British Association Of Perinatal Medicine Research Articles

Perinatal optimisation for periviable birth and outcomes: a 4-year network analysis (2018-2021) across a change in national guidance.

The British Association of Perinatal Medicine (BAPM) released their revised framework for extremely preterm infant management in 2019. This revised framework promotes consideration of perinatal optimisation and survival-focused care from 22 weeks gestation onwards. This was a departure from the previous BAPM framework which recommended comfort care as the only recommended management for infants <23 + 0 weeks. Our study evaluates the clinical impact that this updated framework has had across the Northwest of England. We utilised anonymised network data from periviable infants delivered across the region to examine changes in perinatal optimisation practices and survival outcomes following the release of the latest BAPM framework. Our data show that after the introduction of the updated framework there has been an increase in perinatal optimisation practices for periviable infants and an 80% increase in the number of infants born at 22 weeks receiving survival-focused care and admission to a neonatal unit. There remain significant discrepancies in optimisation practices by gestational age, which may be contributing to the static survival rates that were observed in the lowest gestational ages.

Risk assessment of survival and morbidity of infants born at

BackgroundInfants born at the threshold of viability have a high risk of mortality and morbidity. The British Association of Perinatal Medicine (BAPM) provided updated guidance in 2019 advising a risk-based approach to balancing decisions about active versus redirected care at birth. AimsTo determine survival and morbidity of infants born between 22 and 24 completed weeks of gestation. To develop a scoring system to categorise infants at birth according to risk for mortality or severe adverse outcome. MethodsA retrospective, single centre observational study of infants who received neonatal care from 2011 to 2021. Data were collected on mortality, morbidity and two-year neurodevelopmental outcomes. Each infant was risk categorised utilising the proposed tools in the BAPM (2019) framework. A composite adverse score for either dying or surviving with severe impairment was created. ResultsFour infants born at 22 weeks, 49 at 23 weeks and 105 at 24 weeks of gestation were included. The mortality rate was 23.4 %. Following risk categorisation there were 8 (5.1 %) extremely high risk, 44 (27.8 %) high risk and 106 (67.1 %) moderate risk infants. The rate of dying or surviving with severe impairment for extremely high risk, high risk and moderate risk were 100 %, 88.9 % and 53 % respectively. The proportions with the composite adverse outcome differed significantly according to the risk category (p < 0.001). ConclusionsWhen applying a scoring system to risk categorise infants at birth, high rates of dying or surviving with severe impairment were found in infants born at 22 or 23 weeks of gestation.

Diagnosis and Management of Neonatal Hypoglycemia: A Comprehensive Review of Guidelines.

Hypoglycemia represents one of the most frequent metabolic disturbances of the neonate, associated with increased morbidity and mortality, especially if left untreated or diagnosed after the establishment of brain damage. The aim of this study was to review and compare the recommendations from the most recently published influential guidelines on the diagnosis, screening, prevention and management of this common neonatal complication. Therefore, a descriptive review of the guidelines from the American Academy of Pediatrics (AAP), the British Association of Perinatal Medicine (BAPM), the European Foundation for the Care of the Newborn Infants (EFCNI), the Queensland Clinical Guidelines-Australia (AUS), the Canadian Pediatric Society (CPS) and the Pediatric Endocrine Society (PES) on neonatal hypoglycemia was carried out. There is a consensus among the reviewed guidelines on the risk factors, the clinical signs and symptoms of NH, and the main preventive strategies. Additionally, the importance of early recognition of at-risk infants, timely identification of NH and prompt initiation of treatment in optimizing the outcomes of hypoglycemic neonates are universally highlighted. All medical societies, except PES, recommend screening for NH in asymptomatic high-risk and symptomatic newborn infants, but they do not provide consistent screening approaches. Moreover, the reviewed guidelines point out that the diagnosis of NH should be confirmed by laboratory methods of BGL measurement, although treatment should not be delayed until the results become available. The definition of NH lacks uniformity and it is generally agreed that a single BG value cannot accurately define this clinical entity. Therefore, all medical societies support the use of operational thresholds for the management of NH, although discrepancies exist regarding the recommended cut-off values, the optimal treatment and surveillance strategies of both symptomatic and asymptomatic hypoglycemic neonates as well as the treatment targets. Over the past several decades, ΝH has remained an issue of keen debate as it is a preventable cause of brain injury and neurodevelopmental impairment; however, there is no clear definition or consistent treatment policies. Thus, the establishment of specific diagnostic criteria and uniform protocols for the management of this common biochemical disorder is of paramount importance as it will hopefully allow for the early identification of infants at risk, the establishment of efficient preventive measures, the optimal treatment in the first hours of a neonate's life and, subsequently, the improvement of neonatal outcomes.

