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Journal articleYeo KT, Oei JL, De Luca D, et al., 2020,
Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID-19.
, Acta Paediatrica: Nurturing the Child, Vol: 109, Pages: 2192-2207, ISSN: 1651-2227AIM: This review examined how applicable national and regional clinical practice guidelines and recommendations for managing neonates born to mothers with COVID-19 mothers were to the evolving pandemic. METHODS: A systematic search and review identified 20 guidelines and recommendations that had been published by 25 May 2020. We analysed documents from 17 countries: Australia, Brazil, Canada, China, France, India, Italy, Japan, Saudi Arabia, Singapore, South Africa, South Korea, Spain, Sweden, Switzerland, the UK and the USA. RESULTS: The documents were based on expert consensus with limited evidence and were of variable, low methodological rigour. Most did not provide recommendations for delivery methods or managing symptomatic infants. None provided recommendations for post-discharge assimilation of potentially-infected infants into the community. The majority encouraged keeping mothers and infants together, subject to infection control measures, but one-third recommended separation. Although breastfeeding or using breastmilk were widely encouraged, two countries specifically prohibited this. CONCLUSION: The guidelines and recommendations for managing infants affected by COVID-19 were of low, variable quality and may be unsustainable. It is important that transmission risks are not increased when new information is incorporated into clinical recommendations. Practice guidelines should emphasise the extent of uncertainty and clearly define gaps in the evidence.
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Journal articleRees P, Stilwell PA, Bolton C, et al., 2020,
Childhood health and educational outcomes after neonatal abstinence syndrome: a systematic review and meta-analysis.
, The Journal of Pediatrics, Vol: 226, Pages: 149-156.e16, ISSN: 0022-3476OBJECTIVE: To systematically review and meta-analyze the association between neonatal abstinence syndrome (NAS) and adverse health or educational childhood outcomes. STUDY DESIGN: An all-language search was conducted across 11 databases between 1/1/75, and 9/3/19, and 5865 titles were identified. Observational studies of children between 28 days and 16 years of age, in whom a diagnosis of NAS was documented, were included. Outcomes included reasons for hospital admissions, childhood diagnoses, developmental outcomes, and academic attainment scores. All studies underwent independent review by two trained reviewers, who extracted study data and assessed risk of bias using the Newcastle Ottawa Tool. RESULTS: Fifteen studies were included comprising 10,907 children with previous NAS and 1,730,213 children without previous NAS, aged 0-16 years. There was a strong association between NAS and subsequent child maltreatment (aOR 6.49 (4.46, 9.45, I2=52%)), injuries and poisoning (aOR 1.34 (1.21, 1.49, I2= 0%)), and a variety of mental health conditions. Studies consistently demonstrated an increased incidence of strabismus and nystagmus among those with previous NAS. Children with NAS also had lower mean academic scores than the control group in every domain of testing across age groups. CONCLUSIONS: NAS is significantly associated with future child maltreatment, mental health diagnoses, visual problems and poor school performance. Due to the necessary inclusion of non-randomized studies, incomplete reporting among studies and likely unadjusted confounding, this review does not suggest causation. However, we highlight associations requiring further investigation and targeted intervention, to positively impact the life course trajectories of this growing population of children.
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Journal articlePrior E, Modi N, 2020,
Adult outcomes after preterm birth
, POSTGRADUATE MEDICAL JOURNAL, Vol: 96, Pages: 619-622, ISSN: 0032-5473- Author Web Link
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- Citations: 7
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Journal articleHaumont D, Modi N, Saugstad OD, et al., 2020,
Evaluating preterm care across Europe using the eNewborn European Network database
, Pediatric Research, Vol: 88, Pages: 484-495, ISSN: 0031-3998BackgroundThe inefficiency of recording data repeatedly limits the number of studies conducted. Here we illustrate the wider use of data captured as part of the European eNewborn benchmarking programme.MethodsWe extracted data on 39,529 live-births from 22 weeks 0 days to 31 weeks 6 days gestational age (GA) or ≤1500 g birth weight. We explored relationships between delivery room care and Apgar scores on mortality and bronchopulmonary dysplasia (BPD) and calculated the time needed for each country to detect a clinically relevant change in these outcomes following a hypothetical intervention.ResultsEarly neonatal, neonatal, and in-hospital mortality were 3.90% (95% CI 3.71, 4.09), 6.00% (5.77, 6.24) and 7.57% (7.31, 7.83), respectively. The odds of death were greater with decreasing GA, lower Apgar scores, growth restriction, male sex, multiple birth and no antenatal steroids. Relationships for BPD were similar. The time required for participating countries to achieve 80% power to detect a relevant change in outcomes following a hypothetical intervention in 23–25 weeks’ GA infants ranged from 12 years for neonatal mortality and 22 years for BPD compared to 1 year for the whole network.ConclusionsThe eNewborn platform offers opportunity to drive efficiencies in benchmarking, quality control and research.
