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Gyamfi-Bannerman C. Antenatal Late Preterm Steroids: The Evolution of the ALPS Trial. Clin Obstet Gynecol 2024; 67:399-410. [PMID: 38688083 PMCID: PMC11068095 DOI: 10.1097/grf.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
The Antenatal Late Preterm Steroids (ALPS) trial was designed to address respiratory morbidity common in infants born late preterm. The study was published in April, 2016 and, shortly thereafter, changed clinical practice in obstetrics in the United States. The following chapter describes the ALPS trial study design in detail, including the background leading to the trial, the study outcomes, and the initial findings of the long-term follow-up study. The ALPS story would not be complete without Elizabeth Thom, PhD, who died before her time. Her brilliance largely contributed to the design of the ALPS trial.
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Affiliation(s)
- Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, La Jolla, California
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Miller ME, Donohue P, Seltzer R, Kwak C, Boss RD. Costs of Neonatal Medical Complexity: Impact on New Parent Stress and Decision-Making. Am J Perinatol 2024; 41:e833-e842. [PMID: 36130670 DOI: 10.1055/a-1948-2580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Parents of children with medical complexity experience substantial financial burdens. It is unclear how neonatal intensive care unit (NICU) clinicians prepare new parents of medically complex infants for this reality. This study explored new parent awareness of health care costs, desire to discuss costs with clinicians, and impact of costs on parents' medical decision-making. STUDY DESIGN The study design comprised semistructured interviews and surveys of parents of infants with medical complexity currently or previously in a NICU. Conventional content analysis was performed on interview transcripts, and descriptive analyses were applied to surveys. RESULTS Thematic saturation was reached with 27 families (15 NICU families and 12 post-NICU families) of diverse race/ethnicity/education/household income. Most were worried about their infants' current/future medical expenses and approximately half wanted to discuss finances with clinicians, only one parent had. While finances were not part of most parent's NICU decision-making, some later regretted this and wished cost had been incorporated into treatment choices. The family desire to discuss costs did not vary by family financial status. Parents described their infant's health care costs as: "We are drowning"; and "We'll never pay it off." CONCLUSION Most parents were worried about current and future medical expenses related to their infant's evolving medical complexity. Many wanted to discuss costs with clinicians; almost none had. NICU clinicians should prepare families for the future financial realities of pediatric medical complexity. KEY POINTS · Many families want to discuss costs with NICU clinicians.. · Some families want costs to be a part of medical decisions.. · Few families currently discuss costs with NICU providers..
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Affiliation(s)
- Mattea E Miller
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Pamela Donohue
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Population and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rebecca Seltzer
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Population and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Berman Institute of Bioethics, Baltimore, Maryland
| | - Cecilia Kwak
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Berman Institute of Bioethics, Baltimore, Maryland
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Engjom HM, Ramakrishnan R, Vousden N, Bunch K, Morris E, Simpson N, Gale C, O'Brien P, Quigley M, Brocklehurst P, Kurinczuk JJ, Knight M. Perinatal outcomes after admission with COVID-19 in pregnancy: a UK national cohort study. Nat Commun 2024; 15:3234. [PMID: 38622110 PMCID: PMC11018846 DOI: 10.1038/s41467-024-47181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
There are few population-based studies of sufficient size and follow-up duration to have reliably assessed perinatal outcomes for pregnant women hospitalised with SARS-CoV-2 infection. The United Kingdom Obstetric Surveillance System (UKOSS) covers all 194 consultant-led UK maternity units and included all pregnant women admitted to hospital with an ongoing SARS-CoV-2 infection. Here we show that in this large national cohort comprising two years' active surveillance over four SARS-CoV-2 variant periods and with near complete follow-up of pregnancy outcomes for 16,627 included women, severe perinatal outcomes were more common in women with moderate to severe COVID-19, during the delta dominant period and among unvaccinated women. We provide strong evidence to recommend continuous surveillance of pregnancy outcomes in future pandemics and to continue to recommend SARS-CoV-2 vaccination in pregnancy to protect both mothers and babies.
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Affiliation(s)
- Hilde Marie Engjom
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
- Division of Physical and Mental Health, Norwegian Institute of Public Health, 5015, Bergen, Norway
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Nicola Vousden
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Kathryn Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Edward Morris
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Nigel Simpson
- Department of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, London, London, UK, SW7 2BX and Centre for Paediatrics and Child Health, Imperial College, London, SW7 2AZ, UK
| | - Pat O'Brien
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
- Institute for Women's Health, University College London, London, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
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Hua X, Petrou S, Coathup V, Carson C, Kurinczuk JJ, Quigley MA, Boyle E, Johnson S, Macfarlane A, Rivero-Arias O. Gestational age and hospital admission costs from birth to childhood: a population-based record linkage study in England. Arch Dis Child Fetal Neonatal Ed 2023; 108:485-491. [PMID: 36759168 PMCID: PMC10447377 DOI: 10.1136/archdischild-2022-324763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To examine the association between gestational age at birth and hospital admission costs from birth to 8 years of age. DESIGN Population-based, record linkage, cohort study in England. SETTING National Health Service (NHS) hospitals in England, UK. PARTICIPANTS 1 018 136 live, singleton births in NHS hospitals in England between 1 January 2005 and 31 December 2006. MAIN OUTCOME MEASURES Hospital admission costs from birth to age 8 years, estimated by gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks). RESULTS Both birth admission and subsequent admission hospital costs decreased with increasing gestational age at birth. Differences in hospital admission costs between gestational age groups diminished with increasing age, particularly after the first 2 years following birth. Children born extremely preterm (<28 weeks) and very preterm (28-31 weeks) still had higher average hospital admission costs (£699 (95% CI £419 to £919) for <28 weeks; £434 (95% CI £305 to £563) for 28-31 weeks) during the eighth year of life compared with children born at 40 weeks (£109, 95% CI £104 to £114). Children born extremely preterm had the highest 8-year cumulative hospital admission costs per child (£80 559 (95% CI £79 238 to £82 019)), a large proportion of which was incurred during the first year after birth (£71 997 (95% CI £70 866 to £73 097)). CONCLUSIONS The association between gestational age at birth and hospital admission costs persists into mid-childhood. The study results provide a useful costing resource for future economic evaluations focusing on preventive and treatment strategies for babies born preterm.
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Affiliation(s)
- Xinyang Hua
- Centre for Health Policy, Melbourne School for Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health, University of Oxford, Oxford, UK
| | - Victoria Coathup
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alison Macfarlane
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Mielewczyk FJ, Boyle EM. Uncharted territory: a narrative review of parental involvement in decision-making about late preterm and early term delivery. BMC Pregnancy Childbirth 2023; 23:526. [PMID: 37464284 DOI: 10.1186/s12884-023-05845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Almost 30% of live births in England and Wales occur late preterm or early term (LPET) and are associated with increased risks of adverse health outcomes throughout the lifespan. However, very little is known about the decision-making processes concerning planned LPET births or the involvement of parents in these. This aim of this paper is to review the evidence on parental involvement in obstetric decision-making in general, to consider what can be extrapolated to decisions about LPET delivery, and to suggest directions for further research.A comprehensive, narrative review of relevant literature was conducted using Medline, MIDIRS, PsycInfo and CINAHL databases. Appropriate search terms were combined with Boolean operators to ensure the following broad areas were included: obstetric decision-making, parental involvement, late preterm and early term birth, and mode of delivery.This review suggests that parents' preferences with respect to their inclusion in decision-making vary. Most mothers prefer sharing decision-making with their clinicians and up to half are dissatisfied with the extent of their involvement. Clinicians' opinions on the limits of parental involvement, especially where the safety of mother or baby is potentially compromised, are highly influential in the obstetric decision-making process. Other important factors include contextual factors (such as the nature of the issue under discussion and the presence or absence of relevant medical indications for a requested intervention), demographic and other individual characteristics (such as ethnicity and parity), the quality of communication; and the information provided to parents.This review highlights the overarching need to explore how decisions about potential LPET delivery may be reached in order to maximise the satisfaction of mothers and fathers with their involvement in the decision-making process whilst simultaneously enabling clinicians both to minimise the number of LPET births and to optimise the wellbeing of women and babies.
