OPTI-PREM: Optimising neonatal service provision for preterm babies born between 27 and 31 weeks of gestation in England using national data, qualitative research and economic analysis

Logo for the OPTI-PREM study

Date: April 2017 – March 2020

Funder: NIHR Health Services & Delivery Research



Care given early in a baby’s life is very important for that baby’s later health and development. Because babies’ brains and bodies are still developing at this time, early birth puts them at increased risk of later problems with health and development. Three types of units provide neonatal care (that is, care for new-born babies) in England: Neonatal Intensive Care Units (NICUs); Local Neonatal Units (LNUs); and Special Care Baby Units (SCBUs). Place of care has been demonstrated to impact outcomes for babies born at 23-26 weeks, but there is a paucity of research data on whether the same is true for babies born at 27-31 weeks.

Project aims

The project aims to assess whether care in a NICU (Neonatal Intensive Care Unit) or care in a LNU (Local Neonatal Unit) results in better outcomes for babies born at 27-31 weeks. Current practice for this group makes no distinction between care delivered in LNUs and NICUs; the decision on where individual babies are born is based on maternal choice at booking, presentation to the nearest hospital, and cot capacity at delivery. However these units differ in terms of facilities, staffing, and skill mix for the care of preterm babies, with NICUs providing the very highest level of care. The data generated by the project will be used to make recommendations to guide doctors and to shape delivery of care for preterm babies.


The research project

OPTI-PREM’s primary objective is to assess for preterm babies born at 27-31 weeks and admitted to a neonatal unit, whether care in a NICU vs LNU impacts on survival and other key morbidities (to 1 year), at each gestational age in weeks. This will be achieved through statistical analysis of routinely collected data from the National Neonatal Research Database (NNRD),Hospital Episode statistics (HES) and Office for National Statistics (ONS).

The project’s secondary objectives are to assess: (i) whether key differences in clinical care exist between LNUs and NICUs, and whether these are associated with gestation-specific differences in outcomes; (ii) where it is most cost –effective to provide care, and (iii) parents’ and clinicians' perspectives on place of care, and how these can guide clinical decision making.

SAPPHIRE researchers, led by Natalie Armstrong, will conduct an ethnographic study with patients and clinicians. Observations and interviews will be used to explore: factors parents think do and should guide decision making about place of care and how it happens in practice; clinicians’ perspectives and practices around decision making on place of care; the impacts on parents and families of these decisions and subsequent change in care location; and how parents can best be supported at this time. Researchers will study up to 20 “real-time” cases in which the baby is currently receiving neonatal care, and up to 20 “retrospective” cases in which the baby has since been discharged. The findings of all project streams will be used to develop recommendations, in collaboration with national bodies, to inform clinical practice, commissioning, and policy making.


Research team

Thillagavathie Pillay (Royal Wolverhampton Hospitals NHS Trust), Elaine Boyle (University of Leicester), Elizabeth Draper (University of Leicester), Brad Manktelow (University of Leicester), Sarah Seaton (University of Leicester), Natalie Armstrong, (University of Leicester) , Oliver Revero-Arias (NPEU, Oxford), Neena Modi (Imperial College London), Michelle Greenaway.


Find out more about the study on the project webpage.

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