Strategies for airway management in neonates : Results of asurvey of German perinatal centers levelsII andIII

Airway management in children, especially in patients with adifficult airway, remains amajor challenge for anesthesiologists, pediatricians, and emergency medicine physicians. In recent years new tools have been introduced into the clinical practice. The aim was to present the current strategies for securing the airway in neonates in perinatal centers levelsII andIII in Germany, and to collect data on the rare event of coniotomy. From 5April 2021 to 15 June 2021, physicians practicing intensive care in pediatrics and neonatology at perinatal centers levels II and III in Germany were surveyed by means of an anonymized online questionnaire. The questionnaire was designed by the authors and verified by pretesting with the help of five pediatric specialists. Contact was made digitally via the e‑mail addresses provided on the websites of the respective centers. The survey was administered through the fee for service provider LimeSurvey©. The collected data were transferred to the IBM© statistical package for the social scientists (SPSS, version28, IBM© Corporation, Armonk, NY, USA) and statistically analyzed. Pearson's χ2-test was used to perform significance testing (significance level p = < 0.05). Only completed questionnaires were included in the analysis. A total of 219participants completed the questionnaire. Available airway devices: 94.5% (n = 207) nasopharyngeal tubes, 79.9% (n = 175) video laryngoscope/fiber optic, 73.1% (n = 160) laryngeal masks, 64.8% (n = 142) oropharyngeal tube (Guedel). Of the participants 6 (2.7%) performed coniotomy (⌀1.6children). Out of six cases five (83.3%) were resuscitation situations caused by complex anatomical malformations. Training of coniotomy was not provided in 98.6% (n = 216). AStandard Operating Procedure (SOP) for difficult airway in neonates was possessed by 20.1% (n = 44). The comparison with international studies showed that the equipment of German perinatal centers is above average. The trend towards acquisition of avideo laryngoscope and its importance in clinical routine could be confirmed by our data; however, the fact that 20% of the respondents did not have access to video laryngoscopy suggests that further acquisitions will have to be made here in the future. Front of neck access (FONA) methods remain acritically questioned component of neonatal difficult airway algorithms due to their rarity and the resulting lack of data. In summary of the recommendations of the British Association of Perinatal Medicine (BAPM) and the collected data on the theoretical and practical education of the FONA methods in Germany, the implementation of the FONA methods by pediatricians and neonatologists cannot be recommended. As most resuscitation situations were caused by complex anatomical malformations, the early detection of such malformations by means of high-resolution ultrasound seems to be of particular importance. With improvement of early detection, neonates with potentially unmanageable airway problems can be left on uteroplacental circulation for aprolonged period in order to perform necessary interventions, such as tracheostomy, bronchoscopy, or extracorporeal membrane oxygenation (ECMO) device known as the ex utero intrapartum treatment (EXIT) procedure.

Understanding the current and future usage of donor human milk in hospitals: An online survey of UK neonatal units.

The use of donor human milk (DHM) where there is a shortfall of maternal milk can benefit both infant and maternal outcomes but DHM supply is not always assured. This study aimed to understand current DHM usage in UK neonatal units and potential future demand to inform service planning. An online survey was disseminated to all UK neonatal units using Smart Survey or by telephone between February and April 2022 after development alongside neonatal unit teams. Surveys were completed by 55.4% of units (108/195) from all 13 Operational Delivery Networks. Only four units reported not using DHM, and another two units only if infants are transferred on DHM feeds. There was marked diversity in DHM implementation and usage and unit protocols varied greatly. Five of six units with their own milk bank had needed to source milk from an external milk bank in the last year. Ninety units (84.9%) considered DHM was sometimes (n = 35) or always (n = 55) supportive of maternal breastfeeding, and three units (2.9%) responded that DHM was rarely supportive of breastfeeding. Usage was predicted to increase by 37 units (34.9%), and this drive was principally a result of parental preference, clinical trials and improved evidence. These findings support the assumption that UK hospital DHM demand will increase after updated recommendations from the World Health Organization (WHO) and the British Association of Perinatal Medicine. These data will assist service delivery planning, underpinned by an ongoing programme of implementation science and training development, to ensure future equity of access to DHM nationally.