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Affiliation(s)
- Frances J Mielewczyk
- Leicester City Football Club (LCFC) Research Programme, Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Elaine M Boyle
- Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
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Kovács G, Abonyi-Tóth Z, Fadgyas-Freyler P, Kaló Z. Incremental cost of premature birth - a public health care payer perspective from Hungary. BMC Health Serv Res 2023; 23:686. [PMID: 37353814 DOI: 10.1186/s12913-023-09697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/13/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Preterm birth remains a significant burden to families, health systems and societies. The aim was to quantify the incremental prematurity-related public health expenditure in Hungary and to estimate the potential impact of a decrease in the prevalence of prematurity on the public payer's spending. METHODS Over a 6-year time horizon, public financing data of inpatient, outpatient and pharmaceutical care for children born at ≥ 25 weeks of gestation in 2009/2010 were retrieved from the Hungarian National Health Insurance Fund database. In descriptive analysis, the public payer's spending was given as cost/capita. The impact of a decrease in prematurity prevalence was specified as the total budget impact. An exchange rate of 294 Hungarian forint/Euro was applied. RESULTS A total of 93,124 children (including 8.6% who were premature babies) were included in the analysis. A strong negative relationship was shown between gestational age and per capita cost. The 6-year cost of care for the cohort born at 26 weeks of gestation (28,470 Euro per capita) was 24 times higher than that for the cohort born at 40 weeks. First-year inpatient spending accounted for the largest proportion of total health care spending across all gestational ages. All investigated prematurity complications (retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular cerebral bleeding and leukomalacia) resulted in additional significant incremental spending. If 70% of pregnancies ending with preterm birth could be prolonged by 1 week, the savings would be almost 7.0 million Euros in the first 6 years of life. CONCLUSION This comprehensive analysis of prematurity-related health care spending confirmed that premature infants have much higher costs for care than those born at term in Hungary. These quantitative outcomes can provide essential inputs for the cost-effectiveness analysis of medical technologies and public health interventions that can decrease the prevalence of premature birth. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Gábor Kovács
- Doctoral School of Sociology, Eötvös Loránd University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - Zsolt Abonyi-Tóth
- University of Veterinary Medicine, Budapest, Hungary
- RxTarget Ltd, Budapest, Hungary
| | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary.
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Yang M, Campbell H, Pillay T, Boyle EM, Modi N, Rivero-Arias O. Neonatal health care costs of very preterm babies in England: a retrospective analysis of a national birth cohort. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001818. [PMID: 37130654 PMCID: PMC10163543 DOI: 10.1136/bmjpo-2022-001818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/06/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Babies born between 27+0 and 31+6 weeks of gestation represent the largest group of very preterm babies requiring National Health Service (NHS) care; however, up-to-date, cost figures for the UK are not currently available. This study estimates neonatal costs to hospital discharge for this group of very preterm babies in England. DESIGN Retrospective analysis of resource use data recorded within the National Neonatal Research Database. SETTING Neonatal units in England. PATIENTS Babies born between 27+0 and 31+6 weeks of gestation in England and discharged from a neonatal unit between 2014 and 2018. MAIN OUTCOME MEASURES Days receiving different levels of neonatal care were costed, along with other specialised clinical activities. Mean resource use and costs per baby are presented by gestational age at birth, along with total costs for the cohort. RESULTS Based on data for 28 154 very preterm babies, the annual total costs of neonatal care were estimated to be £262 million, with 96% of costs attributable to routine daily care provided by units. The mean (SD) total cost per baby of this routine care varied by gestational age at birth; £75 594 (£34 874) at 27 weeks as compared with £27 401 (£14 947) at 31 weeks. CONCLUSIONS Neonatal healthcare costs for very preterm babies vary substantially by gestational age at birth. The findings presented here are a useful resource to stakeholders including NHS managers, clinicians, researchers and policymakers.
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Affiliation(s)
- Miaoqing Yang
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population, University of Oxford, Oxford, UK
- Centre for Guidelines, National Institute for Health and Care Excellence, London, UK
| | - Helen Campbell
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population, University of Oxford, Oxford, UK
| | - Thillagavathie Pillay
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
- Department of Neonatology, Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Elaine M Boyle
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Neena Modi
- Section of Neonatal Medicine, School of Public Health, Chelsea and Westminster Hospital Campus, Imperial College London, London, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population, University of Oxford, Oxford, UK
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Kim SW, Andronis L, Seppänen AV, Aubert AM, Barros H, Draper ES, Sentenac M, Zeitlin J, Petrou S. Health-related quality of life of children born very preterm: a multinational European cohort study. Qual Life Res 2023; 32:47-58. [PMID: 35976599 PMCID: PMC9829588 DOI: 10.1007/s11136-022-03217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE This study aims to (1) describe the health-related quality of life (HRQoL) outcomes experienced by children born very preterm (28-31 weeks' gestation) and extremely preterm (< 28 weeks' gestation) at five years of age and (2) explore the mediation effects of bronchopulmonary dysplasia (BPD) and severe non-respiratory neonatal morbidity on those outcomes. METHODS This investigation was based on data for 3687 children born at < 32 weeks' gestation that contributed to the EPICE and SHIPS studies conducted in 19 regions across 11 European countries. Descriptive statistics and multi-level ordinary linear squares (OLS) regression were used to explore the association between perinatal and sociodemographic characteristics and PedsQL™ GCS scores. A mediation analysis that applied generalised structural equation modelling explored the association between potential mediators and PedsQL™ GCS scores. RESULTS The multi-level OLS regression (fully adjusted model) revealed that birth at < 26 weeks' gestation, BPD status and experience of severe non-respiratory morbidity were associated with mean decrements in the total PedsQL™ GCS score of 0.35, 3.71 and 5.87, respectively. The mediation analysis revealed that the indirect effects of BPD and severe non-respiratory morbidity on the total PedsQL™ GCS score translated into decrements of 1.73 and 17.56, respectively, at < 26 weeks' gestation; 0.99 and 10.95, respectively, at 26-27 weeks' gestation; and 0.34 and 4.80, respectively, at 28-29 weeks' gestation (referent: birth at 30-31 weeks' gestation). CONCLUSION The findings suggest that HRQoL is particularly impaired by extremely preterm birth and the concomitant complications of preterm birth such as BPD and severe non-respiratory morbidity.
