cPVL. 
0.5% increase from previous year 
(2023: 2.5%)
Results at a glance
Bronchopulmonary 
dysplasia (BPD)
39.8% of 7,341 babies born at 
less than 32 weeks developed 
BPD or died.
0.3% decrease from previous year 
(2023: 40.1%)
Antenatal magnesium sulphate
86.7% of 3,795 mothers of babies 
born at less than 30 weeks’ were 
given antenatal magnesium 
sulphate.
1.5% increase from previous year 
(2023: 85.2%)
NNAP
National Neonatal 
Audit programme
4

Parental partnership in care
Further information and resources
Care processes and nurse stafﬁ ng
WITHIN
DAYS
14
For neonatal services, 
neonatal networks and 
trusts/health boards
For parents and families
Full annual results
Full annual results at neonatal unit and network 
levels, interactive reporting tools and unit posters 
are available on NNAP Online at: 
www.rcpch.ac.uk/resources/nnap-online-report-data 
Your Baby’s Care Guide 2024
Parents and families can ﬁ nd more information about the 
NNAP and 2024 results in Your Baby’s Care, a guide to the 
NNAP, while NNAP Online provides more in-depth results 
for each neonatal unit and network in England, Wales, 
Scotland and Isle of Man.
Your Baby’s Care: www.rcpch.ac.uk/your-babys-care
NNAP Online: www.rcpch.ac.uk/resources/nnap-online-
report-data
To ﬁ nd out more about how we use 
information about babies experiencing 
neonatal care and their mothers, visit 
www.rcpch.ac.uk/your-babys-information 
or scan the QR code with your phone to 
read our leaﬂ et, Your Baby’s Information.
Extended Analysis Report
The NNAP 2024 Data: Extended Analysis Report, providing 
in-depth results and a summary of ﬁ ndings by audit measure, 
along with full national recommendations, local quality 
improvement recommendations and links to case studies 
and useful resources is available at: www.rcpch.ac.uk/nnap   
How we use information
AT
DISCHARGE
89.6%
72.7%
80.8%
84.6%
50.1%
65.8%
96.7%
92.2%
94.6%
58.2%
25.2%
36%
88.2%
68.9%
80%
85.8%
67.7%
77.9%
61.7%
43.3%
51.7%
91.1%
66.3%
81.5%
Breastmilk feeding at 14 days of life
80.8% of 11,601 babies born at less 
than 34 weeks’ received their 
mother’s milk at 14 days of life.
1.4% increase from previous year 
(2023: 79.4%)
Breastmilk feeding at discharge
65.8% of 11,596 babies born at less 
than 34 weeks’ received their 
mother’s milk at discharge. 
2.7% increase from previous year 
(2023: 63.1%)
On-time screening for retinopathy 
of prematurity (ROP)
80% of 6,725 eligible babies 
were screened on time for ROP. 
1.5% increase from previous year 
(2023: 78.5%)
Medical follow up at two years
77.9% of 3,890 babies born at less 
than 30 weeks’ had a documented 
medical follow up at the right time.  
0.7% increase from previous year 
(2023: 77.2%)
Non-invasive breathing support
51.7% of 6,642 babies born at less 
than 32 weeks’ received only non- 
invasive breathing support in the 
ﬁ rst seven days of life. 
2.4% increase from previous year 
(2023: 49.3%)
Neonatal nurse stafﬁ ng
81.5% of 124,981 nursing shifts 
were staffed according to 
recommended levels. 
2.6% increase from previous year 
(2023: 78.9%)
Parent consultation within 24 hours
94.6% of 56,864 parents had 
a documented consultation with 
a senior member of the neonatal 
team within 24 hours of their 
baby’s admission. 
0.5% decrease from previous year 
(2023: 95.1%)
Parent inclusion in 
consultant ward rounds
36% of 772,337 baby care days 
had a consultant-led ward round 
with at least one parent included.
2.7% decrease from previous year 
(2023: 38.7%)
Note that all previous years’ results in the 2024 report use the latest metric deﬁ nitions, methodology and data (as of March 2025) to ensure that ﬁ gures are comparable between years. For this reason, results from previous years will not always 
match previously published NNAP annual results. The total number of babies included differs between measures because of differences in inclusion criteria and missing data. Babies with missing outcomes are not included in the total.