Variability of neonatal premedication practices for endotracheal intubation and LISA in the UK (NeoPRINT survey)

ObjectiveThe NeoPRINT Survey was designed to assess premedication practices throughout UK NHS Trusts for both neonatal endotracheal intubation and less invasive surfactant administration (LISA). DesignAn online survey consisting of multiple choice and open answer questions covering preferences of premedication for endotracheal intubation and LISA was distributed over a 67-day period. Responses were then analysed using STATA IC 16.0. SettingOnline survey distributed to all UK Neonatal Units (NNUs). ParticipantsThe survey evaluated premedication practices for endotracheal intubation and LISA in neonates requiring these procedures. Main outcome measuresThe use of different premedication categories as well as individual medications within each category was analysed to create a picture of typical clinical practice across the UK. ResultsThe response rate for the survey was 40.8 % (78/191). Premedication was used in all hospitals for endotracheal intubation but overall, 50 % (39/78) of the units that have responded, use premedications for LISA. Individual clinician preference had an impact on premedication practices within each NNU. ConclusionThe wide variability on first-line premedication for endotracheal intubation noted in this survey could be overcome using best available evidence through consensus guidance driven by organisations such as British Association of Perinatal |Medicine (BAPM). Secondly, the divisive view around LISA premedication practices noted in this survey requires an answer through a randomised controlled trial.

Parents and healthcare professionals' attitudes to Kangaroo Care for preterm infants in the United Kingdom.

To explore the attitudes of parents and healthcare professionals (HCPs), and facilitators and barrier to implementation of Kangaroo Care (KC) in the United Kingdom. Online cross-sectional survey; distributed via the British Association of Perinatal Medicine, Bliss (UK-based charity), social media. Sixty HCPs responded. 37 (62%) were nurses/nurse practitioners. 57 (95%) regularly implement KC. The most important factor that supported KC implementation was the team's belief in benefits of KC. Increased workload, staff shortage and fear about safely of KC in unwell infants were recognised as the challenges preventing implementation. Five hundred eighteen parents responded. 421 (81%) had a preterm baby within 3 years. 338 (80%) were familiar with KC. The main facilitator was the belief that their baby enjoyed it. Excess noise and crowding on the unit were the most frequently reported barriers. Lack of opportunity and limited staff support were the main reasons why they had been unable to practice KC. We found that most HCPs and parents believe that KC is beneficial and would like to practice it. Lack of resources to enable effective implementation is the main barrier. Service development and implementation research is required to ensure that KC is delivered in all UK neonatal units.

Assessing risks at 22-24 weeks gestation.

The recent British Association of Perinatal Medicine (BAPM) guidance published in 2019 suggested for the first time that we can consider resuscitation of extremely premature infants (EPI) at 22-24 weeks gestational age (GA) on a case-by-case basis in the UK. This has sent waves throughout UK neonatal units, and we believe this arises because we're now confronted with challenging decisions about whether a foetus under 24 weeks will be viable or not, and whether it's in their best interests to provide 'survival-focused' care (SFC) or 'comfort-focused' care (CFC). Despite a robust framework introduced by BAPM, we believe uncertainty still remains.

Data-driven approach to understanding neonatal palliative care needs in England and Wales: a population-based study 2015–2020

ObjectiveTo quantify admissions to neonatal units in England and Wales with potential need for palliative care.Design, setting and patientsDiagnoses and clinical attributes indicating a high likelihood of requiring palliative care...

National priority setting partnership using a Delphi consensus process to develop neonatal research questions suitable for practice-changing randomised trials in the United Kingdom

IntroductionMethodologically robust clinical trials are required to improve neonatal care and reduce unwanted variations in practice. Previous neonatal research prioritisation processes have identified important research themes rather than specific research...