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Affiliation(s)
- Sung Wook Kim
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Lazaros Andronis
- grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anna-Veera Seppänen
- grid.513249.80000 0004 8513 0030Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, 75004 Paris, France
| | - Adrien M. Aubert
- grid.513249.80000 0004 8513 0030Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, 75004 Paris, France
| | - Henrique Barros
- grid.5808.50000 0001 1503 7226EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Elizabeth S. Draper
- grid.9918.90000 0004 1936 8411Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mariane Sentenac
- grid.513249.80000 0004 8513 0030Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, 75004 Paris, France
| | - Jennifer Zeitlin
- grid.513249.80000 0004 8513 0030Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, 75004 Paris, France
| | - Stavros Petrou
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
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Shen R, Embleton N, Lyng Forman J, Gale C, Griesen G, Sangild PT, Uthaya S, Berrington J. Early antibiotic use and incidence of necrotising enterocolitis in very preterm infants: a protocol for a UK based observational study using routinely recorded data. BMJ Open 2022; 12:e065934. [PMID: 36379645 PMCID: PMC9667987 DOI: 10.1136/bmjopen-2022-065934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Necrotising enterocolitis (NEC) remains a major contributor to preterm mortality and morbidity. Prolonged duration of antibiotic therapy after delivery is associated with later NEC development but recent evidence suggests that absence of antibiotic treatment after delivery may also increase NEC risk. We will explore this controversy using a large pre-existing dataset of preterm infants in the UK. METHODS AND ANALYSIS This is a retrospective cohort study using data from UK National Neonatal Research Database (NNRD) for infants born 1 January 2012 to 31 December 2020. Eligible infants will be <32 weeks gestation, alive on day 3. Primary outcome is development of severe NEC, compared in infants receiving early antibiotics (days 1-2 after birth) and those not. Subgroup analysis on duration of early antibiotic exposure will also occur. Secondary outcomes are: late onset sepsis, total antibiotic use, predischarge mortality, retinopathy of prematurity, intraventricular haemorrhage, bronchopulmonary dysplasia, focal intestinal perforation and any abdominal surgery. To address competing risks, incidence of death before day 7, 14 and 28 will be analysed. We will perform logistic regression and propensity score matched analyses. Statistical analyses will be guided by NEC risk factors, exposures and outcome presented in a causal diagram. These covariates include but are not limited to gestational age, birth weight, small for gestational age, sex, ethnicity, delivery mode, delivery without labour, Apgar score, early feeding and probiotic use. Sensitivity analyses of alternate NEC definitions, specific antibiotics and time of initiation will occur. ETHICS AND DISSEMINATION We will use deidentified data from NNRD, which holds permissions for the original data, from which parents can opt out and seek study-specific research ethics approval. The results will help to determine optimal use of early antibiotics for very preterm infants. IMPLICATIONS This data will help optimise early antibiotic use in preterm infants. TRIAL REGISTRATION NUMBER ISRCTN55101779.
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Affiliation(s)
- Rene Shen
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhgaen, Denmark
| | - Nicholas Embleton
- Neonatology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | | | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Gorm Griesen
- Neonatology, Odense University Hospital, Odense, Denmark
| | - Per Torp Sangild
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhgaen, Denmark
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
| | - Sabita Uthaya
- Faculty of Medicine, Imperial College London, London, UK
| | - Janet Berrington
- Neonatology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Clinical and Translational Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
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Hunter R, Beardmore-Gray A, Greenland M, Linsell L, Juszczak E, Hardy P, Placzek A, Shennan A, Marlow N, Chappell LC. Cost-Utility Analysis of Planned Early Delivery or Expectant Management for Late Preterm Pre-eclampsia (PHOENIX). PHARMACOECONOMICS - OPEN 2022; 6:723-733. [PMID: 35861912 PMCID: PMC9440173 DOI: 10.1007/s41669-022-00355-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
AIM There is currently limited evidence on the costs associated with late preterm pre-eclampsia beyond antenatal care and post-natal discharge from hospital. The aim of this analysis is to evaluate the 24-month cost-utility of planned delivery for women with late preterm pre-eclampsia at 34+0-36+6 weeks' gestation compared to expectant management from an English National Health Service perspective using participant-level data from the PHOENIX trial. METHODS Women between 34+0 and 36+6 weeks' gestation in 46 maternity units in England and Wales were individually randomised to planned delivery or expectant management. Resource use was collected from hospital records between randomisation and primary hospital discharge following birth. Women were followed up at 6 months and 24 months following birth and self-reported resource use for themselves and their infant(s) covering the previous 6 months. Women completed the EQ-5D 5L at randomisation and follow-up. RESULTS A total of 450 women were randomised to planned delivery, 451 to expectant management: 187 and 170 women, respectively, had complete data at 24 months. Planned delivery resulted in a significantly lower mean cost per woman and infant(s) over 24 months (- £2711, 95% confidence interval (CI) - 4840 to - 637), with a mean incremental difference in QALYs of 0.019 (95% CI - 0.039 to 0.063). Short-term and 24-month infant costs were not significantly different between the intervention arms. There is a 99% probability that planned delivery is cost-effective at all thresholds below £37,000 per QALY gained. CONCLUSION There is a high probability that planned delivery is cost-effective compared to expectant management. These results need to be considered alongside clinical outcomes and in the wider context of maternity care. TRIAL REGISTRATION ISRCTN registry ISRCTN01879376. Registered 25 November 2013.
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Affiliation(s)
- Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK.
- Royal Free Medical School, Rowland Hill Street, London, NW3 2PF, UK.
| | | | | | - Louise Linsell
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Pollyanna Hardy
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Placzek
- Experimental Psychology Unit, University of Oxford, Oxford, UK
| | - Andrew Shennan
- School of Life Course Sciences, King's College London, London, UK
| | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
| | - Lucy C Chappell
- School of Life Course Sciences, King's College London, London, UK
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Bertozzi S, Corradetti B, Seriau L, Diaz Ñañez JA, Cedolini C, Fruscalzo A, Cesselli D, Cagnacci A, Londero AP. Nanotechnologies in Obstetrics and Cancer during Pregnancy: A Narrative Review. J Pers Med 2022; 12:jpm12081324. [PMID: 36013273 PMCID: PMC9410527 DOI: 10.3390/jpm12081324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Nanotechnology, the art of engineering structures on a molecular level, offers the opportunity to implement new strategies for the diagnosis and management of pregnancy-related disorders. This review aims to summarize the current state of nanotechnology in obstetrics and cancer in pregnancy, focusing on existing and potential applications, and provides insights on safety and future directions. A systematic and comprehensive literature assessment was performed, querying the following databases: PubMed/Medline, Scopus, and Endbase. The databases were searched from their inception to 22 March 2022. Five independent reviewers screened the items and extracted those which were more pertinent within the scope of this review. Although nanotechnology has been on the bench for many years, most of the studies in obstetrics are preclinical. Ongoing research spans from the development of diagnostic tools, including optimized strategies to selectively confine contrast agents in the maternal bloodstream and approaches to improve diagnostics tests to be used in obstetrics, to the synthesis of innovative delivery nanosystems for therapeutic interventions. Using nanotechnology to achieve spatial and temporal control over the delivery of therapeutic agents (e.g., commonly used drugs, more recently defined formulations, or gene therapy-based approaches) offers significant advantages, including the possibility to target specific cells/tissues of interest (e.g., the maternal bloodstream, uterus wall, or fetal compartment). This characteristic of nanotechnology-driven therapy reduces side effects and the amount of therapeutic agent used. However, nanotoxicology appears to be a significant obstacle to adopting these technologies in clinical therapeutic praxis. Further research is needed in order to improve these techniques, as they have tremendous potential to improve the accuracy of the tests applied in clinical praxis. This review showed the increasing interest in nanotechnology applications in obstetrics disorders and pregnancy-related pathologies to improve the diagnostic algorithms, monitor pregnancy-related diseases, and implement new treatment strategies.
