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  • Journal article
    Mann JP, Statnikov E, Modi N, Johnson N, Springett A, Morris JKet al., 2016,

    Management and outcomes of neonates with down syndrome admitted to neonatal units

    , Birth Defects Research Part A-Clinical and Molecular Teratology, Vol: 106, Pages: 468-474, ISSN: 1542-9768

    BackgroundStudies have reported that advanced maternal age is a risk factor for congenital heart disease (CHD), but none of these have been performed in the United Kingdom. Currently, women in the United Kingdom are not referred for specialist fetal echocardiography based on maternal age alone. The aim of this study is to examine the association between maternal age at delivery and CHD prevalence in the North of England.MethodsSingleton cases of CHD notified to the Northern Congenital Abnormality Survey and born between January 1, 1998, to December 31, 2013, were included. Cases with chromosomal anomalies were excluded. The relative risk (RR) of CHD according to maternal age at delivery was estimated using Poisson regression.ResultsThere were 4024 singleton cases of nonchromosomal CHD, giving a prevalence of 8.1 (95% confidence interval [CI], 7.8–8.3) per 1000 live and stillbirths. There was no association between maternal age at delivery and CHD prevalence (p = 0.97), with no evidence of an increased risk of CHD in mothers aged ≥35 compared to aged 25 to 29 (RR = 0.99; 95% CI, 0.89–1.09). There were no significant associations between maternal age at delivery and severity III CHD (p = 0.84), severity II CHD (p = 0.74), or severity I CHD (p = 0.66), although there was a slight increased risk of severity I CHD in mothers aged ≥35 (RR = 1.27; 95% CI, 0.83–1.95).ConclusionWe found little evidence that advanced maternal age is a risk factor for CHD. There is no evidence that women in the United Kingdom should be referred for specialist prenatal cardiac screening based on their age.
  • Journal article
    Shah PS, Lui K, Sjors G, Mirea L, Reichman B, Adams M, Modi N, Darlow BA, Kusuda S, Feliciano LS, Yang J, Hakansson S, Mori R, Bassler D, Figueras-Aloy J, Lee SKet al., 2016,

    Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates: An International Comparison

    , Journal of Pediatrics, Vol: 177, Pages: 144-152.e6, ISSN: 0022-3476

    ObjectiveTo compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes.Study designWe included 58 004 infants born weighing <1500 g at 240–316 weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses.ResultsDespite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons.ConclusionsWe identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify care practices and health care organizational factors, which has the potential to improve neonatal outcomes.
  • Journal article
    Martin LJ, Sjörs G, Reichman B, Darlow BA, Morisaki N, Modi N, Bassler D, Mirea L, Adams M, Kusuda S, Lui K, Feliciano LS, Håkansson S, Isayama T, Mori R, Vento M, Lee SK, Shah PSet al., 2016,

    Country-Specific vs. Common Birthweight-for-Gestational Age References to Identify Small for Gestational Age Infants Born at 24–28 weeks: An International Study

    , Paediatric and Perinatal Epidemiology, Vol: 30, Pages: 450-461, ISSN: 0269-5022

    BACKGROUND: Controversy exists as to whether birthweight-for-gestational age references used to classify infants as small for gestational age (SGA) should be country specific or based on an international (common) standard. We examined whether different birthweight-for-gestational age references affected the association of SGA with adverse outcomes among very preterm neonates. METHODS: Singleton infants (n = 23 788) of 24(0) -28(6) weeks' gestational age in nine high-resource countries were classified as SGA (<10th centile) using common and country-specific references based on birthweight and estimated fetal weight (EFW). For each reference, the adjusted relative risk (aRR) for the association of SGA with composite outcome of mortality or major morbidity was estimated. RESULTS: The percentage of infants classified as SGA differed slightly for common compared with country specific for birthweight references [9.9% (95% CI 9.5, 10.2) vs. 11.1% (95% CI 10.7, 11.5)] and for EFW references [28.6% (95% CI 28.0, 29.2) vs. 24.6% (95% CI 24.1, 25.2)]. The association of SGA with the composite outcome was similar when using common or country-specific references for the total sample for birthweight [aRRs 1.47 (95% CI 1.43, 1.51) and 1.48 (95% CI 1.44, 1.53) respectively] and for EFW references [aRRs 1.35 (95% CI 1.31, 1.38) and 1.39 (95% CI 1.35, 1.43) respectively]. CONCLUSION: Small for gestational age is associated with higher mortality and morbidity in infants born <29 weeks' gestational age. Although common and country-specific birthweight/EFW references identified slightly different proportions of SGA infants, the risk of the composite outcome was comparable.
  • Journal article
    Gale CRK, Morris I, 2016,

    The UK National Neonatal Research Database: using neonatal data for research, quality improvement and more

    , Archives of Disease in Childhood-Education and Practice Edition, Vol: 101, Pages: 216-218, ISSN: 1743-0593