5

Figure 1: Front and back plot of mortality to discharge in very preterm babies, by neonatal 
network, 2017-2024.
The "front and back" plot is a time series chart showing all networks as individual lines. The x axis is the NNAP 
report year, and the y axis shows the percentage of babies with a given outcome in that network. The chart is 
split into tiles, with each tile showing the same set of lines, but with a particular network's results highlighted 
by a blue line in each case.
Overall, the proportion of very preterm babies, born 
between 24 and 32 weeks gestational age, who die 
before discharge home from the neonatal unit is 
unchanged from 2023 at 6.4% (451 of 7,038) and has not 
improved over recent years. Unacceptable geographical 
variation persists between neonatal networks, which 
is not explained by the clinical or demographic 
background characteristics of babies cared for in 
the neonatal network (Figure 1, NNAP Online and 
extended analysis report). 
Although the NNAP reports only deaths occurring 
after admission to a neonatal unit, not including 
stillbirths and delivery room deaths, it’s clear that the 
national ambition in England to halve the number 
of stillbirths and neonatal deaths by 20251 is unlikely 
to be achieved, and a different approach to reducing 
mortality is needed. 
Mortality to discharge 
in very preterm babies
1
Key messages & recommendations
1.	
Dept. of Health and Social Care. 2015. New ambition to halve the rate of stillbirths and neonatal deaths. Available here. 
4
6
8
10
2017
2018
2019
2020
2021
2022
2023
2024
National Average
East England
East Midlands
Kent Surrey Sussex
London NCE
London NW
London South
North West
Northern
Scotland
South West
Thames Valley Wsx
Wales
West Midlands
Yorkshire Humber
Mortality (%)
6
National Neonatal Audit Programme Summary report on 2024 data

Figure 2: Babies born at 22 and 23 weeks gestational age, admitted to a neonatal unit 
and surviving to 44 weeks gestational age, 2018-2024.
0
100
200
300
Number of babies
2018
2019
2020
2021
2022
2023
2024
22 weeks - died
22 weeks - survived
23 weeks - died
23 weeks - survived
National recommendation:
1.	 Neonatal networks should: 
a.	 Review their mortality data and, where rates are higher than expected, develop locally prioritised 
improvement plans. Quality improvement activity should focus on best practices identified from 
Neonatal Networks exhibiting low mortality, with particular attention given to differences in network 
structure, staffing, clinical governance, and clinical practices. (Recommendation repeated from the 
2023 data report).
b.	 With their constituent units, undertake reviews of deaths in accordance with the BAPM Framework 
for Practice: Neonatal Mortality Governance (expected to be published in the second part of 2025) 
and engage with other statutory death review processes. Shared learning from these reviews should 
inform network governance and unit level clinical practice.
The number of babies born at 22 weeks gestational 
age and admitted to neonatal care appears to have 
plateaued (108 in 2024), having increased approximately 
seven-fold between 2018 (15) and 2023 (112). The number 
of babies born at this gestational age and surviving to 
discharge has increased from 5 in 2018 to 33 in 2024 
(Figure 2). The proportion of admitted babies born at 22 
weeks and surviving to 44 weeks or discharge is largely 
unchanged (Figure 2).
7
National Neonatal Audit Programme Summary report on 2024 data

This year, the highest proportion to date of neonatal 
units were able to provide assurance that all required 
data relating to key complications of prematurity 
were submitted to the audit (bloodstream infection – 
90% (161 of 179), necrotising enterocolitis – 92% (164 of 
179), preterm brain injury – 89% (160 of 179). However, 
caution should continue to be exercised in interpreting 
measure results due to continuing levels of missing 
data and unclear quality assurance, as well as the risk of 
imprecision in reporting cases of preterm brain injury 
and necrotising enterocolitis.
Rates of late onset bloodstream infection have 
remained static since 2019 with no evidence of 
improvement over time nationally; ranging between 
4.7% and 5.9% (extended analysis report). When case 
mix is taken into consideration, variation in rates of 
infection between neonatal units and networks is 
low (NNAP Online, extended analysis report).
