Five health board regions in Scotland have been rated 'red' for neonatal mortality rates in the latest national audit, which also highlights a steep increase in the Grampian region.
The annual UK-wide evaluation known as MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries) uses a traffic light system to rate NHS trusts and health boards as green, yellow, amber or red based on how their infant mortality or stillbirth rates compare against areas with similar numbers of births or specialist services, such as a neonatal intensive care unit (NICU) and neonatal surgery.
Regions are red-flagged if their death rates are more than 5% higher than the UK average for their group.
Neonatal mortality are deaths within the first 28 days of life.
READ MORE:
- ANALYSIS: Maternal death rates in the UK are up 50 per cent - what's going on?
- SPECIAL REPORT: Changing birth trends, from home deliveries to rising C sections
- A £.6.6m recruitment drive begins to restore consultant-led care to Moray
In 2022, five health boards in Scotland - Grampian, Lothian, Western Isles, Lanarkshire, and Borders - were 'red' for neonatal mortality once "congenital abnormalities", also known as birth defects, were excluded as a cause of death.
This is up from one in both 2020 and 2021, and is the highest at any point since 2017.
Congenital anomalies - which occur during unborn babies development in the womb and are mostly not preventable - account for around 33% of deaths among newborn babies.
The most common causes after birth defects are extreme prematurity, neurological problems, cardio-respiratory complications, and infections.
Of the five health boards, NHS Grampian - one of only three regions in Scotland with a Level 3 NICU and neonatal surgery - had the highest neonatal mortality rate once congenital abnormalities were excluded, at 1.94 deaths per 1000 live births, 24% higher than the group average.
In Lothian - also rated red and with a Level 3 NICU and neonatal surgery - the mortality rate was 1.8 per 1000, while in Greater Glasgow and Clyde, the third area with a Level 3 NICU and neonatal surgery, the mortality rate was 'green' at 1.3 per 1000 live births.
Green means the mortality rate is more than 15% lower than the UK group average.
As well as grouping health boards and trusts into categories based on the numbers and complexity of infants in their care, the MBRRACE report also adjusts for factors such as maternal age and deprivation and infants' sex, ethnicity, gestational age, and whether the births were singleton, twin or multiple.
In this way, variations in risk are ironed out so that areas can be fairly compared.
The report shows that the neonatal mortality rate in Grampian has gone from green in 2018 to yellow in 2019 then amber in both 2020 and 2021 before a sharp year-on-year increase to red.
Over that five-year period, the mortality rate almost doubled, from 1.05 to 1.94, despite a decline in the number of births from 6,055 to a low of 5,033.
Broken down by postcode, neonatal mortality rates were highest for mothers resident in the Aberdeen City area, followed by Moray where there has been ongoing controversy over the downgrading of maternity services at Dr Gray's hospital in Elgin in July 2018.
Since then, mothers at higher risk of labour complications have had to travel to Aberdeen or Inverness to give birth, and the neonatal mortality rate among mothers resident in Moray has crept up by 22%.
The Scottish Government has pledged £6.6 million to fully restore consultant-led obstetric care at Dr Gray's by the end of 2026, with elective caesarean births due to re-start in early 2025.
Marj Adams, from the Keep MUM campaign group which has lobbied to restore Moray's maternity services, said the figures for Grampian were "depressing".
She added: "We would never ever say that the downgrade of the 2018 has caused this without a lot more information, because it’s so difficult to establish cause and effect.
"But it’s important that NHS Grampian carry out analysis of these figures to see if there’s any common factor, and share their findings with the general public, because to have the highest neonatal mortality rate in Scotland is extremely worrying for the citizens of Grampian.”
A spokesman for NHS Grampian said that mortality rates will "fluctuate" from year to year and had fallen back below average in 2023, though this has not yet been analysed by MBRACCE.
Hugh Bishop, integrated family portfolio director at NHS Grampian, said: “Firstly, our thoughts and condolences are with each and every family affected by the tragedy of the death of their newborn baby.
"We have thoroughly reviewed the findings of the report and worked with colleagues to look again at the detailed circumstances of each case - which account for around 0.32% of births in Grampian in 2022.
“This process, which is ongoing, has included the external review of cases."
READ MORE:
- Beyond reasonable doubt? Statistics, confessions, and the campaign to free Lucy Letby
- 80 tenants seek personal injury damages for black mould after toddler's death
- 'I thought I'd lost my mind': Why long Covid changed this GP's outlook on medicine
Overall, the report shows that Scotland had the lowest neonatal mortality rate of any of the UK nations in 2022, at 1.59 per 1000 births compared to 2.29 in Northern Ireland, 1.91 in Wales, and 1.67 in England.
UK-wide, the difference in neonatal mortality between the least and most deprived areas is widening, with newborns in the most deprived areas now twice as likely to die.
It comes months after witnesses giving evidence to a Fatal Accident Inquiry into the deaths of three babies in Lanarkshire between 2019 and 2021 blamed a series of errors during pregnancy and delivery.
The determination is expected before the end of the year.
The Scottish Government previously commissioned an independent review to examine an unusual spike in neonatal deaths in Scotland between April 2021 and March 2022.
The review, published in February, did not identify any "new or unusual" cause for the increase or evidence of "systemic failures of maternity or neonatal care" across Scotland or in any single health board, but noted that a rise in babies being born prematurely - including a higher than expected number of twin and triplet births - appeared to have contributed.
However, the review, led by retired consultant neonatologist Dr Helen Mactier, did criticise "significant variation" in the quality of neonatal death investigations carried out by different health boards.
The Scottish Government said it is working with the NHS to implement the recommendations of the review.
A spokeswoman added: “MBRRACE reports give us valuable insight into national and local rates of stillbirth and neonatal mortality.
"Their evidence has contributed to the continuing overall decline in the extended perinatal mortality rate in Scotland from a rate of 5.43 in 2013 to 4.9 in 2022.
“We expect all health boards to carefully consider MBRRACE reports and undertake local reviews of services rated ‘red’ for stillbirth or neonatal death, and ensure that when deaths occur, any improvements are identified and acted on.”
Why are you making commenting on The Herald only available to subscribers?
It should have been a safe space for informed debate, somewhere for readers to discuss issues around the biggest stories of the day, but all too often the below the line comments on most websites have become bogged down by off-topic discussions and abuse.
heraldscotland.com is tackling this problem by allowing only subscribers to comment.
We are doing this to improve the experience for our loyal readers and we believe it will reduce the ability of trolls and troublemakers, who occasionally find their way onto our site, to abuse our journalists and readers. We also hope it will help the comments section fulfil its promise as a part of Scotland's conversation with itself.
We are lucky at The Herald. We are read by an informed, educated readership who can add their knowledge and insights to our stories.
That is invaluable.
We are making the subscriber-only change to support our valued readers, who tell us they don't want the site cluttered up with irrelevant comments, untruths and abuse.
In the past, the journalist’s job was to collect and distribute information to the audience. Technology means that readers can shape a discussion. We look forward to hearing from you on heraldscotland.com
Comments & Moderation
Readers’ comments: You are personally liable for the content of any comments you upload to this website, so please act responsibly. We do not pre-moderate or monitor readers’ comments appearing on our websites, but we do post-moderate in response to complaints we receive or otherwise when a potential problem comes to our attention. You can make a complaint by using the ‘report this post’ link . We may then apply our discretion under the user terms to amend or delete comments.
Post moderation is undertaken full-time 9am-6pm on weekdays, and on a part-time basis outwith those hours.
Read the rules hereLast Updated:
Report this comment Cancel