Individualised decision making: interpretation of risk for extremely preterm infants—a survey of UK neonatal professionals

BackgroundThe British Association of Perinatal Medicine (BAPM) published a revised framework for perinatal management of extremely preterm infants (EPIs) in 2019. We aimed to assess UK neonatal professionals’ interpretation of...

Peter Dunn: coined the term “perinatal medicine”

Peter Dunn was a big man with an immense presence who contributed massively to the better care of newborn babies. When he qualified, 40 of every 1000 babies born alive...

Managing parental stress during COVID-19: experiences from the neonatal unit

British Journal of Healthcare ManagementVol. 27, No. 2 EditorialManaging parental stress during COVID-19: experiences from the neonatal unitJennifer Fuerte AlmalbisJennifer Fuerte AlmalbisCorrespondence to: Jennifer Fuerte Almalbis; E-mail Address: [email protected]Search for more papers by this authorJennifer Fuerte AlmalbisPublished Online:8 Feb 2021https://doi.org/10.12968/bjhc.2020.0177AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Association of Perinatal Medicine. BAPM-COVID-19: frequently asked questions within the neonatal services. 2020. https://www.rcpch.ac.uk/resources/bapm-covid-19-frequently-asked-questions-within-neonatal-services (accessed 8 January 2021) Google ScholarBliss. Statistics about neonatal care. 2016. https://www.bliss.org.uk/research-campaigns/neonatal-care-statistics (accessed 8 January 2021) Google ScholarMarch of Dimes. Coping with Stress in the NICU. 2017. https://www.marchofdimes.org/complications/coping-with-stress-in-the-nicu.aspx (accessed 8 January 2021) Google ScholarLudviggson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088–1095. https://doi.org/10.1111/apa.15270 Crossref, Google ScholarMuniraman H, Ali M, Cawley P et al.. Parental perceptions of the impact of neonatal unit visitation policies during COVID-19 pandemic. BMJ Paediatr Open. 2020;4(1):1–8. https://doi.org/10.1136/bmjpo-2020-000899 Crossref, Google ScholarUNICEF UK Baby Friendly Initiative. Guide to the UNICEF UK baby friendly initiative standards for children's hospital settings. 2019. https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2020/11/Unicef-UK-Baby-Friendly-Initiative-Guide-to-Childrens-Hospital-Settings-Standards.pdf Google Scholar FiguresReferencesRelatedDetails 2 February 2021Volume 27Issue 2ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 8 February 2021 Published in print 2 February 2021 Information© MA Healthcare LimitedPDF download

A Mini-Review of the BAPM Framework for Practice – Perinatal Management of Extreme Preterm Birth before 27 Weeks of Gestation

The recent publication of a new framework for practice from the British Association of Perinatal Medicine has altered the management of babies born in the UK at the threshold of viability. A risk stratification is used to determine which infants will receive active management, and which receive palliative management. This is achieved through a combination of assessment of risk factors and discussion with parents. The most notable feature of the new framework is the recommendation to consider babies of 22 weeks gestation for active care. This has been the subject of much discussion amongst neonatal and obstetric teams. The framework also emphasises the importance of early transfer to a maternity unit with a co-located neonatal intensive care unit if active management is pursued. This new guidance has led to a change in the way the management of extreme prematurity is approached, and will continue to impact on neonatal, obstetric, and anaesthetic care.

Feasibility of using an Early Warning Score for preterm or low birthweight infants in a low-resource setting: results of a mixed-methods study at a national referral hospital in Kenya

IntroductionFifteen million babies are born prematurely, before 37 weeks gestational age, globally. More than 80% of these are in sub-Saharan Africa and Asia. 35% of all deaths in the first...