There is some evidence of a small overall reduction in 
the incidence of necrotising enterocolitis (NEC) (2017 – 
6.6%; 2024 – 5.1%, 351 of 6,909) (extended analysis report); 
with regional variation not explained by differences in 
gestational age of the babies being cared for (NNAP 
Online, extended analysis report). However, caution 
should continue to be exercised over these results due 
to the levels of missing data and quality assurance, while 
data completeness - and ultimately quality - continue 
to improve.
The completeness of preterm brain injury data reported 
in the NNAP continues to improve year on year, with 
only two networks with missing data over 20% in 2024 
for each of the reported brain injury types (IVH grades 3 
or 4, cPVL and PHVD) (NNAP Online, extended analysis 
report). However, data quality issues and reporting of 
PHVD mean that NNAP cannot yet confidently describe 
rates of brain injury and trends over time.
Over the last three years, the overall proportion of 
babies born at less than 32 weeks who developed 
bronchopulmonary dysplasia (BPD) or died has 
remained stable (2024 – 39.8%, 2,925 of 7,341; 2023 – 
40.1%, 2022 – 40.2%) (Figure 3). Prior to 2022, there was 
evidence of an increase over time2. 
Outcomes of 
neonatal care
2
Figure 3: Proportion of babies born at less than 32 weeks GA who developed BPD or died, 
2017-2024, using 2024 data, definitions and methodology.
2.	
Kwok, T. C. et al. 2025. Changes in respiratory support received in very preterm infants between 36 and 40 weeks postmenstrual age - a national observational study in England 
and Wales. [Article submitted for publication]
36.7
37.6
36.9
39.7
38.5
40.1
40.1
39.8
0
20
40
60
Percentage
2017
2018
2019
2020
2021
2022
2023
2024
Year
National proportion
National proportion missing
8
National Neonatal Audit Programme Summary report on 2024 data

3.	
NICE. Specialist neonatal respiratory care for babies born preterm. Quality standard QS193. 15 July 2020. Available here.
4.	 In reporting outcomes, the NNAP describes the observed number of infants with an outcome, and a “balanced proportion” which is the proportion of that outcome in a matched 
group of babies with similar baseline characteristics to those in the network of interest. Comparing the balanced proportion to the observed proportion allows calculation of a 
“treatment effect”. Treatment effect is the difference between the observed and balanced proportion. A negative treatment effect means that the observed proportion is lower 
than the balanced proportion, and suggests that the babies were more likely to survive/not have a particular outcome in the network than elsewhere in the country. A positive 
treatment effect means that the observed proportion is higher than the balanced proportion, and suggests that the babies would have been more likely to survive/not have a 
particular outcome had they been born and treated elsewhere.
5.	
NHS England or succeeding responsible organisation in England.
Use of non-invasive breathing support is recommended 
where clinically appropriate to reduce the risk of 
mortality and incidence of BPD3. There is a continued 
overall improvement in the proportion of babies 
receiving only non-invasive breathing support during 
their first week of life; rising to 51.7% (3,437 of 6,642) in 
2024 (2023 – 49.3%; 2022 – 47.8%) (extended analysis 
report). 
However, there is significant variation in adherence to 
NICE guidance among neonatal units and networks, 
which is not decreasing over time. Network proportions 
range between 43.3% and 61.7%; and among NICUs, 
24% - 68.8% (extended analysis report, figure 4). 
Differences in treatment effect4 indicate that regional 
and local variation is not explained by differences in the 
gestational age of the babies being cared for(extended 
analysis report). 
Figure 4: Observed proportion of non-invasive breathing support, by neonatal unit (2024).
0
20
40
60
80
100
Non-invasive ventilation (%)
0
178
Rank of neonatal unit
NICU
LNU
SCU
National average (51.7%)
National recommendation:
2.	 NHS England5 and health departments in Devolved Governments should: 
a. 	 issue clear guidance to neonatal services around the correct reporting of preterm brain 
injury including PHVD, so that robust data collection can support the achievement of the 
national ambition for neonatal brain injury. 
b. 	 develop a mandatory NHS neonatal information standard to ensure that clinical 
reporting systems are interoperable, ensuring robust data collection to support effective 
measurement and reporting of all neonatal processes and outcomes.
9
National Neonatal Audit Programme Summary report on 2024 data

Optimal perinatal care
Despite rapid improvement in the proportion of babies 
receiving all reported perinatal optimisation measures6, 
only 1 in 5 babies (21.9%, 2,849 of 13,023) currently receives 
a complete optimal perinatal care journey, increased 
from 7.7% in 2021 (extended analysis report).