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Journal articleWebbe J, Gale C, 2020,
NICE guidelines on neonatal parenteral nutrition: a step towards standardised care but evidence is scarce
, The Lancet Child and Adolescent Health, Vol: 4, Pages: 645-646, ISSN: 2352-4642Globally, neonatal conditions are the leading cause of reductions in disability-adjusted life-years and affect outcomes that extend throughout life. Providing neonatal care to optimise such long-term outcomes is challenging because short-term research outcomes might conflict, even within individual trials. Evidence-based guidelines are a welcome tool to translate research into practice and reduce variation in care. Such standardisation of care can improve outcomes for patients. For example, adherence to a standardised guideline for enteral feeding is protective against necrotising enterocolitis, despite the heterogeneity in the content of the individual guidelines. The latest guideline by the UK's National Institute for Health and Care Excellence (NICE) on neonatal parenteral nutrition is a welcome addition to neonatal practice, and is particularly important given the deficiencies frequently found in the provision of neonatal nutritional care in the UK.
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Journal articleDorling J, Tume LN, Arch B, et al., 2020,
Gastric residual volume measurement in British neonatal intensive care units: a survey of practice
, BMJ Paediatrics Open, Vol: 4, ISSN: 2399-9772Objective: Despite little evidence, the practice of routine gastric residual volume (GRV) measurement to guide enteral feeding in neonatal units is widespread. Due to increased interest in this practice, and to examine trial feasibility, we aimed to determine enteral feeding and GRV measurement practices in British neonatal units.Design & Setting: An online survey was distributed via email to all neonatal units and networks in England, Scotland and Wales. A clinical nurse, senior doctor and dietitian were invited to collaboratively complete the survey and submit a copy of relevant guidelines. Results: 95/184 (51.6%) approached units completed the survey, 81/95 (85.3%) reported having feeding guidelines and 28 guidelines were submitted for review. The majority of units used intermittent (90/95) gastric feeds as their primary feeding method. 42/95 units reported specific guidance for measuring and interpreting GRV. 20/90 units measured GRV before every feed, 39/90 at regular time-intervals (most commonly 4-6 hourly 35/39) and 26/90 when felt to be clinically indicated. Most units reported uncertainty on the utility of aspirate volume for guiding feeding decisions; 13/90 reported that aspirate volume affected decisions ‘very much’. In contrast, aspirate colour was reported to affect decisions ‘very much’ by 37/90 of responding units. Almost half, 44/90, routinely returned aspirates to the stomach. Conclusions: Routine GRV measurement is part of standard practice in British neonatal units, although there was inconsistency in how frequently to measure or how to interpret the aspirate. Volume was considered less important than colour of the aspirate.
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Journal articleLittle M, Dupre S, Wormald J, et al., 2020,
Surgical intervention for paediatric infusion-related extravasation injury: a systematic review
, BMJ Open, Vol: 10, Pages: 1-14, ISSN: 2044-6055ObjectivesThis systematic review aims to assess the quality of literature supporting surgical interventions for paediatric extravasation injury and to determine whether there is sufficient evidence to support invasive techniques in children.MethodsWe performed a systematic review by searching Ovid MEDLINE and EMBASE as well as AMED, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception to February 2019. Studies other than case reports were eligible for inclusion if the population was younger than 18 years old, there was a surgical intervention aimed at treating extravasation injury and they reported on outcomes. Study quality was graded according to the National Institutes of Health (NIH) study quality assessment tools.Results26 studies involving 728 children were included – one before-and-after study and 25 case series. Extravasation injuries were mainly confined to skin and subcutaneous tissues but severe complications were also encountered, including amputation (one toe and one below elbow). Of the surgical treatments described, the technique of multiple puncture wounds and instillation of saline and/or hyaluronidase was the most commonly used. However, there were no studies in which its effectiveness was tested against another treatment or a control and details of functional and aesthetic outcomes were generally lacking. ConclusionSurgical management is commonly reported in the literature in cases where there is significant soft tissue injury but as there are no comparative studies, it is unclear whether this is optimal. Further observational and experimental research evaluating extravasation injuries, including a centralized extravasation register using a universal grading scheme and core outcome set with adequate follow-up, are required to provide evidence to guide clinician decision-making.
