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Journal articleBeltempo M, Isayama T, Vento M, et al., 2018,
Respiratory Management of Extremely Preterm Infants: An International Survey
, NEONATOLOGY, Vol: 114, Pages: 28-36, ISSN: 1661-7800- Author Web Link
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- Citations: 49
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Journal articleHelenius K, Sjors G, Shah PS, et al., 2017,
Survival in Very Preterm Infants: An International Comparison of 10 National Neonatal Networks
, Pediatrics, Vol: 140, ISSN: 0031-4005OBJECTIVES: To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks.METHODS: A cohort study of very preterm infants, born between 24 and 29 weeks’ gestation and weighing <1500 g, admitted to participating neonatal units between 2007 and 2013 in the International Network for Evaluating Outcomes of Neonates. Survival was compared by using standardized ratios (SRs) comparing survival in each network to the survival estimate of the whole population.RESULTS: Network populations differed with respect to rates of cesarean birth, exposure to antenatal steroids and birth in nontertiary hospitals. Network SRs for survival were highest in Japan (SR: 1.10; 99% confidence interval: 1.08–1.13) and lowest in Spain (SR: 0.88; 99% confidence interval: 0.85–0.90). The overall survival differed from 78% to 93% among networks, the difference being highest at 24 weeks’ gestation (range 35%–84%). Survival rates increased and differences between networks diminished with increasing gestational age (GA) (range 92%–98% at 29 weeks’ gestation); yet, relative differences in survival followed a similar pattern at all GAs. The median age at death varied from 4 days to 13 days across networks.CONCLUSIONS: The network ranking of survival rates for very preterm infants remained largely unchanged as GA increased; however, survival rates showed marked variations at lower GAs. The median age at death also varied among networks. These findings warrant further assessment of the representativeness of the study populations, organization of perinatal services, national guidelines, philosophy of care at extreme GAs, and resources used for decision-making.
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Journal articleTann CJ, Martinello KA, Sadoo S, et al., 2017,
Neonatal Encephalopathy With Group B Streptococcal Disease Worldwide: Systematic Review, Investigator Group Datasets, and Meta-analysis
, Clinical Infectious Diseases, Vol: 65, Pages: S173-S189, ISSN: 1058-4838BackgroundNeonatal encephalopathy (NE) is a leading cause of child mortality and longer-term impairment. Infection can sensitize the newborn brain to injury; however, the role of group B streptococcal (GBS) disease has not been reviewed. This paper is the ninth in an 11-article series estimating the burden of GBS disease; here we aim to assess the proportion of GBS in NE cases.MethodsWe conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups reporting GBS-associated NE. Meta-analyses estimated the proportion of GBS disease in NE and mortality risk. UK population-level data estimated the incidence of GBS-associated NE.ResultsFour published and 25 unpublished datasets were identified from 13 countries (N = 10436). The proportion of NE associated with GBS was 0.58% (95% confidence interval [CI], 0.18%–.98%). Mortality was significantly increased in GBS-associated NE vs NE alone (risk ratio, 2.07 [95% CI, 1.47–2.91]). This equates to a UK incidence of GBS-associated NE of 0.019 per 1000 live births.ConclusionsThe consistent increased proportion of GBS disease in NE and significant increased risk of mortality provides evidence that GBS infection contributes to NE. Increased information regarding this and other organisms is important to inform interventions, especially in low- and middle-resource contexts.
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Journal articleParkinson JRC, Wijeyesekera A, Hyde MJ, et al., 2017,
Early preterm nutrition and the urinary metabolome in young adult life; follow-up of a randomised controlled trial
, BMJ Paediatrics Open, Vol: 1, ISSN: 2399-9772Objective We aimed to test the hypothesis that early diet programmes the metabolic profile of young adults born preterm.Design We analysed banked urine samples obtained at a 20-year follow-up visit from adults that had participated as neonates in controlled trials involving randomisation within 48 hours of birth to feeds of preterm formula (PTF), banked breast milk (BBM) or term formula (TF) for 1 month postnatally.Main outcome measures We performed proton nuclear magnetic resonance spectroscopy, analysing spectra by dietary group and sex. Orthogonal projections to latent structure discriminant analyses was used to model class differences and identify metabolites contributing to the differences between groups. Additionally, spectra were correlated with birth weight, gestational age and weight z score at 2 weeks of age.Results Of the original number of 926 trial participants, urine samples were available from 197 (21%) healthy young adults (42% men) born preterm (mean 30.7±2.8 weeks) and randomised to BBM (n=55; 28 men), TF (n=48; 14 men) and PTF (n=93; 40 men). We found no significant differences in urinary spectra between dietary groups including when stratified by sex. Correlation analysis revealed a weak association between metabolic profile and gestational age that was lost on controlling for ethanol excretion.Conclusions We found no evidence that dietary exposures in the neonatal period influence the metabolic phenotype in young adult life.
