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Journal articleStatnikov Y, Ibrahim B, Modi N, 2017,
A systematic review of administrative and clinical databases of infants admitted to neonatal units
, Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 102, Pages: F270-F276, ISSN: 1468-2052Objectives:High quality information, increasingly captured in clinical databases, is a useful resource for evaluating and improving newborn care. We conducted a systematic review to identify neonatal databases, and define their characteristics. MethodsWe followed a preregistered protocol using MesH terms to search MEDLINE, EMBASE, CINAHL, Web of Science and OVID Maternity and Infant Care Databases for articles identifying patient level databases covering more than one neonatal unit. Full-text articles were reviewed and information extracted on geographic coverage, criteria for inclusion, data source, and maternal and infant characteristics. ResultsWe identified 82 databases from 2,037 publications. Of the country specific databases there were 39 regional and 39 national. Sixty databases restricted entries to neonatal unit admissions by birth characteristic or insurance cover; 22 had no restrictions. Data were captured specifically for 53 databases; 21 administrative sources; 8 clinical sources. Two clinical databases hold the largest range of data on patient characteristics, USA’s Pediatrix BabySteps Clinical Data Warehouse and UK’s National Neonatal Research Database.Conclusion A number of neonatal databases exist that have potential to contribute to evaluating neonatal care. The majority are created by entering data specifically for the database, duplicating information likely already captured in other administrative and clinical patient records. This repetitive data entry represents an unnecessary burden in an environment where electronic patient records are increasingly used. Standardisation of data items is necessary to facilitate linkage within and between countries.
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Journal articleKelly LE, Shah PS, Hakansson S, et al., 2017,
Perinatal health services organization for preterm births: a multinational comparison
, JOURNAL OF PERINATOLOGY, Vol: 37, Pages: 762-768, ISSN: 0743-8346 -
Journal articleDarlow BA, Lui K, Kusuda S, et al., 2017,
International variations and trends in the treatment for retinopathy of prematurity
, BRITISH JOURNAL OF OPHTHALMOLOGY, Vol: 101, Pages: 1399-1404, ISSN: 0007-1161 -
Journal articleHines D, Modi N, Lee SK, et al., 2017,
Scoping review shows wide variation in the definitions of bronchopulmonary dysplasia in preterm infants and calls for a consensus
, ACTA PAEDIATRICA, Vol: 106, Pages: 366-374, ISSN: 0803-5253 -
Journal articleAchana F, Petrou S, Khan K, et al., 2017,
A methodological framework for assessing agreement between cost-effectiveness outcomes estimated using alternative sources of data on treatment costs and effects for trial-based economic evaluations.
, European Journal of Health Economics, Vol: 19, Pages: 75-86, ISSN: 1618-7601A new methodological framework for assessing agreement between cost-effectiveness endpoints generated using alternative sources of data on treatment costs and effects for trial-based economic evaluations is proposed. The framework can be used to validate cost-effectiveness endpoints generated from routine data sources when comparable data is available directly from trial case report forms or from another source. We illustrate application of the framework using data from a recent trial-based economic evaluation of the probiotic Bifidobacterium breve strain BBG administered to babies less than 31 weeks of gestation. Cost-effectiveness endpoints are compared using two sources of information; trial case report forms and data extracted from the National Neonatal Research Database (NNRD), a clinical database created through collaborative efforts of UK neonatal services. Focusing on mean incremental net benefits at £30,000 per episode of sepsis averted, the study revealed no evidence of discrepancy between the data sources (two-sided p values >0.4), low probability estimates of miscoverage (ranging from 0.039 to 0.060) and concordance correlation coefficients greater than 0.86. We conclude that the NNRD could potentially serve as a reliable source of data for future trial-based economic evaluations of neonatal interventions. We also discuss the potential implications of increasing opportunity to utilize routinely available data for the conduct of trial-based economic evaluations.