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Journal articleWong HS, Wadon M, Evans A, et al., 2020,
Contribution of de novo and inherited rare CNVs to very preterm birth
, JOURNAL OF MEDICAL GENETICS, Vol: 57, Pages: 552-557, ISSN: 0022-2593- Author Web Link
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- Citations: 2
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Journal articleWong HS, Hopkins L, ODonovan MC, et al., 2020,
Pilot study to establish a prospective neonatal cohort: Study of Preterm Infants and Neurodevelopmental Genes (SPRING)
, BMJ Paediatrics Open, Vol: 4, ISSN: 2399-9772Background: Genetic risk variants and preterm birth are early and potent risk factors for later neuropsychiatric disorders. To understand the interrelationships between these factors, a large-scale genetic study of very preterm (VPT, <32 weeks gestation) infants with prospective follow-up is required. In this paper we describe a streamlined study approach, using efficient processes for biological and clinical data collection, to feasibly establish such a cohort. Methods: We sought to recruit 500 VPT families within a one-year period from neonatal units. Treating clinical teams recruited eligible participants, obtained parent consent, collected blood samples and posted specimens to the research laboratory. We extracted all clinical data from the National Neonatal Research Database, an existing UK resource that captures daily patient-level data on all VPT infants. Results: Between May 2017 and June 2018, we established a cohort of 848 VPT infants and their parents from 60 English neonatal units. The study population (median (inter-quartile range) gestation 28.9 (26-30) weeks; birthweight 1120 (886-1420) grams) represented 18.9% of eligible infants born at the study sites during the recruitment period (n= 4491). From the subset of 521 complete family trios, we successfully completed genotyping for 510 (97.9%) trios. Of the original 883 infants whose parents consented to participate, the parents of 796 (90.1%) infants agreed to future data linkage and 794 (89.9%) agreed to be recalled. Conclusion: We demonstrate the feasibility and acceptability of streamlined strategies for genetic, neonatal and longitudinal data collection and provide a template for future cost-effective and efficient cohort development.
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Journal articleHo A, Webster L, Bowen L, et al., 2020,
Research priorities for pregnancy hypertension: a UK priority setting partnership with the James Lind Alliance.
, BMJ Open, Vol: 10, Pages: 1-8, ISSN: 2044-6055OBJECTIVES: To identify research priorities for hypertensive disorders of pregnancy from individuals with lived experience and healthcare professionals. DESIGN: Prospective surveys and consensus meetings using principles outlined by the James Lind Alliance. SETTING: UK. METHODS: A steering group was established and 'uncertainties' were gathered using an online survey and literature search. An interim online survey ranked long-listed questions and the top 10 research questions were reached by consensus at a final prioritisation workshop. PARTICIPANTS: Women, partners, relatives and friends of those with lived experience of pregnancy hypertension, researchers and healthcare professionals. RESULTS: The initial online survey was answered by 278 participants (180 women with lived experience, 9 partners/relatives/friends, 71 healthcare professionals and 18 researchers). Together with a literature search, this identified 764 questions which were refined into 50 summary questions. All summary questions were presented in an interim prioritisation survey that was answered by 155 participants (87 women with lived experience, 4 partners/relatives/friends, 49 healthcare professionals and 15 researchers). The top 25 highest ranked questions were considered by the final prioritisation workshop. The top 10 uncertainties were identified by consensus and ranked as follows in order of priority: long-term consequences of pregnancy hypertension (for the woman and baby), short-term complications of pregnancy hypertension (for the woman and baby), screening tests for pre-eclampsia, prevention of long-term problems (for the woman and baby), causes of pregnancy hypertension, prevention of recurrent pregnancy hypertension, educational needs of healthcare professionals, diagnosis of pre-eclampsia, management of pregnancy hypertension, provision of support for women and families. CONCLUSIONS: Research priorities shared by those with lived experience of pregnancy hypertension and healthcare pro
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