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Journal articleGale C, Statnikov Y, Jawad S, et al., 2017,
Neonatal brain injuries in England: population-based incidence derived from routinely recorded clinical data held in the National Neonatal Research Database
, Archives of Disease in Childhood. Fetal and Neonatal Edition, Vol: 103, Pages: F301-F306, ISSN: 1359-2998In 2015, the Department of Health in England announced an ambition to reduce 'brain injuries occurring during or soon after birth'. We describe the development of a pragmatic case definition and present annual incidence rates.Retrospective cohort study using data held in the National Neonatal Research Database (NNRD) extracted from neonatal electronic patient records from all National Health Service (NHS) neonatal units in England, Wales and Scotland. In 2010-2011, population coverage in the NNRD was incomplete, hence rate estimates are presented as a range; from 2012, population coverage is complete, and rates (95% CIs) are presented. Rates are per 1000 live births.NHS neonatal units in England.Infants admitted for neonatal care; denominator: live births in England.'Brain injuries occurring at or soon after birth' defined as infants with seizures, hypoxic-ischaemic encephalopathy, stroke, intracranial haemorrhage, central nervous system infection and kernicterus and preterm infants with cystic periventricular leucomalacia.In 2010, the lower estimate of the rate of 'Brain injuries occurring at or soon after birth' in England was 4.53 and the upper estimate was 5.19; in 2015, the rate was 5.14 (4.97, 5.32). For preterm infants, the population incidence in 2015 was 25.88 (24.51, 27.33) and 3.47 (3.33, 3.62) for term infants. Hypoxic-ischaemic encephalopathy was the largest contributor to term brain injury, and intraventricular/periventricular haemorrhage was the largest contributor to preterm brain injury.Annual incidence rates for brain injuries can be estimated from data held in the NNRD; rates for individual conditions are consistent with published rates. Routinely recorded clinical data can be used for national surveillance, offering efficiencies over traditional approaches.
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Journal articleGale CRK, Modi N, 2017,
Towards greater efficiency in neonatal clinical research
, Lancet Child and Adolescent Health, Vol: 1, Pages: 169-170, ISSN: 2352-4642 -
Journal articleSanthakumaran S, Gray D, Statnikov Y, et al., 2017,
Survival of very preterm infants admitted to neonatal care in England 2008-2014: time trends and regional variation
, Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 103, Pages: F208--F215, ISSN: 1468-2052ObjectiveTo analyse survival trends and regional variation for very preterm infants admitted to neonatal care.SettingAll neonatal units in EnglandPatientsInfants born at 22+0-31+6 weeks+days gestational age (GA) over 2008-2014 and admitted to neonatal care; published data for admitted infants 22+0-25+6 weeks+days GA in 1995 and 2006, and for live births at 22+0-31+6 weeks+days GA in 2013.MethodsWe obtained data from the National Neonatal Research Database (NNRD). We used logistic regression to model survival probability with birth-weight, GA, sex, antenatal steroid exposure, and multiple birth included in the risk-adjustment model, and calculated Average Percentage Change (APC) for trends using joinpoint regression. We evaluated survival over a 20-year period for infants <26 weeks GA using additional published data from the EPICure studies.ResultsWe identified 50,112 eligible infants. There was an increase in survival over 2008-2014 (2008 88.0%, 2014 91.3%; adjusted APC 0.46% (95% Confidence Interval 0.30 to 0.62) p<0.001). The greatest improvement was at 22+0-23+6 weeks (APC 6.03% (2.47 to 3.53) p=0.002). Improvement largely occurred in London and South of England (APC: London 1.26% (0.60 to 1.96); South of England 1.09% (0.36 to 1.82); Midlands and East of England 0.15%(-0.56 to 0.86); North of England 0.26% (-0.54 to 1.07)). Survival at the earliest gestations improved at a similar rate over 1995-2014 (22+0-25+6 weeks, APC 2.73% (2.35 to 3.12) p-value for change=0.25). ConclusionsContinued national improvement in the survival of very preterm admissions masks important regional variation. Timely assessment of preterm survival is feasible using electronic records.
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Journal articleDuffy JMN, Hirsch M, Gale CRK, et al., 2017,
A systematic review of primary outcomes and outcome measure reporting in randomized trials evaluating treatments for pre-eclampsia
, International Journal of Gynecology and Obstetrics, Vol: 139, Pages: 262-267, ISSN: 0020-7292BackgroundAn evaluation of outcome reporting is required to develop a core outcome set.ObjectivesTo assess primary outcomes and outcome measure reporting in pre-eclampsia trials.Search strategyFive online databases were searched from inception to January 2016 using terms including “preeclampsia” and “randomized controlled trial”.Selection criteriaRandomized controlled trials evaluating treatments for pre-eclampsia published in any language were included.Data collection and analysisPrimary outcomes and data on outcome measure reporting were systematically extracted and categorized.Main resultsOverall, 79 randomized trials including data from 31 615 women were included. Of those, 38 (48%) reported 35 different primary outcomes; 28 were maternal outcomes and seven were fetal/neonatal outcomes. Three randomized trials reported composite outcomes, incorporating between six and nine outcome components. The method of definition or measurement was infrequently or poorly reported. Even when outcomes were consistent across trials, different methods of definition or measurement were frequently described.ConclusionsIn randomized trials evaluating interventions for pre-eclampsia, critical information related to the primary outcome, including definition and measurement, is regularly omitted. Developing a core outcome set for pre-eclampsia trials would help to inform primary outcome selection and outcome measure reporting.
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Journal articleModi N, Ellis J, Marsh M, 2017,
The UK Royal College of Paediatrics and Child Health's Policy on Funding From Commercial Organizations
, JAMA PEDIATRICS, Vol: 171, Pages: 1016-1017, ISSN: 2168-6203 -
Journal articleAdams GGW, Williams C, Modi N, et al., 2017,
Can we reduce the burden of the current UK guidelines for retinopathy of prematurity screening?
, EYE, Vol: 32, Pages: 235-237, ISSN: 0950-222X
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