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Journal articleBattersby CWS, Longford N, Costeloe K, et al., 2017,
Development of a gestational age–specific case definition for neonatal necrotizing enterocolitis
, JAMA Pediatrics, Vol: 171, Pages: 256-263, ISSN: 2168-6211Importance Necrotizing enterocolitis (NEC) is a major cause of neonatal morbidity and mortality. Preventive and therapeutic research, surveillance, and quality improvement initiatives are hindered by variations in case definitions.Objective To develop a gestational age (GA)–specific case definition for NEC.Design, Setting, and Participants We conducted a prospective 34-month population study using clinician-recorded findings from the UK National Neonatal Research Database between December 2011 and September 2014 across all 163 neonatal units in England. We split study data into model development and validation data sets and categorized GA into groups (group 1, less than 26 weeks’ GA; group 2, 26 to less than 30 weeks’ GA; group 3, 30 to less than 37 weeks’ GA; group 4, 37 or more weeks’ GA). We entered GA, birth weight z score, and clinical and abdominal radiography findings as candidate variables in a logistic regression model, performed model fitting 1000 times, averaged the predictions, and used estimates from the fitted model to develop an ordinal NEC score and cut points to develop a dichotomous case definition based on the highest area under the receiver operating characteristic curves [AUCs] and positive predictive values [PPVs].Exposures Abdominal radiography performed to investigate clinical concerns.Main Outcomes and Measures Ordinal NEC likelihood score, dichotomous case definition, and GA-specific probability plots.Results Of the 3866 infants, the mean (SD) birth weight was 2049.1 (1941.7) g and mean (SD) GA was 32 (5) weeks; 2032 of 3663 (55.5%) were male. The total included 2978 infants (77.0%) without NEC and 888 (23.0%) with NEC. Infants with NEC in group 1 were less likely to present with pneumatosis (31.1% vs 47.2%; P = .01), blood in stool (11.8% vs 29.6%; P < .001), or mucus in stool (2.1% vs 5.6%; P = .048) but more likely to present with gasless abdominal radiograp
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Journal articleBattersby CWS, Longford N, Mandalia S, et al., 2016,
Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012-13: a whole-population surveillance study
, Lancet Gastroenterology and Hepatology, Vol: 2, Pages: 43-51, ISSN: 2468-1253BackgroundNecrotising enterocolitis is a neonatal gastrointestinal inflammatory disease with high mortality and severe morbidity. This disorder is growing in global relevance as birth rates and survival of babies with low gestational age improve. Population data are scant and pathogenesis is incompletely understood, but enteral feed exposures are believed to affect risk. We aimed to quantify the national incidence of severe necrotising enterocolitis, describe variation across neonatal networks, and investigate enteral feeding-related antecedents of severe necrotising enterocolitis.MethodsWe undertook a 2-year national surveillance study (the UK Neonatal Collaborative Necrotising Enterocolitis [UKNC-NEC] Study) of babies born in England to quantify the burden of severe or fatal necrotising enterocolitis confirmed by laparotomy, leading to death, or both. Data on all liveborn babies admitted to neonatal units between Jan 1, 2012, and Dec 31, 2013, were obtained from the National Neonatal Research Database. In the subgroup of babies born before a gestational age of 32 weeks, we did a propensity score analysis of the effect of feeding in the first 14 postnatal days with own mother’s milk, with or without human donor milk and avoidance of bovine-origin formula, or milk fortifier, on the risk of developing necrotising enterocolitis.FindingsDuring the study period, 118 073 babies were admitted to 163 neonatal units across 23 networks, of whom 14 678 were born before a gestational age of 32 weeks. Overall, 531 (0·4%) babies developed severe necrotising enterocolitis, of whom 247 (46·5%) died (139 after laparotomy). 462 (3·2%) of 14 678 babies born before a gestational age of 32 weeks developed severe necrotising enterocolitis, of whom 222 (48·1%) died. Among babies born before a gestational age of 32 weeks, the adjusted network incidence of necrotising enterocolitis ranged from 2·51% (95% CI 1·13–3·60) to 3·