P36 Numeta G13% preterm neonatal parenteral nutrition solution – a licensed all-in-one triple chamber, ready to use and terminally sterilised parenteral nutrition for preterm newborn infants

AimsWe aim to evaluate the efficacy and safety of Numeta G13%E preterm neonatal parenteral nutrition (PN) in our neonatal population.In September 2017 a National Patient Safety Alert (NPSA) highlighted the risk of harm to babies when lipid was mistakenly run at the rate intended for the aqueous component resulting in significant lipid overdose.Although we have worked to implement many of the alert’s recommendations, we feel we can avoid this risk further by using an all-in-one PN solution.1Numeta meets current nutritional guidelines as per British Association of Perinatal Medicine (BAPM) but this project allows comparison of outcomes important to both patient and service between those achieved with our current regimen and those with the all-in-one regimen.2MethodsWe carried out a quality improvement project from April 2018 to April 2019. We collected data from 330 babies in our neonatal unit during six months before (154 babies) and after (176 babies) the adoption of the all-in-one solution.Our previous PN regimen consisted of a ‘menu’ of aqueous bags (starter, maintenance, ‘light’ and bespoke) and a separate lipid solution. All of them were suitable for peripheral or central administration. Numeta came with similar choices: starter, maintenance -for central administration only- and ‘lite’ and Numeta peripheral, suitable for peripheral administration. Bespoke bags were also available if clinically indicated. We set out our desired outcomes and measured parameters accordingly:Patient outcomesMetabolic stability: electrolyte, glucose, bilirubin and lipid measurements summarised by the need to change from standard PN regimen and/or requirement for insulin.Fluid balance summarised by the lowest weight during the first two weeks of life and time taken to regain birth weight.Growth summarised by change of standard deviation score of weight and head circumference between birth and discharge or transfer back to local hospital.Liver tolerance of lipid solutions summarised by incidence of cholestasis (&gt;25 μmol/l conjugated fraction of serum bilirubin)Days and type of PNSepsisService outcomesNursing time taken to prepare PNCostWastageAccess to productResultsAlthough we finished collecting the data in April 2019, we are still in the process of analysing it and evaluating the final results. There have been no cases of lipid overdose and our neonates (including the preterm ones) have so far tolerated well the new parenteral nutrition solution. Average nursing time preparing Numeta went down from 18.5 minutes to 8 minutes and comparison of cost came in favour of Numeta. PN wastage was higher with Numeta (4.7% Maintenance, 10% ‘light’, peripheral 50%) especially in the first month during the transition phase. There was no significant increase of bespoke bags when Numeta was introduced.ConclusionsIn summary, so far we have not identified significant clinical differences between the first six months of the project -using our old standardised nutrition regimen- and the last months -on the new all-in-one solution. We have continued with Numeta preterm solution on the basis of assumed safety.ReferencesRisk of severe harm and death from infusing total parenteral nutrition too rapidly in babies. NHS improvement patient safety alert September 2017.The Provision of Parenteral Nutrition within Neonatal Services – A Framework for Practice. British Association of Perinatal Medicine (BAPM) April 2016 www.bapm.org

P17 Introducing concentrated preterm stock parenteral nutrition and the impact on bespoke compounding

