Quality improvement or target-driven care? Reduced neonatal hypoglycaemia admissions but with long-term neurodevelopmental uncertainty

There remains much controversy and limited evidence base for the definition of neonatal hypoglycaemia, and in this context, we read with interest the article ‘Term neonatal admissions for hypoglycaemia in England and Wales, 2012–2020: a population-based study…’, which reports a reduction in term admissions for hypoglycaemia following publication of the British Association of Perinatal Medicine (BAPM) framework.1 This report reflects an important contribution to national efforts to reduce unnecessary intervention and parent-infant separation and it clearly demonstrates a service-level change over time.2 However, interpretation of these findings requires consideration of the wider policy and commissioning context, in which the BAPM framework was introduced. In particular, this framework was introduced alongside a much larger NHS-led quality-improvement and commissioning programme: Avoiding Term Admissions into Neonatal Units (ATAIN).3 Neither provided information about or recommendations to monitor longer-term potential benefits and harms.