Results
- Showing results for:
- Reset all filters
Search results
-
Conference paperModi N, 2017,
Implementing Best Practice in Preterm Enteral Care
, Publisher: KARGER, Pages: 309-310, ISSN: 1661-7800 -
Journal articleUthaya S, Liu X, Modi N, 2016,
Nutritional Evaluation and Optimisation in Neonates trial: is the protein-to-energy ratio important? Reply
, AMERICAN JOURNAL OF CLINICAL NUTRITION, Vol: 104, Pages: 1721-1722, ISSN: 0002-9165 -
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·
-
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 articleMcColgan M, Winch R, Clark SJ, et al., 2016,
The changing UK paediatric consultant workforce: report from the Royal College of Paediatrics and Child Health
, Archives of Disease in Childhood. Fetal and Neonatal Edition, Vol: 102, Pages: 170-173, ISSN: 1359-2998Objectives To determine if there had been changes in the size of the UK paediatric workforce and working patterns between 1999 and 2013.Design Analysis of prospectively collected datasets.Setting UK consultant paediatricians.Interventions Data from the Royal College of Paediatrics and Child Health's workforce census from 1999 to 2013 and the annual surveys of new paediatric Certificate of Completion of Training (CCT) and Certificate of Equivalence of Specialist Registration (CESR) holders between 2010 and 2013.Main outcome measures Paediatric consultant numbers, programmed activities (PAs) and resident shift working.Results The UK paediatric consultant workforce grew from 1933 in 1999 to 3718 in 2013. Over the same time period, there was a decline in the number of consultants with a primary academic contract from 210 to 143. There was an increase in the proportion of consultants who were female (40% in 1999 to 50% in 2013, p<0.01). The median number of PAs declined from 11 in 2009 to 10 in 2013 (p<0.001) as did the median number of PAs for supporting professional activities (2.5–2.3, p<0.001). In 2013, 38% of new consultants in general paediatrics or neonatology were working resident shifts. Between 2009 and 2013, the proportion of less than full-time working consultants rose from 18% to 22%, which was more common among female consultants (35% vs 9%).Conclusion The paediatric consultant workforce has doubled since 1999, but more are working less than full time. The decline in those with a primary academic contract is of concern.
-
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.
-
Journal articleModi N, 2016,
Junior doctors' dispute leaves big questions about state of NHS
, BMJ, Vol: 355, ISSN: 0959-8138 -
Journal articleDuffy J, Hirsch M, Kawsar A, et al., 2016,
Completeness of outcome and outcome measure reporting across seventy-nine randomised trials, 31,615 participants, evaluating therapeutic interventions for pre-eclampsia: a systematic review
, JOURNAL OF HUMAN HYPERTENSION, Vol: 30, Pages: 642-642, ISSN: 0950-9240 -
Journal articleGale CRK, Hyde MJH, Modi N, 2016,
Research Ethics Committee decision-making in relation to an efficient neonatal trial
, Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 102, Pages: F291-F298, ISSN: 1468-2052ObjectiveRandomised controlled trials, a gold-standard approach to reduce uncertainties in clinical practice, are growing in cost and are often slow to recruit. We determined the acceptability to United Kingdom (UK) Research Ethics Committees (REC) of approaches to facilitate large, efficient clinical trials. DesignWe developed a protocol in collaboration with parents, for a comparative-effectiveness, randomised controlled trial comparing two widely used blood transfusion practices in preterm infants. We incorporated four approaches to improve recruitment and efficiency: i) point-of-care design using Electronic Patient Records for patient identification, randomisation and data acquisition, ii) short two-page information sheet; iii) explicit mention of possible inclusion benefit; iv) opt-out consent with enrollment as the default. With the support of the UK Health Research Authority, we submitted an identical protocol to 12 UK REC. SettingResearch Ethics Committees in the UKMain outcomeNumber of REC granting favourable opinions.ResultsThe use of Electronic Patient Records was acceptable to all REC; one REC raised concerns about the short parent information sheet, 10 about inclusion benefit and 9 about opt-out consent. Following responses to queries 9 REC granted a favourable final opinion; 3 rejected the application because they considered the opt-out consent process invalid. ConclusionsA majority of REC in this study consider the use of Electronic Patient Record data, short information sheets, opt-out consent and mention of possible inclusion benefit to be acceptable in neonatal comparative-effectiveness research. We identified a need for guidance for REC in relation to opt-out consent processes. These methods provide opportunity to facilitate large randomised controlled trials.
-
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.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.
General enquiries
Neonatal Medicine Research Group and Neonatal Data Analysis Unit Manager
(All research related queries)
Room G 4.3
Chelsea and Westminster Hospital
ndau@imperial.ac.uk
+44 (0)20 3315 5841
Research Communications Lead
(Communications related queries only)
dsakyi@imperial.ac.uk