BackgroundIt is widely recommended that stock parenteral nutrition (PN) bags are used where possible to reduce the risks associated with bespoke PN compounding.1 A review was undertaken within a level three neonatal unit which identified that a large proportion of compounded bags were made due to the need to provide full nutrition in a smaller volume. A preterm concentrated aqueous PN bag was developed which, when run with stock lipid syringes, meets the nutritional requirements of preterm babies in a total volume of 100 ml/kg/day.2AimThe aim of this work is to evaluate the impact of the introduction of a preterm concentrated stock bag on the need for bespoke PN in preterm babies.MethodThe new concentrated PN bag was transitioned into use from November 2017. Data regarding the number of preterm patients admitted and the type of PN they received was collected from January to October 2017, (Group A), this was then repeated for all preterm patients admitted from August 2018 to May 19, (Group B), after the preterm concentrated bag was fully introduced. Preterm babies were classified as babies that were born &lt; 34 weeks gestation as the concentrated bag was formulated with these patients in mind.ResultsGroup A, (n=143), had 1045 bags supplied over the collection period. 47% of the PN bags supplied were bespoke PN bags, largely due to the need to provide PN in a smaller volume than the 130 ml/kg/day that the preterm stock bags available at that time. Group B, (n=118), had a total of 965 bags supplied, 16% of these bags were bespoke PN. The reasons behind requiring bespoke bags included the need for manganese free bags, requiring a reduction in glucose and a high electrolyte requirement in patients especially those with stomas. This has resulted in an overall reduction in spend on preterm PN of 34% and a reduction in compounded PN spend of 69%.ConclusionThis work has highlighted several benefits of introducing preterm concentrated PN bags. Firstly having concentrated preterm stock bags available on the ward has meant that a larger proportion of babies are maintained on stock PN without recourse to compounded PN. Secondly this has preserved the compounding capacity of our technical services unit so when a patient requires a bespoke bag that facility is available. Also, capacity for the compounding service has been preserved across the hospital minimising the need to outsource compounding. Finally the neonatal unit has seen a reduction in overall PN costs in this patient group. The introduction of this bag has been instrumental in reducing the need to outsource PN bags to commercial compounding units during periods of high demand, meeting national recommendations on the management of aseptic compounding capacity.3ReferencesA Report from the Paediatric Chief Pharmacists Group: Improving Practice and Reducing Risk in the Provision of Parenteral Nutrition for Neonates and Children. November 2011.British Association of Perinatal Medicine. The Provision of Parenteral Nutrition within Neonatal Services - A Framework for Practice. April 2016.Specialist Pharmacy Service/NHS England. National Pharmaceutical Supply Group (NPSG) Communication: Making best use of restricted aseptic compounding capacity. September 2018.

CARE FOR NEWBORNS FROM MOTHERS WITH SUSPECTED OR CONFIRMED COVID-19

Since the onset of the COVID-19 outbreak, numerous publications have highlighted the features of this infection in adults, but epidemiological and clinical data on neonates remain conflicting and fragmentary. At the same time, with the significant and rapid increase in the number of infected persons in European countries, the proportion of pregnant women and children with COVID-19 is also increasing, requiring health professionals to know the general principles and specific actions needed to prevent, diagnose and treat potential infections in newborn babies.This publication represents guidancefor the care of newborns from mothers with suspected or confirmed COVID-19 of the Royal College of Pediatrics and Child Health, developed with the participation of the British Association of Perinatal Medicine. Due to the immaturity of the immune system and the possibility of vertical or aerosol transmission of the infection from the mother, newborns are particularly vulnerable to SARS-CoV-2. Obstetric and neonatology departments need to work closely together and have integrated approaches to providing care to relevant categories of patients. In particular, neonatal intensive care units should develop emergency plans that objectively take into account the epidemiological situation in the region and health care facilities, the availability of staff, equipment, personal protective equipment, and not only provide effective prevention, isolation, diagnosis and treatment of relevant cases, but aimed at the meeting of the psychosocial needs of families and health care professionals. The presented recommendations include, in particular, information aboutadmission of pregnant women and mothers with suspected or confirmed COVID-19, carefor infants after birth, during rooming-in and in specialized neonatal units, use of personal protective equipment, transportation of infants, requirements for testing and isolation of newborns, rules for parents and visitors, breastfeeding, newborn screening, neonatal discharge, follow up, etc.

Correction.

AnaesthesiaVolume 74, Issue 3 p. 393-393 CorrectionFree Access Correction This article corrects the following: Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC-NIC survey H. Mactier, A. Jackson, J. Davis, G. Menon, C. J. Morley, C. C. Roehr, R. J. Tinnion, , Volume 74Issue 1Anaesthesia pages: 116-117 First Published online: December 4, 2018 First published: 28 December 2018 https://doi.org/10.1111/anae.14576AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL In the letter by Mactier et al. 1, the affiliation for the authors is incorrect. It should be the British Association of Perinatal Medicine. Reference 1Mactier H, Jackson A, Davis J, et al. Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC-NIC survey. Anaesthesia 2019; 74: 116– 17. Volume74, Issue3March 2019Pages 393-393 ReferencesRelatedInformation

Evidence suggests that kangaroo mother care improves premature infant outcomes.

The British Association of Perinatal Medicine ( 2016 ) has reported that 60,000-70,000 infants a year require neonatal intervention in the UK, or about 10% of all babies born in England. The World Health Organization ( 2015 ) found a 0% decrease in mortality rates in neonatal units worldwide through the adoption of KMC.