There is evidence that optimal perinatal interventions 
are linked to key outcomes such as mortality and brain 
injury.7,8,9 Therefore, there is an important opportunity 
to improve perinatal optimisation nationally, to increase 
the proportion of babies receiving an optimal perinatal 
care journey and reduce regional variation in mortality 
and brain injury.
Since the introduction of deferred cord clamping into 
NNAP reporting in 2020, there has been rapid uptake of 
this important intervention by the neonatal community, 
with significant overall year-on year improvement in 
data completeness and delivery - from 36.9% in 2020 to 
73.5% (9,479 of 12,894) in 2024 (Figure 5). 
However, there is still striking unit level variation (from 
30.8% to 100%) (extended analysis report) and therefore 
opportunities exist for further improvement.
Using the latest definition of this measure, there is a 
clear year-on-year improvement in the proportion of 
babies with a normal temperature on admission and 
within an hour of birth, from 64.5% (9,542 of 14,801) 
in 2017 to 77.6% (10,149 of 13,077) in 2024 (Figure 6). 
While improvements can clearly still be made, variation 
between networks is relatively low, ranging from 69.1% 
to 82.2%, with year-on-year improvement continuing in 
most networks (extended analysis report).
3
Figure 5: Proportion of babies born at less than 34 weeks GA receiving deferred cord 
clamping, 2017-2024, using 2024 data, definitions and methodology*.
6.	
Antenatal steroids, antenatal magnesium sulphate, birth in a centre with a NICU, deferred cord clamping, normal temperature on admission, breastmilk feeding in the first 2 days 
of life.
7.	
Fogarty, M. et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol. 2018 Jan;218(1):1-18. doi: 10.1016/j.
ajog.2017.10.231. Available here. 
8.	
Oddie S., Tuffnell D. J., McGuire W. Antenatal magnesium sulfate: Neuro-protection for preterm infants. Archives of Disease in Childhood - Fetal and Neonatal Edition 2015; 100: 
F553-F557. Available here.
9.	
McCall EM, Alderdice F, Vohara S, et al. Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database of Systematic Reviews 2018, 
Issue 2. Available here.
36.9
49.1
60.6
68.5
73.5
0
20
40
60
80
100
Percentage
2017
2018
2019
2020
2021
2022
2023
2024
Year
National proportion
National proportion missing
Pre-NNAP measurement
Pre-NNAP measurement
*From 2022, the measure was changed to include babies born at 32 and 33 weeks gestational age, therefore 
data relating to these babies may not have been completed and quality assured prior to this point. 
10
National Neonatal Audit Programme Summary report on 2024 data

Figure 6: Proportion of babies born at less than 34 weeks GA with normal temperature on 
admission, 2017-2024, using 2024 data, definitions and methodology*.
10.	 Pettinger, K. et al, (2025) Hitting the target and missing the point with shortened courses of antenatal steroids: An observational study. Neonatal Society Summer Meeting. 
19 June 2025; London. Available here.
11.	 Pettinger KJ, Spencer R, Oddie SJ. Perinatal medicine’s best treatment: how should we be using antenatal steroids? Archives of Disease in Childhood - Fetal and Neonatal Edition 
2025;110:245-246. Available here.  
12.	 NHS England. PReCePT – using magnesium sulphate to reduce cerebral palsy in pre-term babies. 20 June 2023. Available here.   
13.	 NHS Wales Executive. PERIPrem Cymru for professionals. Available here. 
64.5
66.5
68.4
68.3
69.6
71.2
75
77.6
0
20
40
60
80
100
Percentage
2017
2018
2019
2020
2021
2022
2023
2024
Year
National proportion
National proportion missing
*From 2023, this measure was changed to include babies born at 32 and 33 weeks gestational age, therefore 
data relating to these babies may not have been completed and quality assured prior to this point. 
There has been a small reduction in the overall proportion 
of eligible mothers receiving a full course of antenatal 
steroids within one week prior to delivery (2024 – 51.8%, 
5,867 of 11,321; 2023 - 53%) (extended analysis report). 