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Affiliation(s)
- Serena Bertozzi
- Breast Unit, Department of Surgery, DAME, University Hospital of “Santa Maria della Misericordia”, 33100 Udine, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
| | - Bruna Corradetti
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX 77030, USA
| | - Luca Seriau
- Breast Unit, Department of Surgery, DAME, University Hospital of “Santa Maria della Misericordia”, 33100 Udine, Italy
| | - José Andrés Diaz Ñañez
- Breast Unit, Department of Surgery, DAME, University Hospital of “Santa Maria della Misericordia”, 33100 Udine, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
| | - Carla Cedolini
- Breast Unit, Department of Surgery, DAME, University Hospital of “Santa Maria della Misericordia”, 33100 Udine, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
| | - Arrigo Fruscalzo
- Clinic of Obstetrics and Gynecology, University Hospital of Fribourg, 1752 Fribourg, Switzerland
| | - Daniela Cesselli
- Institute of Pathology, DAME, University of Udine, University Hospital of Udine, 33100 Udine, Italy
| | - Angelo Cagnacci
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, Italy
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Ambrogio P. Londero
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, Italy
- Correspondence: or
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12
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Cost-effectiveness of a dietary and physical activity intervention in adolescents: a prototype modelling study based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme. BMJ Open 2022. [PMCID: PMC9362792 DOI: 10.1136/bmjopen-2021-052611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To assess costs, health outcomes and cost-effectiveness of interventions that aim to improve quality of diet and level of physical activity in adolescents. Design A Markov model was developed to assess four potential benefits of healthy behaviour for adolescents: better mental health (episodes of depression and generalised anxiety disorder), higher earnings and reduced incidence of type 2 diabetes and adverse pregnancy outcomes (in terms of preterm delivery). The model parameters were informed by published literature. The analysis took a societal perspective over a 20-year period. One-way and probabilistic sensitivity analyses for 10 000 simulations were conducted. Participants A hypothetical cohort of 100 adolescents with a mean age of 13 years. Interventions An exemplar school-based, multicomponent intervention that was developed by the Engaging Adolescents for Changing Behaviour programme, compared with usual schooling. Outcome measure Incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life-year (QALY) gained. Results The exemplar dietary and physical activity intervention was associated with an incremental cost of £123 per adolescent and better health outcomes with a mean QALY gain of 0.0085 compared with usual schooling, resulting in an ICER of £14 367 per QALY. The key model drivers are the intervention effect on levels of physical activity, quality-of-life gain for high levels of physical activity, the duration of the intervention effects and the period over which effects wane. Conclusions The results suggested that such an intervention has the potential to offer a cost-effective use of healthcare-resources for adolescents in the UK at a willingness-to-pay threshold of £20 000 per QALY. The model focused on short-term to medium-term benefits of healthy eating and physical activity exploiting the strong evidence base that exists for this age group. Other benefits in later life, such as reduced cardiovascular risk, are more sensitive to assumptions about the persistence of behavioural change and discounting. Trail registration number ISRCTN74109264.
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de Melo TFM, Carregaro RL, de Araújo WN, da Silva EN, de Toledo AM. Direct costs of prematurity and factors associated with birth and maternal conditions. Rev Saude Publica 2022; 56:49. [PMID: 35703603 PMCID: PMC9239337 DOI: 10.11606/s1518-8787.2022056003657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To estimate the direct costs due to hospital care for extremely, moderate, and late preterm newborns, from the perspective of a public hospital in 2018. The second objective was to investigate whether factors associated with birth and maternal conditions explain the costs and length of hospital stay. METHODS This is a cost-of-illness study, with data extracted from hospital admission authorization forms and medical records of a large public hospital in the Federal District, Brazil. The association of characteristics of preterm newborns and mothers with costs was estimated by linear regression with gamma distribution. In the analysis, the calculation of the parameters of the estimates (B), with a confidence interval of 95% (95%CI), was adopted. The uncertainty parameters were estimated by the 95% confidence interval and standard error using the Bootstrapping method, with 1,000 samples. Deterministic sensitivity analysis was performed, considering lower and upper limits of 95%CI in the variation of each cost component. RESULTS A total of 147 preterm newborns were included. We verified an average cost of BRL 1,120 for late preterm infants, BRL 6,688 for moderate preterm infants, and BRL 17,395 for extremely preterm infants. We also observed that factors associated with the cost were gestational age (B = -123.00; 95%CI: -241.60 to -4.50); hospitalization in neonatal ICU (B = 6,932.70; 95%CI: 5,309.40-8,556.00), and number of prenatal consultations (B = -227.70; 95%CI: -403.30 to -52.00). CONCLUSIONS We found a considerable direct cost resulting from the care of preterm newborns. Extreme prematurity showed a cost 15.5 times higher than late prematurity. We also verified that a greater number of prenatal consultations and gestational age were associated with a reduction in the costs of prematurity.
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Affiliation(s)
- Thamires Francelino Mendonça de Melo
- Universidade de BrasíliaFaculdade de CeilândiaPrograma de Pós-Graduação em Ciências da ReabilitaçãoBrasíliaDFBrasil Universidade de Brasília. Faculdade de Ceilândia. Programa de Pós-Graduação em Ciências da Reabilitação. Brasília, DF, Brasil
| | - Rodrigo Luiz Carregaro
- Universidade de BrasíliaFaculdade de CeilândiaPrograma de Pós-Graduação em Ciências da ReabilitaçãoBrasíliaDFBrasil Universidade de Brasília. Faculdade de Ceilândia. Programa de Pós-Graduação em Ciências da Reabilitação. Brasília, DF, Brasil
| | - Wildo Navegantes de Araújo
- Universidade de Brasília.Faculdade de CeilândiaBrasíliaDFBrasil Universidade de Brasília. Faculdade de Ceilândia. Curso de Saúde Coletiva. Brasília, DF, Brasil
| | - Everton Nunes da Silva
- Universidade de Brasília.Faculdade de CeilândiaBrasíliaDFBrasil Universidade de Brasília. Faculdade de Ceilândia. Curso de Saúde Coletiva. Brasília, DF, Brasil
| | - Aline Martins de Toledo
- Universidade de BrasíliaFaculdade de CeilândiaPrograma de Pós-Graduação em Ciências da ReabilitaçãoBrasíliaDFBrasil Universidade de Brasília. Faculdade de Ceilândia. Programa de Pós-Graduação em Ciências da Reabilitação. Brasília, DF, Brasil
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Krüse-Ruijter MF, Boswinkel V, Consoli A, Nijholt IM, Boomsma MF, de Vries LS, van Wezel-Meijler G, Leijser LM. Neurological Surveillance in Moderate-Late Preterm Infants—Results from a Dutch–Canadian Survey. CHILDREN 2022; 9:children9060846. [PMID: 35740783 PMCID: PMC9221620 DOI: 10.3390/children9060846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
Preterm birth remains an important cause of abnormal neurodevelopment. While the majority of preterm infants are born moderate-late preterm (MLPT; 32–36 weeks), international and national recommendations on neurological surveillance in this population are lacking. We conducted an observational quantitative survey among Dutch and Canadian neonatal level I–III centres (June 2020–August 2021) to gain insight into local clinical practices on neurological surveillance in MLPT infants. All centres caring for MLPT infants designated one paediatrician/neonatologist to complete the survey. A total of 85 out of 174 (49%) qualifying neonatal centres completed the survey (60 level I–II and 25 level III centres). Admission of MLPT infants was based on infant-related criteria in 78/85 (92%) centres. Cranial ultrasonography to screen the infant’s brain for abnormalities was routinely performed in 16/85 (19%) centres, while only on indication in 39/85 (46%). In 57/85 (67%) centres, neurological examination was performed at least once during admission. Of 85 centres, 51 (60%) followed the infants’ development post-discharge, with follow-up duration ranging from 1–52 months of age. The survey showed a wide variety in neurological surveillance in MLPT infants among Dutch and Canadian neonatal centres. Given the risk for short-term morbidity and long-term neurodevelopmental disabilities, future studies are required to investigate best practices for in-hospital care and follow-up of MLPT infants.
