Limited comparability of classifications of levels of neonatal care in UK units

AIM—To assess whether different classifications ofneonatal care or dependency scales are comparable when used inmulticentre studies of cost effectiveness.
METHODS—A survey of classifications was used in anationally representative group of 57 units in 1990-1, with aretrospective study of 10 354 cot days using patient records from a 5%random sample of 1042 admissions. Local and national classificationswere correlated with medical and nursing procedures recorded for up to26 days after each admission.
RESULTS—Classifications varied substantially. Ofthe 57 units in our sample, 26 used one of two nationalclassifications, sometimes modified; 17 used the Northern NeonatalNetwork dependency scale; and the other 14 did not record daily levelsof care. In each classification, the highest level was havingrespiratory support by ventilation or continuous distending pressurethrough an endotracheal tube, nasal prongs, facemask or negativepressure device. This level of care was consistently comparable betweenclassifications; lower levels were not.
CONCLUSIONS—Retrospective comparisonsbetween units with different classifications can only reliablydifferentiate between days with and without respiratory support. Thereis a pressing need to develop and validate more appropriate scales forprospective multicentre studies. These should relate activity to costsand outcome.