However, there is evidence that shortened courses (less 
than 24 hours) are common.10 Antenatal steroid courses 
with a short duration do not have additional benefit 
over standard length courses and may cause harm.11 
It is important to ensure that NNAP measurement of 
antenatal steroid usage does not inadvertently encourage 
sub-optimal delivery of this treatment.
Broadly, delivery of antenatal magnesium sulphate 
is relatively unchanged in recent years (2024 – 86.7%, 
3,291 of 3,795; 2023 – 85.2%; 2022 – 85.5%) following the 
introduction in 2018 of the PReCePT programme12 in 
England, and in 2020, PERIPrem Cymru13 in Wales. 
Three neonatal networks are meeting the NNAP 
developmental standard of 90% (extended analysis 
report).
Despite a small increase in the overall proportion of 
extremely preterm babies born in a centre with a 
NICU this year, performance has remained relatively 
unchanged since 2020 (2024 – 80.7%, 1,549 of 1,920; 
2020 – 79.7%) (extended analysis report). Regional 
National
recommendation: 
As recommended in the NNAP Summary 
Report on 2023 Data:
3.	 Neonatal Networks should ensure that their 
constituent units are using the NNAP restricted 
access dashboard to regularly review their rates 
of optimal perinatal care delivery, identifying 
instances of non-adherence, and implementing 
quality improvement activities in response 
to them.
variation does exist, with network rates ranging from 
71% to 91.3%; only four networks are meeting the NNAP 
developmental standard of 85% (extended analysis 
report). The network variation observed reflects both 
population geography and network management of 
patient flows.
11
National Neonatal Audit Programme Summary report on 2024 data

Parental partnership in care
Communication and decision making
94.6% (53,817 of 56,864) of families have a consultation 
with a senior member of the neonatal team within 
24 hours of admission. This is a small drop since 2023 
(95.1%), coinciding with this measure no longer being 
subject to the outlier management process (extended 
analysis report). However, network variation remains low; 
all neonatal networks achieve this for over 92% of baby 
admissions (NNAP Online, extended analysis report).
The audit has been measuring parental inclusion on 
daily consultant ward rounds since 2017, and it is now 
widely accepted that parents should be included in 
these key decision-making discussions. Initially reporting 
on whether a parent was involved in the ward round 
at least once during their baby’s stay, the NNAP now 
looks at whether this happened on each day of a baby’s 
stay. Overall, a parent is involved in the ward round for 
36% of baby care days (277,943 of 772,337). There is wide 
variation in how well this is achieved geographically, 
from 25.2% to 58.2% between neonatal networks (NNAP 
Online, extended analysis report).
Changes to the way these data are recorded in clinical 
systems make it difficult to compare data over time, 
and to effectively interpret the impact of missing data, 
and therefore the NNAP recommends caution when 
comparing and interpreting results. Feedback to 
the audit from some users has indicated that parent 
partnership could be measured in ways which take 
better into account other opportunities for parents’ 
inclusion. The NNAP is committed to exploring what 
parent partnership in care means to parents and 
families, and how this could be better measured in the 
future.

Breastmilk feeding
There is an encouraging increase in the proportion of 
babies receiving breastmilk in their first two days of 
life, from 52.4% in 2022, to 66.8% (8,586 of 12,847) in 2024, 
with minimal missing data (0.7% in 2024) (extended 
analysis report). Opportunities do however exist for 
improvement; there is striking unit level variation, from 
38.4% to 91.6% across NICUs, and 21.4% to 100% across all 
levels of neonatal unit (Figure 7). 
Overall, high rates of any breastmilk feeding are being 
achieved at 14 days, and this rate has been sustained 
over the last 5 years (2019 – 78.4%; 2024 – 80.8%, 9,371 
of 11,601). Breastmilk feeding rates decrease to 65.8% 
at discharge home, although this represents an 
improvement from 59.5% in 2017 (extended analysis 
report).
Geographical variation exists between networks in the 
rates of feeding with any mother’s milk at day 14 (from 
72.7% to 89.6%), which widens further by discharge 
home (50.1% and 84.6%). Evidence shows that the higher 
the proportion of breastmilk consumption during 
the neonatal stay, the better the odds of continued 
breastfeeding14,15. Rates of exclusive breastmilk feeding at 
day 14 range from 43.6% to 59.5% across networks, while 
rates of exclusive breastmilk feeding at discharge range 
from 29.9% to 47.2% (extended analysis report). 