    Electronic data are increasingly recorded in clinical practice. Just as advances in genetics have gradually led to clinical benefit1 so too are ‘big data’ bringing tangible advances to patient care.2The UK has a long history of using electronic neonatal data for research and is now in the enviable position of having electronic patient data on all admissions to National Health Service (NHS) neonatal units in England, Wales and Scotland. This national resource, the National Neonatal Research Database (NNRD), is available for research, audit, benchmarking and quality improvement. Here, we provide an overview of how data entered into an electronic system (Badger.net; Clevermed Ltd) as a component of day-to-day care, are used to form the NNRD and how this can be used by health professionals.
  • Journal article
    Watson SI, Arulampalam W, Petrou S, Marlow N, Morgan AS, Draper ES, Modi Net al., 2016,

    The effects of a one-to-one nurse-to-patient ratio on the mortality rate in neonatal intensive care: a retrospective, longitudinal, population-based study

    , Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 101, Pages: F195-F200, ISSN: 1468-2052

    Objective To estimate the effect of the provision of a one-to-one nurse-to-patient ratio on mortality rates in neonatal intensive care units.Design A population-based analysis of operational clinical data using an instrumental variable method.Setting National Health Service neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit and participating in the Neonatal Economic, Staffing, and Clinical Outcomes Project.Participants 43 tertiary-level neonatal units observed monthly over the period January 2008 to December 2012.Intervention Proportion of neonatal intensive care days or proportion of intensive care admissions for which one-to-one nursing was provided.Outcomes Monthly in-hospital intensive care mortality rate.Results Over the study period, the provision of one-to-one nursing in tertiary neonatal units declined from a median of 9.1% of intensive care days in 2008 to 5.9% in 2012. A 10 percentage point decrease in the proportion of intensive care days on which one-to-one nursing was provided was associated with an increase in the in-hospital mortality rate of 0.6 (95% CI 1.2 to 0.0) deaths per 100 infants receiving neonatal intensive care per month compared with a median monthly mortality rate of 4.5 deaths per 100 infants per month. The results remained robust to sensitivity analyses that varied the estimation sample of units, the choice of instrumental variables, unit classification and the selection of control variables.Conclusions Our study suggests that decreases in the provision of one-to-one nursing in tertiary-level neonatal intensive care units increase the in-hospital mortality rate.
  • Journal article
    Raban S, Santhakumaran S, Keraan Q, Joolay Y, Uthaya S, Horn A, Modi N, Harrison Met al., 2016,

    A randomised controlled trial of high vs low volume initiation and rapid vs slow advancement of milk feeds in infants with birthweights 1000 g in a resource-limited setting

    , Paediatrics and International Child Health, Vol: 36, Pages: 288-295, ISSN: 2046-9047

    Background: Optimal feeding regimens for infants ≤ 1000 g have not been established and are a global healthcare concern.Aims and objectives: A controlled trial to establish the safety and efficacy of high vs low volume initiation and rapid vs slow advancement of milk feeds in a resource-limited setting was undertaken.Methods: Infants ≤ 1000 g birthweight were randomised to one of four arms, either low (4 ml/kg/day) or high (24 ml/kg/day) initiation and either slow (24 ml/kg/day) or rapid (36 ml/kg/day) advancement of exclusive feeds of human milk (mother’s or donor) until a weight of 1200 g was reached. After this point, formula was used to supplement insufficient mother’s milk. The primary outcome was time to reach 1500 g.Results: infants were recruited (51: low/slow; 47: low/rapid; 52: high/slow; 50: high/rapid). Infants on rapid advancement regimens reached 1500 g most rapidly (hazard ratio 1.48, 95% CI 1.05–2.09, P=0.03). The rapid advancement groups also regained birthweight more rapidly (hazard ratio 1.77, 95% CI 1.26–2.50, P=0.001). There was no apparent effect of high vs low initiation volumes but there was some evidence of interaction between interventions. There were no significant differences in other secondary outcomes, including necrotising enterocolitis, feed intolerance and late-onset sepsis.Conclusions: In this small pilot study, higher initiation feed volumes and larger daily increments appeared to be well tolerated and resulted in more rapid early weight gain. These data provide justification for a larger study in resource-limited settings to address mortality, necrotising enterocolitis and other important outcomes.
  • Journal article
    Gale C, Modi N, 2015,

    Neonatal randomised point-of-care trials are feasible and acceptable in the UK: results from two national surveys

    , Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 101, Pages: 86-86, ISSN: 1468-2052
  • Journal article
    Battersby C, Santhakumaran S, Upton M, Radbone L, Birch J, Modi Net al., 2014,

    The impact of a regional care bundle on maternal breast milk use in preterm infants: outcomes of the East of England quality improvement programme

    , ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 99, Pages: F395-F401, ISSN: 1359-2998
  • Journal article
    Battersby C, Santhakumaran S, Costeloe K, Modi Net al., 2014,

    PC.15 The UK Neonatal Collaborative Necrotising Enterocolitis (NEC) Study: development of an evidence-based case-definition for NEC.

    , Arch Dis Child Fetal Neonatal Ed, Vol: 99 Suppl 1

    Lack of a universal case-definition hinders (NEC) surveillance and clinical trials. Bell's staging, although widely used, was devised to guide surgical management after diagnosis(1). We aimed to develop an evidence-based NEC case-definition.
  • Journal article
    Wong HS, Santhakumaran S, Statnikov Y, Gray D, Watkinson M, Modi Net al., 2014,

    Retinopathy of prematurity in English neonatal units: a national population-based analysis using NHS operational data

    , ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 99, Pages: F196-F202, ISSN: 1359-2998

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