National Collaboration on Audit of Excessive Weight Loss in the first three weeks of life

The Hospital Infant Feeding Network is coordinating NHS Trusts in the UK to perform a simple audit of excessive weight loss in the first three weeks of life before and after the onset of the Covid-19 pandemic, so that this data can be compared and used for benchmarking. Try and submit data by 31st May 2021 - but we understand the further peak in Covid-19 admissions may interfere with this. These are the guidelines for each local audit (download a printable version here):
 
  • Should cover one entire NHS Trust, including all locations where babies in the first three weeks of life might be admitted to hospital. This is likely to include postnatal wards, neonatal units and paediatric wards. You are likely to need a multidisciplinary audit team to ensure you understand admissions to these different locations and how best to identify them
  • Covers two separate periods of time: the six month period from September 1st 2019 to February 29th 2020 (pre-pandemic) and the six month period from April 1st 2020 to September 30th 2020 (pandemic). If this is too much for your Trust, you can choose to submit only the pre-pandemic time period
  • Seeks to identify all babies (born at 34 weeks gestation or more) assessed and/or treated in a hospital setting because of excessive weight loss of 12.5% or more in the first three weeks of life. If this is too much for your Trust, you can choose to submit only babies with weight loss of 15% or more in the first three weeks of life.
  • Seeks to identify all babies (born at 34 weeks gestation or more) with a plasma sodium level of 155mmol/l or more in the first three weeks of life.
 

Planning the local audit

  • Depending on your IT systems you may identify babies to include by using admission or discharge codes - these should be widely defined to ensure you don’t miss babies with problems related to excessive weight loss such as jaundice. Examples of Badgernet and Maternity codes are given below. However if you cannot use codes or you suspect that cases would be missed by using codes then please extract all babies assessed in a hospital setting in the first three weeks of life
  • Once you have a list of babies to assess for inclusion in the audit you will need to decide whether they fit the audit criteria:
    1. Born at 34 weeks gestation or more AND
    2. Assessed in or admitted to a hospital setting AND
    3. Within the first 21 days of life AND
    4. In the correct time period (defined above) AND
    5. EITHER has weight loss of 12.5% or more relative to their birthweight OR has plasma sodium level of 155mmol/l or more (babies may have both of these)
  • Exclude babies with a congenital anomaly (such as cleft palate, cardiac condition) that was identified before day 3 of life
  • You must go through all relevant local governance protocols to register your audit and inform the governance team that you will be sharing anonymised aggregate statistics with the Hospital Infant Feeding Network for benchmarking. Individual trusts will not be identified in any publication or public setting apart from in acknowledgement of their hard work in collecting data.
 
When your data collection is ready to submit please enter it using this link. We will also ask you some questions about how your Trust assesses and manages excessive weight loss pre and post pandemic - you can see all the questions here but make sure to enter your data with the link above.
 
Before you submit data on the online form, please ensure you can answer the following 7 questions:
 
How many babies are born within the care of your NHS trust in a six month period (include any babies who would be seen within your NHS trust hospital/s for concerns about excessive weight loss, for example this might include home births and standalone midwife led units). This can be an approximate number
 
In the six month period 1/9/19 to 29/2/20 how many babies (born at 34 weeks gestation or more) were assessed or treated in a hospital setting in the first three weeks of life with weight loss of 12.5% or more of their birthweight? (optional)
 
In the six month period 1/9/19 to 29/2/20 how many babies (born at 34 weeks gestation or more) were assessed or treated in a hospital setting in the first three weeks of life with weight loss of 15% or more of their birthweight? (mandatory)
 
In the six month period 1/9/19 to 29/2/20 how many babies (born at 34 weeks gestation or more) in the first three weeks of life had a plasma sodium value of 155 mmol/l or higher? (mandatory)
 
In the six month period 1/4/20 to 30/9/20 how many babies (born at 34 weeks gestation or more) were assessed or treated in a hospital setting in the first three weeks of life with weight loss of 12.5% or more of their birthweight? (optional)
 
In the six month period 1/4/20 to 30/9/20 how many babies (born at 34 weeks gestation or more) were assessed or treated in a hospital setting in the first three weeks of life with weight loss of 15% or more of their birthweight? (optional)
 
In the six month period 1/4/20 to 30/9/20 how many babies (born at 34 weeks gestation or more) in the first three weeks of life had a plasma sodium value of 155 mmol/l or higher? (optional)

 

Example Codes

Badgernet (neonatal unit admissions):

'hypernatraemia'
'hypernatraemic dehydration'
'dehydration'
'dehydration of newborn'
'feeding problem newborn: lactation problem'
'feeding problem newborn: tongue tie'
'feeding problems (breast fed)'
'poor feeding - newborn'
'slow feeding'
'underfeeding of newborn'
'poor weight gain (postnatal)'
'weight loss'
'weight loss - 12 percent or more'
'suppressed lactation (insufficient milk supply)'
 

Maternity codes

‘abnormal weight loss’
‘hyperosmolality and hypernatraemia’
‘feeding problem of newborn, unspecified’
‘other feeding problems of newborn’
‘neonatal jaundice, unspecified’
‘neonatal jaundice from other specified causes’