4
14.	 Valentine, G. et al. (2021) Percent mother’s own milk feedings for preterm neonates predicts discharge feeding outcomes. Journal of Perinatology, 41(12), 2766–2773. Avaliable here.
15.	 Levene, I., et al. (2024). The relationship of early expressed milk quantity and later full breastmilk feeding after very preterm birth: A cohort study. Maternal & Child Nutrition. 
Avaliable here. 
Figure 7: Proportions of any breastmilk feeding in the first two days of life, by neonatal unit 
(2024).
0
20
40
60
80
100
Breastmilk by day 2 (%)
0
178
Rank of neonatal unit
NICU
LNU
SCU
National average (66.8%)
developmental standard (60%)
12
National Neonatal Audit Programme Summary report on 2024 data

Medical follow up at two years of age 
The rate of improvement in the delivery of medical follow-up at two years of age has been slow, from 69.9% 
in 2018 to 77.9% (3,029 of 3,890) in 2024, and regional variation remains, from 67.7% to 85.8% (NNAP Online, 
extended analysis report). However, there is clear evidence of some regional and local good practice – 41 units 
are achieving the NNAP developmental standard that says that at least 90% of babies should have two-year 
follow up data entered (NNAP Online, extended analysis report). 
The NNAP will now consider and consult on reporting rates of survival without severe disability for centres 
following up over 90% of their babies, which may support improvements in follow-up delivery in other centres.
National recommendation:
4.	 Neonatal networks and local maternity and neonatal systems should ask their constituent 
units with below average rates of breastmilk feeding by day 2 to:
a.	 investigate reasons for variation in uptake locally, and 
b.	 with families, co-design targeted, quality improvement programmes.
Since the publication of new ROP screening 
guidance in March 2022, there has been a clear 
increase in the proportion of eligible babies 
receiving on time screening in line with the new 
recommendations; from 66.4% in 2022 to 80% 
(5,377 of 6,725) in 2024 (extended analysis report). 
This important screening needs to be delivered 
within a precise time window by highly specialised 
staff, and this challenge has been increasingly met 
by the neonatal community.
Luna having her first cuddle 
and skin-to-skin with dad, 
Mike Smith, whilst on CPAP. 
We were given bonding 
hearts on the unit to use 
so that our scent could be 
transferred and comfort Luna 
when we were away from 
her. Luna is now an amazing 
two year old and our miracle. 
Photos courtesy 
of Rosanna Smith
There is an overall trend towards improving 
compliance with nurse staffing levels over time, 
from 62.5% in 2017 to 81.5% (101,921 shifts of 124,981) 
in 2024, with evidence of a recovery following the 
aftermath of the COVID pandemic (2020 – 79.3%, 
2021 – 74.1%, 2022 – 72.3%, see extended analysis 
report). However local and regional variation 
remains; from 66.3% to 91.1% between networks 
(extended analysis report). 
Neonatal nurse staffing
6
On-time screening for 
retinopathy of prematurity (ROP)
5
13
National Neonatal Audit Programme Summary report on 2024 data

Equity in neonatal care 
process delivery by ethnicity
This year, for the first time, the NNAP has also 
undertaken analysis of data for areas where differences 
in the delivery of important neonatal care interventions 
according to ethnicity have been demonstrated.16  
More detailed results are available on NNAP Online 
and the NNAP Dashboard. The results presented are 
not adjusted for differences in case mix, because the 
unadjusted results are those which need to be actioned.
Robust reporting of equity in neonatal care relies 
on accurate and complete reporting of patient 
demographics. The NNAP is driving improvements 
in completeness of demographic data through its 
dashboard. Among babies born in 2024 and admitted 
to a neonatal unit, 11.4% had missing ethnicity (8.5% of 
babies born at less than 34 weeks gestational age), after 
using baby’s ethnicity if a mother’s ethnicity was not 
recorded. 
Optimal perinatal care
•	
Nationally, a lower proportion of babies of Black 
mothers received deferred cord clamping (68.5%, 
755 of 1,102) than White (74.1%, 5,927 of 8,002), Asian 
(75.5%, 1,594 of 2,112) and mothers classified as Mixed/
Other (70.2%, 458 of 652) (extended analysis report).