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Affiliation(s)
- Martine F. Krüse-Ruijter
- Department of Neonatology, Isala Women and Children’s Hospital, 8025 AB Zwolle, The Netherlands; (M.F.K.-R.); (V.B.); (G.v.W.-M.)
| | - Vivian Boswinkel
- Department of Neonatology, Isala Women and Children’s Hospital, 8025 AB Zwolle, The Netherlands; (M.F.K.-R.); (V.B.); (G.v.W.-M.)
| | - Anna Consoli
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Ingrid M. Nijholt
- Department of Innovation & Science, Isala Hospital, 8025 AB Zwolle, The Netherlands;
- Department of Radiology, Isala Hospital, 8025 AB Zwolle, The Netherlands;
| | - Martijn F. Boomsma
- Department of Radiology, Isala Hospital, 8025 AB Zwolle, The Netherlands;
| | - Linda S. de Vries
- Department of Neonatology, University Medical Center, 3584 EA Utrecht, The Netherlands;
| | - Gerda van Wezel-Meijler
- Department of Neonatology, Isala Women and Children’s Hospital, 8025 AB Zwolle, The Netherlands; (M.F.K.-R.); (V.B.); (G.v.W.-M.)
| | - Lara M. Leijser
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Correspondence:
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15
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Lee E, Schofield D, Owens CEL, Oei JL. An economic analysis of the cost of survival of micro preemies: A systematic review. Semin Fetal Neonatal Med 2022; 27:101336. [PMID: 35729046 DOI: 10.1016/j.siny.2022.101336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to systematically review the current literature on the economic costs of micro preemie as well as evidence on the cost-effectiveness of interventions to improve outcomes for micro preemie babies with a birth weight of ≤500 g. METHOD We searched MEDLINE, CINAHL, Scopus, ECONLIT, Business Source Premier and Cochrane Library for studies reporting costs of micro preemie from January 2000. Costs were inflated to 2019 United States dollars (US$). All full-text articles were assessed for eligibility and a quality assessment of included articles was conducted using the Drummond and the Larg and Moss checklists. RESULTS The search identified three studies that met the inclusion criteria; two cost-of-illness studies and one cost-effectiveness study. Across studies, the mean healthcare spending per micro preemie survivor (in 2019 US$) ranged from US$61,310 (birth admission) to US$263,958 (inpatient and outpatient for the first six months of life). One modelling study reported exclusive human milk diet for micro preemies at birth was more cost-effective compared to the standard approach with cow milk diet from the third-party payer and societal perspectives. CONCLUSION Despite significant advances in perinatal care and expanded access to life-saving equipment to improve survival outcomes of micro preemie, there remains a paucity of research on economic costs associated with these babies. No study has utilised quality-adjusted life-years as an outcome measure. Given the chronic conditions and long-term neurologic disability associated with micro preemie survivors, an estimate of the lifetime cost to the individual, healthcare providers and society would provide a benchmark of the potential cost-savings that could accrue from cost-effective interventions to improve the survival rate of micro preemies.
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Affiliation(s)
- Evelyn Lee
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, New South Wales, Australia.
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, New South Wales, Australia
| | - Christopher E L Owens
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, New South Wales, Australia
| | - Ju-Lee Oei
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
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16
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Economic costs at age five associated with very preterm birth: multinational European cohort study. Pediatr Res 2022; 92:700-711. [PMID: 34773085 PMCID: PMC9556316 DOI: 10.1038/s41390-021-01769-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/26/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims to estimate the economic costs of care provided to children born very preterm and extremely preterm across 11 European countries, and to understand what perinatal and socioeconomic factors contribute to higher costs. METHODS Generalised linear modelling was used to explore the association between perinatal and sociodemographic characteristics and total economic costs (€, 2016 prices) during the fifth year of life. RESULTS Lower gestational age was associated with increased mean societal costs of €2755 (p < 0.001), €752 (p < 0.01) and €657 (p < 0.01) for children born at < 26, 26-27 and 28-29 weeks, respectively, in comparison to the reference group born at 30-31 weeks. A sensitivity analyses that excluded variables (BPD, any neonatal morbidity and presence of congenital anomaly) plausibly lying on the causal pathway between gestational age at birth and economic outcomes elevated incremental societal costs by €1482, €763 and €144 at < 26, 26-27 and 28-29 weeks, respectively, in comparison to the baseline model. CONCLUSION This study provides new evidence about the main cost drivers associated with preterm birth in European countries. Evidence identified by this study can act as inputs within cost-effectiveness models for preventive or treatment interventions for preterm birth. IMPACT What is the key message of your article? This study provides new evidence about the magnitude and drivers of economic costs associated with preterm birth in European countries. What does it add to the existing literature? Lower gestational age is associated with increased mean societal costs during mid-childhood with indirect costs representing a key driver of increased costs. What is the impact? For policy makers, this study adds to sparse evidence about the main cost drivers associated with preterm birth in European countries beyond the first 2 years of life.
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17
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Clinical risk models for preterm birth less than 28 weeks and less than 32 weeks of gestation using a large retrospective cohort. J Perinatol 2021; 41:2173-2181. [PMID: 34112965 DOI: 10.1038/s41372-021-01109-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To develop risk prediction models for singleton preterm birth (PTB) < 28 weeks and <32 weeks. METHODS Using a retrospective cohort of 267,226 singleton births in Ontario hospitals, we included variables from the first and second trimester in multivariable logistic regression models to predict overall and spontaneous PTB < 28 weeks and <32 weeks. RESULTS During the first trimester, the area under the curve (AUC) for prediction of PTB < 28 weeks for nulliparous and multiparous women was 68.5% (95% CI: 63.5-73.6%) and 73.4% (68.6-78.2%), respectively, while for PTB < 32 weeks it was 68.9% (65.5-72.3%) and 75.5% (72.3-78.7%), respectively. AUCs for second-trimester models were 72.4% (95% CI: 69.7-75.1%) and 78.2% (95% CI: 75.8-80.5%), respectively, in nulliparous and multiparous women. Predicted probabilities were well-calibrated within a wide range around expected base prevalence for the study outcomes. CONCLUSIONS Our prediction models generated acceptable AUCs for PTB < 28 weeks and <32 weeks with good calibration during the first and second trimester.
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18
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Burgos-Artizzu XP, Baños N, Coronado-Gutiérrez D, Ponce J, Valenzuela-Alcaraz B, Moreno-Espinosa AL, Grau L, Perez-Moreno Á, Gratacós E, Palacio M. Mid-trimester prediction of spontaneous preterm birth with automated cervical quantitative ultrasound texture analysis and cervical length: a prospective study. Sci Rep 2021; 11:7469. [PMID: 33811232 PMCID: PMC8018963 DOI: 10.1038/s41598-021-86906-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to evaluate a novel automated test based on ultrasound cervical texture analysis to predict spontaneous Preterm Birth (sPTB) alone and in combination with Cervical Length (CL). General population singleton pregnancies between 18 + 0 and 24 + 6 weeks’ gestation were assessed prospectively at two centers. Cervical ultrasound images were evaluated and the occurrence of sPTB before weeks 37 + 0 and 34 + 0 were recorded. CL was measured on-site. The automated texture analysis test was applied offline to all images. Their performance to predict the occurrence of sPTB before 37 + 0 and 34 + 0 weeks was evaluated separately and in combination on 633 recruited patients. AUC for sPTB prediction before weeks 37 and 34 respectively were as follows: 55.5% and 65.3% for CL, 63.4% and 66.3% for texture analysis, 67.5% and 76.7% when combined. The new test improved detection rates of CL at similar low FPR. Combining the two increased detection rate compared to CL alone from 13.0 to 30.4% for sPTB < 37 and from 14.3 to 42.9% sPTB < 34. Texture analysis of cervical ultrasound improved sPTB detection rate compared to cervical length for similar FPR, and the two combined together increased significantly prediction performance. This results should be confirmed in larger cohorts.
