CRediT contribution statement
Thillagavathie Pillay (https://orcid.org/0000-0002-4159-3282): Project conceptualisation (lead), Funding acquisition (lead), Methodology (equal), Project administration (lead), Supervision (equal), Visualisation (lead), Writing – original draft (lead), Writing – reviewing and editing (lead).
Oliver Rivero-Arias (https://orcid.org/0000-0003-2233-6544): Conceptualisation (lead for WS3), Methodology (lead for WS3 and equal for WS1), Investigation (lead for WS3, equal for WS1), Supervision (lead for WS3 and equal for WS1), Writing – original draft (lead for WS3), Analysis (equal WS1, lead WS3), Writing – editing and reviewing (supporting for overall project), Data curation (equal WS1 and WS3, and equal for linkage to NHS Digital).
Natalie Armstrong (https://orcid.org/0000-0003-4046-0119): Conceptualisation (lead for WS4), Methodology (lead for WS4), Supervision (lead for WS4), Investigation (equal), Analysis (equal), Writing – original draft (lead for WS4), Data curation (lead WS4).
Sarah E Seaton (https://orcid.org/0000-0001-8711-4817): Conceptualisation (supporting WS1), Methodology (equal for WS1), Investigation (equal WS1), Analysis (equal for WS1), Writing – original draft (equal WS1), Writing – editing and reviewing (supporting overall project), Data curation (equal WS1).
Miaoqing Yang (https://orcid.org/0000-0001-7975-374X): Data curation WS1 (equal) and WS3 (lead), Investigation (supporting WS1 and WS3), Analysis (supporting WS1 and WS3), Writing – editing and reviewing supporting for WS1 and WS3 overall project.
Victor L Banda (https://orcid.org/0009-0000-5251-5055): Data curation (lead for data extraction, curation at NDAU and lead for travel time computation for the instrumental variable analysis) and Linkage to NHS Digital (equal).
Kelvin Dawson (https://orcid.org/0009-0002-0080-9283): Supervision (supporting), Validation of WS4 (supporting), Writing – editing and reviewing (supporting).
Abdul QT Ismail (https://orcid.org/0000-0003-4125-8684): Methodology (supporting WS2), Investigation (lead WS2), Analysis (lead WS2), Writing (lead WS2).
Vasiliki Bountziouka (https://orcid.org/0000-0003-2522-1582): Data curation (equal WS1), Investigation (supporting WS1), Analysis (supporting WS1), Writing (equal WS1), Writing – editing and reviewing (supporting WS1).
Alexis Paton (https://orcid.org/0000-0003-4310-6983): Investigation (supporting), Analysis (supporting), Writing – editing and reviewing (supporting WS4), Data curation (supporting).
Caroline Cupit (https://orcid.org/0000-0002-3377-8471): Investigation (supporting), Analysis (supporting), Writing – editing and reviewing (supporting WS4), Data curation (supporting).
Bradley N Manktelow (https://orcid.org/0000-0002-3264-0323): Conceptualisation (supporting), Methodology (equal WS1), Analysis (supporting WS1).
Elizabeth S Draper (https://orcid.org/0000-0001-9340-8176): Conceptualisation (supporting), Methodology (supporting), Writing – editing and reviewing (supporting).
Neena Modi (https://orcid.org/0000-0002-2093-0681): Conceptualisation (supporting), Methodology (supporting), Supervision (equal), Writing – editing and reviewing (supporting).
Helen E Campbell (https://orcid.org/0000-0003-2070-7794): Analysis (supporting WS3 and WS1), Writing (supporting WS1 and WS3).
Elaine M Boyle (https://orcid.org/0000-0002-5038-3148): Conceptualisation (supporting), Methodology (equal), Supervision (equal), Writing – editing and reviewing (supporting).
Mohammed Riaz: Data analysis (supporting WS1).
The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. All authors reviewed and contributed to the final version.
Acknowledgements
We wish to thank the NIHR HS&DR stream for funding this project.
Parents, babies and the OPTI-PREM parent panel (patient and public involvement)
We wish to thank all babies, their parents and families, who were cared for by neonatal units participating in this project, and all the NHS staff, maternity and neonatal services, and transport teams that took part in the care of mothers and their babies born very preterm during this project period.
We wish to thank Kelvin Dawson, Josie Anderson and Mehali Patel from BLISS national charity for babies born premature or sick, the parents that participated in qualitative interviews, and the OPTI-PREM parent panel for their contributions and guidance throughout this project.
The OPTI-PREM parent panel was led by initially by M Greenaway-Crissold (MG-C), then K Dawson. Initially MG-C, then KD participated in all study steering committee and OPTI-PREM collaborator meetings. K Dawson, M Irfan, M Patel, N Khabbah, A Ferris, C Shepard, M Anderson, L Alexander, J Jeffreys, R Murray, I Marie, L Flanagan, K Hodge, L Hamilton, M West, J Monoghan, K Lund, L Barker, K Micallef, A Eggington, S Marlow, G Lynch, M Greenaway-Crissold. These parents volunteered their time either face to face or virtually at different stages of the project.
Participating neonatal units, and stakeholders
We wish to thank all participating neonatal units, and their research and clinical staff for their contribution to OPTI-PREM. The participating neonatal units and their representative leads at the time of recruitment into OPTI-PREM are noted in Report Supplementary Material 9. We wish to thank all stakeholders for their time spent on reviewing our findings and their critical comments offered.