•	
Nationally, a lower proportion of babies with Black 
mothers had a normal temperature on admission 
(73%, 818 of 1,120), than White (78.1%, 6,302 of 8,072), 
Asian (77.5%, 1,649 of 2,129), and mothers grouped as 
Mixed/Other (76.3%, 505 of 662) (extended analysis 
report).
•	
A lower proportion of babies with White mothers 
were born in a centre with a NICU (77.8%, 755 of 971), 
when compared to Black (82.9%, 213 of 257), Asian 
(82.6%, 327 of 396) and Mixed/Other (83.2%, 99 of 119) 
(extended analysis report).
Parent partnership in care
•	
Parental consultation within 24 hours took place 
for a lower proportion of admissions when the 
mother was Black (93.7%, 3,886 of 4,147) Asian 
(94.2%, 7,783 of 8,261) or grouped as Mixed/Other 
(93.8%, 2,343 of 2,498) than for White mothers 
(95%, 34,656 of 36,483) (extended analysis report). 
7
16.	 Pettinger, K. et al, (2024) Does neonatal care delivery vary by deprivation and ethnicity: a retrospective cohort study. Neonatal Society Spring Meeting. 13 March 2025; London. 
Available here. 
•	
Parental inclusion on the consultant ward round 
took place for a lower proportion of baby care days 
when the mother was Asian (29.3%, 38,083 of 129,969 
baby care days), Black (34.7%, 23,743 of 68,423 baby 
care days), or Mixed or other ethnic background 
(33.6%, 12,989 of 38,651 baby care days) than for White 
mothers (37.9%, 178,111 of 469,391 baby care days) 
(extended analysis report).
•	
Use of breastmilk amongst preterm babies varies 
by ethnicity. A lower proportion of babies born to 
Black and Asian mothers (62.2%, 680 of 1,093; and 
65.5%, 1,370 of 2,091 respectively) received any of their 
mother’s milk in their first 2 days of life than babies 
born to White mothers (67.5%, 5,367 of 7,949) and 
those grouped as Mixed/Other (70.9%, 464 of 654) 
(extended analysis report). 
•	
Conversely, breastmilk feeding was established and 
sustained through the neonatal stay for a higher 
proportion of babies born to Black mothers (day 14 – 
88.9%, 876 of 985; discharge – 82.3%, 795 of 966), than 
for babies born to White mothers (day 14 – 77.4%, 
5,581 of 7,213; discharge – 59.8%, 4,335 of 7,249), Asian 
mothers (day 14 – 86.8%, 1,652 of 1,903; discharge – 
73.1%, 1,362 of 1,863), and mothers grouped as Mixed/
Other (day 14 – 84.9%, 507 of 597; discharge – 74.4%, 
451 of 606) (extended analysis report). This suggests 
there may be opportunities to improve the equity 
of early support provided to women of minoritised 
ethnicity.
National 
recommendation:
5.	 Neonatal networks and local maternity and 
neonatal systems should work with the perinatal 
teams in their constituent neonatal units to:
a.	 ensure that staff receive appropriate and 
consistent training to confidently ask families 
about their ethnicity and that of their baby, and to 
accurately record demographic information,
b.	 use the NNAP dashboard to review how well 
NNAP process measures are delivered locally, and 
whether this differs by ethnicity
c.	 where differences exist, seek to understand the 
underlying causes, and 
d.	  with families, co-design quality improvement 
programme that directly address those causes. 
14
National Neonatal Audit Programme Summary report on 2024 data

Royal College of Paediatrics 
and Child Health
5-11 Theobalds Road, 
London, WC1X 8SH
© 2025 Healthcare Quality Improvement Partnership (HQIP)
Royal College of Paediatrics and Child Health. Incorporated by Royal Charter and registered as a Charity in England 
and Wales: 1057744 and in Scotland: SCO38299. Registered Office 5-11 Theobalds Road, London WC1X 8SH. 
Patron HRH The Princess Royal. 
The National Neonatal Audit Programme is commissioned 
by the Healthcare Quality Improvement Partnership (HQIP) 
and funded by NHS England and the Governments of 
Wales, Scotland and the Isle of Man as part of the 
National Clinical Audit and Patient Outcomes Programme.
Royal College of 
Paediatrics and Child Health
RCPCH
A guide to the
National Neonatal 
Audit Programme 
Summary report
on 2024 data