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Affiliation(s)
- Xavier P Burgos-Artizzu
- Transmural Biotech S. L, Barcelona, Spain. .,BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain.
| | - Nuria Baños
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - David Coronado-Gutiérrez
- Transmural Biotech S. L, Barcelona, Spain.,BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - Julia Ponce
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - Brenda Valenzuela-Alcaraz
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - Ana L Moreno-Espinosa
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - Laia Grau
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | | | - Eduard Gratacós
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer, IDIBAPS, Barcelona, Spain.,Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Montse Palacio
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer, IDIBAPS, Barcelona, Spain.,Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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19
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Abstract
While the high costs of neonatal intensive care have been a topic of increasing study, the financial impact on families have been less frequently reported or summarized. We conducted a systematic review of the literature using Pubmed/Medline and EMBASE (1990-2020) for studies reporting estimates of out-of-pocket costs or qualitative estimates of financial burden on families during a neonatal intensive care unit stay or after discharge. 44 studies met inclusion criteria, with 25 studies providing cost estimates. Cost estimates primarily focused on direct non-medical out-of-pocket costs or loss of productivity, and there was a paucity of cost estimates for insurance cost-sharing. Available estimates suggest these costs are significant to families, cause significant stress, and may impact care received by patients. More high-quality studies estimating the entirety of out-of-pocket costs are needed, and particular attention should be paid to how these costs directly impact the care of our high-risk population.
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Affiliation(s)
- Brian C King
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Division of Newborn Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Meredith E Mowitz
- Department of Pediatrics, Division of Neonatology, University of Florida, Gainesville, FL, USA
| | - John A F Zupancic
- Division of Newborn Medicine, Harvard Medical School, Boston, MA, USA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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20
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Nørgaard SK, Vissing NH, Chawes BL, Stokholm J, Bønnelykke K, Bisgaard H. Cost of Illness in Young Children: A Prospective Birth Cohort Study. CHILDREN-BASEL 2021; 8:children8030173. [PMID: 33668336 PMCID: PMC7996350 DOI: 10.3390/children8030173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 01/08/2023]
Abstract
Childhood illness is extremely common and imposes a considerable economic burden on society. We aimed to quantify the overall economic burden of childhood illness in the first three years of life and the impact of environmental risk factors. The study is based on the prospective, clinical mother-child cohort Copenhagen Prospective Studies on Asthma in Childhood (COPSAC2010) of 700 children with embedded randomized trials of fish-oil and vitamin D supplementations during pregnancy. First, descriptive analyses were performed on the total costs of illness, defined as both the direct costs (hospitalizations, outpatient visits, visit to the practitioner) and the indirect costs (lost earnings) collected from the Danish National Health Registries. Thereafter, linear regression analyses on log-transformed costs were used to investigate environmental determinants of the costs of illness. The median standardized total cost of illness at age 0-3 years among the 559 children eligible for analyses was EUR 14,061 (IQR 9751-19,662). The exposures associated with reduced costs were fish-oil supplementation during pregnancy (adjusted geometric mean ratio (GMR) 0.89 (0.80; 0.98), p = 0.02), gestational age in weeks (aGMR = 0.93 (0.91; 0.96), p < 0.0001), and birth weight per 100 g (aGMR 0.98 (0.97; 0.99), p = 0.0003), while cesarean delivery was associated with higher costs (aGMR = 1.30 (1.15; 1.47), p < 0.0001). In conclusion, common childhood illnesses are associated with significant health-related costs, which can potentially be reduced by targeting perinatal risk factors, including maternal diet during pregnancy, cesarean delivery, preterm birth and low birth weight.
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21
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Trends in Costs of Birth Hospitalization and Readmissions for Late Preterm Infants. CHILDREN-BASEL 2021; 8:children8020127. [PMID: 33578773 PMCID: PMC7916486 DOI: 10.3390/children8020127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 11/17/2022]
Abstract
Background: The objective is to study previously unexplored trends of birth hospitalization and readmission costs for late preterm infants (LPIs) in the United States between 2005 and 2016. Methods: We conducted a retrospective analysis of claims data to study healthcare costs of birth hospitalization and readmissions for LPIs compared to term infants (TIs) using a large private insurance database. We used a generalized linear regression model to study birth hospitalization and readmission costs. Results: A total of 2,123,143 infants were examined (93.2% TIs; 6.8% LPIs). The proportion of LPIs requiring readmission was 4.2% compared to 2.1% of TIs, (p < 0.001). The readmission rate for TIs decreased during the study period. LPIs had a higher mean cost of birth hospitalization (25,700 vs. 3300 USD; p < 0.001) and readmissions (25,800 vs. 14,300 USD; p < 0.001). For LPIs, birth hospitalization costs increased from 2007 to 2013, and decreased since 2014. Conversely, birth hospitalization costs of TIs steadily increased since 2005. The West region showed higher birth hospitalization costs for LPIs. Conclusions: LPIs continue to have a higher cost of birth hospitalization and readmission compared to TIs, but these costs have decreased since 2014. Standardization of birth hospitalization care for LPIs may reduce costs and improve quality of care and outcomes.
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22
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Doetsch JN, Marques SCS, Krafft T, Barros H. Impact of macro-socioeconomic determinants on sustainable perinatal health care in Portugal: a qualitative study on the opinion of healthcare professionals and experts. BMC Public Health 2021; 21:210. [PMID: 33494727 PMCID: PMC7836450 DOI: 10.1186/s12889-021-10194-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal. METHODS A qualitative approach was applied to receive an in-depth understanding and accomplish perspective variability. A purposive sampling technique was used. Semi-structured interviews were conducted with twenty-one healthcare professionals and experts between October 2018-July 2019. Inductive thematic analysis was performed which encompassed a five-step categorization procedure. Data analysis was undertaken by utilizing Nvivo2011 software. Evolved themes were then associated with WHO's Quality Standards on Maternal and New-born Care. A framework on the impact of macro-socioeconomic determinants on perinatal health care quality was developed. RESULTS Although participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was indeed adversely modified in all WHO Quality Standards. Health care provision was perceived as detrimental in five main areas: 1) Availability of human resources; 2) Functional referral systems; 3) Competent and motivated human resources; 4) Emotional support; and 5) Essential physical resources available. Policy reforms by the EAP resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for VPT/VLBW infants and their mothers. The EAP directly influenced working environment of healthcare professionals by causing stress, burnout, work absence, and brain drain. CONCLUSION An interrelation between macro-socioeconomic determinants and perinatal health care quality was disclosed. The economic crisis and EAP have adversely modified equitable perinatal health care quality for VPT/VLBW infants and their mothers. Our findings underlined the negative impact of austerity policies on vulnerable populations.
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Affiliation(s)
- Julia Nadine Doetsch
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-091, Porto, Portugal.
- Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
| | - Sandra C S Marques
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-091, Porto, Portugal
- Centro em Rede de Investigação em Antropologia (CRIA) - Instituto Universitário de Lisboa, Lisbon, Portugal
| | - Thomas Krafft
- Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-091, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
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Perinatal Outcomes Associated with Latency in Late Preterm Premature Rupture of Membranes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020672. [PMID: 33466859 PMCID: PMC7829907 DOI: 10.3390/ijerph18020672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 11/17/2022]
Abstract
This study aims to evaluate the perinatal outcomes of preterm premature rupture of membrane (PPROM) with latency periods at 33 + 0-36 + 6 weeks of gestation. This retrospective case-control study included women with singleton pregnancies who delivered at 33 + 0-36 + 6 weeks at Korea University Ansan Hospital in South Korea between 2006-2019. The maternal and neonatal characteristics were compared between different latency periods (expectant delivery ≥72 h vs. immediate delivery <72 h). Data were compared among 345 women (expectant, n = 39; immediate delivery, n = 306). There was no significant difference in maternal and neonatal morbidities between the groups, despite the younger gestational age in the expectant delivery group. Stratified by gestational weeks, the 34-week infants showed a statistically significant lower exposure to antenatal steroids (73.4% vs. 20.0%, p < 0.001), while the incidence of respiratory distress syndrome (12.8%) and the use of any respiratory support (36.8%) was higher than those in the 33-week infants, without significance. Our study shows that a prolonged latency period (≥72 h) did not increase maternal and neonatal morbidities, and a considerable number of preterm infants immediately delivered at 34 weeks experienced respiratory complications. Expectant management and antenatal corticosteroids should be considered in late preterm infants with PPROM.
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Abstract
Zusammenfassung. Theoretischer Hintergrund: Frühgeborene (FG) haben ein erhöhtes langfristiges Entwicklungsrisiko. Dennoch gibt es in Deutschland kein konzertiertes Vorgehen zur Nachsorge bis ins Schulalter. Die heutigen Erkenntnisse zu Entwicklungsstörungen sind Grundlage einer qualifizierten Förderung. Fragestellung: Wie hoch sind Schulrückstellungsraten bei FG? Wie wird den schulischen Bedürfnissen FG Rechnung getragen? Methode: Evaluation der Schulrückstellung in einer aktuellen Kohorte sehr kleiner FG und qualitative Befragung von Lehrer_innen. Ergebnisse: Das Risiko für Schulrückstellungen ist bei FG erhöht. Lehrer_innen haben ein limitiertes Wissen zu Bedürfnissen FG und gleichzeitig hilfreiche Vorschläge für spezifische Förderung im Unterricht. Diskussion und Schlussfolgerung: Langfristige entwicklungsneurologische Nachsorge für FG ist dringend empfohlen, um potenzielle Probleme früh zu identifizieren, Interventionen zu initiieren und eine optimale Entfaltung des Entwicklungspotentials zu fördern.
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Affiliation(s)
- Britta Maria Hüning
- Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Klinik für Kinderheilkunde I, Universitätsklinikum Essen
| | - Julia Jäkel
- Department of Child and Family Studies, Department of Psychology, University of Tennessee, Knoxville, USA
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Jing S, Chen C, Gan Y, Vogel J, Zhang J. Incidence and trend of preterm birth in China, 1990-2016: a systematic review and meta-analysis. BMJ Open 2020; 10:e039303. [PMID: 33310797 PMCID: PMC7735132 DOI: 10.1136/bmjopen-2020-039303] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/19/2020] [Accepted: 11/24/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To update the WHO estimate of preterm birth rate in China in 1990-2016 and to further explore variations by geographic regions and years of occurrence. DESIGN Systematic review and meta-analysis. DATA SOURCES Pubmed, Embase, Cochrane Library and Sinomed databases were searched from 1990 to 2018. ELIGIBILITY CRITERIA Studies were included if they provided preterm birth data with at least 500 total births. Reviews, case-control studies, intervention studies and studies with insufficient information or published before 1990 were excluded. We estimated pooled incidence of preterm birth by a random effects model, and preterm birth rate in different year, region and by livebirths or all births in subgroup analyses. RESULTS Our search identified 3945 records. After the removal of duplicates and screening of titles and abstracts, we reviewed 254 studies in full text and excluded 182, leaving 72 new studies. They were combined with the 82 studies included in the WHO report (154 studies, 187 data sets in total for the meta-analysis), including 24 039 084 births from 1990 to 2016. The pooled incidence of preterm birth in China was 6.09% (95% CI 5.86% to 6.31%) but has been steadily increasing from 5.36% (95% CI 4.89% to 5.84%) in 1990-1994 to 7.04% (95% CI 6.09% to 7.99%) in 2015-2016. The annual rate of increase was about 1.05% (95% CI 0.85% to 1.21%). Northwest China appeared to have the highest preterm birth rate (7.3%, 95% CI 4.92% to 9.68% from 1990 to 2016). CONCLUSIONS The incidence of preterm birth in China has been rising gradually in the past three decades. It was 7% in 2016. Preterm birth rate varied by region with the West having the highest occurrence.
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Affiliation(s)
- Shiwen Jing
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuexin Gan
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Joshua Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Jun Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Huntington S, Weston G, Seedat F, Marshall J, Bailey H, Tebruegge M, Ahmed I, Turner K, Adams E. Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis. BMJ Open 2020; 10:e038505. [PMID: 33444184 PMCID: PMC7678359 DOI: 10.1136/bmjopen-2020-038505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women. DESIGN A decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results. SETTING UK antenatal screening programme. POPULATION Hypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses. RESULTS Base case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494. CONCLUSIONS Universal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.
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Affiliation(s)
| | | | - Farah Seedat
- UK National Screening Committee, Public Health England, London, UK
| | - John Marshall
- UK National Screening Committee, Public Health England, London, UK
| | - Heather Bailey
- UCL Institute for Global Health, University College London, London, UK
| | - Marc Tebruegge
- Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK
- Department of Paediatrics, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | - Katy Turner
- School of Veterinary Science, University of Bristol, Bristol, UK
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Qiu H, Qian T, Wu T, Wang X, Zhu C, Chen C, Wang L. Umbilical cord blood cells for the treatment of preterm white matter injury: Potential effects and treatment options. J Neurosci Res 2020; 99:778-792. [PMID: 33207392 DOI: 10.1002/jnr.24751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/31/2022]
Abstract
Preterm birth is a global public health problem. A large number of preterm infants survive with preterm white matter injury (PWMI), which leads to neurological deficits, and has multifaceted etiology, clinical course, monitoring, and outcomes. The principal upstream insults leading to PWMI initiation are hypoxia-ischemia and infection and/or inflammation and the key target cells are late oligodendrocyte precursor cells. Current PWMI treatments are mainly supportive, and thus have little effect in terms of protecting the immature brain or repairing injury to improve long-term outcomes. Umbilical cord blood (UCB) cells comprise abundant immunomodulatory and stem cells, which have the potential to reduce brain injury, mainly due to anti-inflammatory and immunomodulatory mechanisms, and also through their release of neurotrophic or growth factors to promote endogenous neurogenesis. In this review, we briefly summarize PWMI pathogenesis and pathophysiology, and the specific properties of different cell types in UCB. We further explore the potential mechanism by which UCB can be used to treat PWMI, and discuss the advantages of and potential issues related to UCB cell therapy. Finally, we suggest potential future studies of UCB cell therapy in preterm infants.