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Conference paperBattersby C, Longford N, Costeloe K, et al., 2016,
The effect of early enteral feed exposures on severe necrotising enterocolitis in very preterm infants: a propensity score matched study
, EAPS Congress 2016, Publisher: Springer Verlag, Pages: 1558-1558, ISSN: 0340-6199 -
Journal articleSeaton SE, Barker L, Draper ES, et al., 2016,
Modelling Neonatal Care Pathways for Babies Born Preterm: An Application of Multistate Modelling
, PLoS ONE, Vol: 11, ISSN: 1932-6203Modelling length of stay in neonatal care is vital to inform service planning and the counsellingof parents. Preterm babies, at the highest risk of mortality, can have long stays in neonatalcare and require high resource use. Previous work has incorporated babies that dieinto length of stay estimates, but this still overlooks the levels of care required during theirstay. This work incorporates all babies, and the levels of care they require, into length ofstay estimates. Data were obtained from the National Neonatal Research Database for singletonbabies born at 24–31 weeks gestational age discharged from a neonatal unit inEngland from 2011 to 2014. A Cox multistate model, adjusted for gestational age, wasused to consider a baby’s two competing outcomes: death or discharge from neonatal care,whilst also considering the different levels of care required: intensive care; high dependencycare and special care. The probabilities of receiving each of the levels of care, orhaving died or been discharged from neonatal care are presented graphically overall andadjusted for gestational age. Stacked predicted probabilities produced for each week ofgestational age provide a useful tool for clinicians when counselling parents about length ofstay and for commissioners when considering allocation of resources. Multistate modellingprovides a useful method for describing the entire neonatal care pathway, where rates ofin-unit mortality can be high. For a healthcare service focussed on costs, it is important toconsider all babies that contribute towards workload, and the levels of care they require.
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Journal articleWong HS, Santhakumaran S, Cowan FM, et al., 2016,
Developmental Assessments in Preterm Children: A Meta-Analysis
, Pediatrics, Vol: 138, ISSN: 0031-4005CONTEXT: Developmental outcomes of very preterm (gestational age ≤32 weeks) or very low birth weight (<1500 g) children are commonly reported before age 3 years although the predictive validity for later outcomes are uncertain.OBJECTIVE: To determine the validity of early developmental assessments in predicting school-age cognitive deficits.DATA SOURCES: PubMed.STUDY SELECTION: English-language studies reporting at least 2 serial developmental/cognitive assessments on the same population, 1 between ages 1 and 3 years and 1 at ≥5 years.DATA EXTRACTION: For each study, we calculated the sensitivity, specificity, and positive and negative predictive values of early assessment for cognitive deficit (defined as test scores 1 SD below the population mean). Pooled meta-analytic sensitivity and specificity were estimated by using a hierarchical summary receiver operator characteristic curve.RESULTS: We included 24 studies (n = 3133 children). Early assessments were conducted at 18 to 40 months and generally involved the Bayley Scales of Infant Development or the Griffiths Mental Development Scales; 11 different cognitive tests were used at school-age assessments at 5 to 18 years. Positive predictive values ranged from 20.0% to 88.9%, and negative predictive vales ranged from 47.8% to 95.5%. The pooled sensitivity (95% confidence interval) of early assessment for identifying school-age cognitive deficit was 55.0% (45.7%–63.9%) and specificity was 84.1% (77.5%–89.1%). Gestational age, birth weight, age at assessment, and time between assessments did not explain between-study heterogeneity.LIMITATIONS: The accuracy of aggregated data could not be verified. Many assessment tools have been superseded by newer editions.CONCLUSIONS: Early developmental assessment has poor sensitivity but good specificity and negative predictive value for school-age cognitive deficit.
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