Specifically, we wish to thank BAPM, for supporting this work, through stakeholder engagement (Eleri Adams), and in the LNU representation that guided the initial discussions (Wendy Tyler, Sarah Bates, Steve Jones, John McIntyre).
Study steering committee
This was led by Andrew Ewer (Emeritus Professor, Neonatology) and included Stavros Petrou (Professor, Health Economics), Lisa Hinton (Dr, senior social scientist), Mehali Patel, then Josie Anderson (Ms, senior engagement officer, BLISS), David Laughton (Professor, Chief Executive, sponsor trust), Karen Luyt (Professor Neonatal Medicine), Gillian Santorelli (Dr, principal statistician).
Sponsor trust and research and development directorate
We wish to thank the sponsor trust, The Royal Wolverhampton NHS Trust, and its Research and Development Directorate: Professor James Cotton, Lorraine Jacques, Sarah Glover and Amy Bennett.
East Midlands and Birmingham RDS teams
We wish to thank these RDS for supporting the development of the project protocol.
The UK Neonatal Collaborative
We wish to thank all the neonatal units and their operational delivery networks, for participating in the study. The details of the participating UK Neonatal Collaborative are listed in Report Supplementary Material 9.
Patient data statement
This work uses data provided by patients and collected by the NHS as part of their care and support. Using patient data is vital to improve health and care for everyone. There is huge potential to make better use of information from people’s patient records, to understand more about disease, develop new treatments, monitor safety, and plan NHS services. Patient data should be kept safe and secure, to protect everyone’s privacy, and it’s important that there are safeguards to make sure that they are stored and used responsibly. Everyone should be able to find out about how patient data are used. #datasaveslives You can find out more about the background to this citation here: https://understandingpatientdata.org.uk/data-citation
Data-sharing statement
The National Neonatal Research Database can be accessed by making a request to the Neonatal Data Analysis Unit at Imperial College London, through the Health Data Research UK Gateway website. All requests for qualitative research data should be sent to the corresponding author.
Ethics statement
Patient consent for publication is not required. Research ethics approval for the OPTI-PREM programme of work was obtained through the national IRAS reference number 212304 and REC reference number 17/NE/0800; North East – Tyne and Wear South.
Dates of approvals were as follows:
- REC approval (17/NE/0080): 17 March 2017.
- Confidentiality Advisory Group (CAG) (19/CAG/0104) approval: 07 November 2019.
- Data Access Request Service (NHS Digital, DARS) (DARS-NIC-125031-Z3D7S-v0.13) Data-sharing framework contract signed 23 December 2020.
Information governance statement
The Royal Wolverhampton NHS Trust is committed to handling all personal information in line with the UK Data Protection Act (2018) and the General Data Protection Regulation (EU GDPR) 2016/679. The NNRD privacy notice, providing information to parents of babies admitted to NHS neonatal units can be found online150 and is General Data Protection Regulation compliant (National Neonatal Research Database/National Research Ethics Service Reference16/LO/1093/Privacy Notice/050618). Under the Data Protection legislation, The Royal Wolverhampton NHS Trust is the Data Controller, and you can find out more about how we handle personal data, including how to exercise your individual rights and the contact details for our Data Protection Officer here www.royalwolverhampton.nhs.uk/privacy-notice/our-services/trust-privacy-notice.html.
Disclosure of interests
Full disclosure of interests: Completed ICMJE forms for all authors, including all related interests, are available in the toolkit on the NIHR Journals Library report publication page at https://doi.org/10.3310/JYWC6538.
Primary conflicts of interest: Thillagavthie Pillay declared funding from the Leicester, Leicestershire and Rutland Clinical Commissioning Group for qualitative work on reducing risks for infant mortality, from Leicester Local Maternity and Neonatal Systems for qualitative research on perinatal dashboards in health inequalities, from De Montford University as visiting lecturer. She was a steering committee member Children’s HIV Association, and its national audit lead (2020–3).
Oliver Rivero-Arias is a member of the Fetal, Maternal and Child Health Reference Group, National Screening Committee.
Natalie Armstrong is supported by a Health Foundation Improvement Science Fellowship and by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands.
Sarah E Seaton is funded through an NIHR Advanced Fellowship and declared honorariums from The Lancet Child and Adolescent Health for expediated peer reviews. She is a member of the data monitoring and ethics committee for HENRY III (Health, Exercise, Nutrition for the Really Young – 2022 onwards) and is an independent member of PICnIC (Paediatric Intensive Care and Infection Control) Trial Steering Committee (a NIHR funded study).
Victor L Banda declared funding through Imperial College for attendances at OPTI-PREM related and HQIP (Healthcare Quality Improvement Partnership) meetings. He has been subcontracted for work with the University of Oxford, HQIP and University of Leeds.
Neena Modi is Director of the UK National Neonatal Research Database.
Protocol versions and major changes from original protocol
These are described in Report Supplementary Material 11.
Publication
Pillay T, Seaton SE, Yang M, Bountziouka V, Banda V, Campbell H, et al. Improving outcomes for very preterm babies in England: does place of birth matter? Findings from OPTI-PREM, a national cohort study. Arch Dis Child Fetal Neonatal Ed 2025:fetalneonatal-2024-327474. https://doi.org/10.1136/archdischild-2024-327474
Disclaimers
This article presents independent research funded by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care.