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Affiliation(s)
- Han Qiu
- Key Laboratory of Neonatal Diseases of Health Commission of the People's Republic of China, Shanghai, China.,Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China
| | - Tianyang Qian
- Key Laboratory of Neonatal Diseases of Health Commission of the People's Republic of China, Shanghai, China.,Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China
| | - Tong Wu
- Key Laboratory of Neonatal Diseases of Health Commission of the People's Republic of China, Shanghai, China.,Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoyang Wang
- Center of Perinatal Medicine and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Changlian Zhu
- Center of Perinatal Medicine and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Chao Chen
- Key Laboratory of Neonatal Diseases of Health Commission of the People's Republic of China, Shanghai, China.,Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China
| | - Laishuan Wang
- Key Laboratory of Neonatal Diseases of Health Commission of the People's Republic of China, Shanghai, China.,Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China
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Tahir W, Monahan M, Dorling J, Hewer O, Bowler U, Linsell L, Partlett C, Berrington JE, Boyle E, Embleton N, Johnson S, Leaf A, McCormick K, McGuire W, Stenson BJ, Juszczak E, Roberts TE. Economic evaluation alongside the Speed of Increasing milk Feeds Trial (SIFT). Arch Dis Child Fetal Neonatal Ed 2020; 105:587-592. [PMID: 32241810 PMCID: PMC7592357 DOI: 10.1136/archdischild-2019-318346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of two rates of enteral feed advancement (18 vs 30 mL/kg/day) in very preterm and very low birth weight infants. DESIGN Within-trial economic evaluation alongside a multicentre, two-arm parallel group, randomised controlled trial (Speed of Increasing milk Feeds Trial). SETTING 55 UK neonatal units from May 2013 to June 2015. PATIENTS Infants born <32 weeks' gestation or <1500 g, receiving less than 30 mL/kg/day of milk at trial enrolment. Infants with a known severe congenital anomaly, no realistic chance of survival, or unlikely to be traceable for follow-up, were ineligible. INTERVENTIONS When clinicians were ready to start advancing feed volumes, infants were randomised to receive daily increments in feed volume of 30 mL/kg (intervention) or 18 mL/kg (control). MAIN OUTCOME MEASURE Cost per additional survivor without moderate to severe neurodevelopmental disability at 24 months of age corrected for prematurity. RESULTS Average costs per infant were slightly higher for faster feeds compared with slower feeds (mean difference £267, 95% CI -6928 to 8117). Fewer infants achieved the principal outcome of survival without moderate to severe neurodevelopmental disability at 24 months in the faster feeds arm (802/1224 vs 848/1246). The stochastic cost-effectiveness analysis showed a likelihood of worse outcomes for faster feeds compared with slower feeds. CONCLUSIONS The stochastic cost-effectiveness analysis shows faster feeds are broadly equivalent on cost grounds. However, in terms of outcomes at 24 months age (corrected for prematurity), faster feeds are harmful. Faster feeds should not be recommended on either cost or effectiveness grounds to achieve the primary outcome.
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Affiliation(s)
| | | | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Dalhousie University—Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Oliver Hewer
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Ursula Bowler
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Louise Linsell
- National Perinatal epidemiology Unit, University of Oxford, Oxford, UK
| | - Christopher Partlett
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | | | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | | | - Alison Leaf
- Neonatal Medicine, Southmead Hospital, Bristol, UK
| | | | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | - Ben J Stenson
- Neonatology, Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ed Juszczak
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tracy E Roberts
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Varley-Campbell J, Mújica-Mota R, Coelho H, Ocean N, Barnish M, Packman D, Dodman S, Cooper C, Snowsill T, Kay T, Liversedge N, Parr M, Knight L, Hyde C, Shennan A, Hoyle M. Three biomarker tests to help diagnose preterm labour: a systematic review and economic evaluation. Health Technol Assess 2020; 23:1-226. [PMID: 30917097 DOI: 10.3310/hta23130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Preterm birth may result in short- and long-term health problems for the child. Accurate diagnoses of preterm births could prevent unnecessary (or ensure appropriate) admissions into hospitals or transfers to specialist units. OBJECTIVES The purpose of this report is to assess the test accuracy, clinical effectiveness and cost-effectiveness of the diagnostic tests PartoSure™ (Parsagen Diagnostics Inc., Boston, MA, USA), Actim® Partus (Medix Biochemica, Espoo, Finland) and the Rapid Fetal Fibronectin (fFN)® 10Q Cassette Kit (Hologic, Inc., Marlborough, MA, USA) at thresholds ≠50 ng/ml [quantitative fFN (qfFN)] for women presenting with signs and symptoms of preterm labour relative to fFN at 50 ng/ml. METHODS Systematic reviews of the published literature were conducted for diagnostic test accuracy (DTA) studies of PartoSure, Actim Partus and qfFN for predicting preterm birth, the clinical effectiveness following treatment decisions informed by test results and economic evaluations of the tests. A model-based economic evaluation was also conducted to extrapolate long-term outcomes from the results of the diagnostic tests. The model followed the structure of the model that informed the 2015 National Institute for Health and Care Excellence guidelines on preterm labour diagnosis and treatment, but with antenatal steroids use, as opposed to tocolysis, driving health outcomes. RESULTS Twenty studies were identified evaluating DTA against the reference standard of delivery within 7 days and seven studies were identified evaluating DTA against the reference standard of delivery within 48 hours. Two studies assessed two of the index tests within the same population. One study demonstrated that depending on the threshold used, qfFN was more or less accurate than Actim Partus, whereas the other indicated little difference between PartoSure and Actim Partus. No study assessing qfFN and PartoSure in the same population was identified. The test accuracy results from the other included studies revealed a high level of uncertainty, primarily attributable to substantial methodological, clinical and statistical heterogeneity between studies. No study compared all three tests simultaneously. No clinical effectiveness studies evaluating any of the three biomarker tests were identified. One partial economic evaluation was identified for predicting preterm birth. It assessed the number needed to treat to prevent a respiratory distress syndrome case with a 'treat-all' strategy, relative to testing with qualitative fFN. Because of the lack of data, our de novo model involved the assumption that management of pregnant women fully adhered to the results of the tests. In the base-case analysis for a woman at 30 weeks' gestation, Actim Partus had lower health-care costs and fewer quality-adjusted life-years (QALYs) than qfFN at 50 ng/ml, reducing costs at a rate of £56,030 per QALY lost compared with qfFN at 50 ng/ml. PartoSure is less costly than Actim Partus while being equally effective, but this is based on diagnostic accuracy data from a small study. Treatment with qfFN at 200 ng/ml and 500 ng/ml resulted in lower cost savings per QALY lost relative to fFN at 50 ng/ml than treatment with Actim Partus. In contrast, qfFN at 10 ng/ml increased QALYs, by 0.002, and had a cost per QALY gained of £140,267 relative to fFN at 50 ng/ml. Similar qualitative results were obtained for women presenting at different gestational ages. CONCLUSION There is a high degree of uncertainty surrounding the test accuracy and cost-effectiveness results. We are aware of four ongoing UK trials, two of which plan to enrol > 1000 participants. The results of these trials may significantly alter the findings presented here. STUDY REGISTRATION The study is registered as PROSPERO CRD42017072696. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rubén Mújica-Mota
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Neel Ocean
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Max Barnish
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - David Packman
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sophie Dodman
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK.,Health Economics Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tracey Kay
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Michelle Parr
- Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Lisa Knight
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Martin Hoyle
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
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Montefiori M, Pasquarella M, Petralia P. The effectiveness of the neonatal diagnosis-related group scheme. PLoS One 2020; 15:e0236695. [PMID: 32785282 PMCID: PMC7423098 DOI: 10.1371/journal.pone.0236695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 07/11/2020] [Indexed: 11/19/2022] Open
Abstract
The goal of this study is to investigate the effectiveness of the neonatal diagnosis-related group scheme in patients affected by respiratory distress syndrome. The variable costs of individual patients in the same group are examined. This study uses the data of infants (N = 243) hospitalized in the Neonatal Intensive Care Unit of the Gaslini Children's Hospital in Italy in 2016. The care unit's operating and management costs are employed to estimate the average cost per patient. Operating costs include those related to personnel, drugs, medical supplies, treatment tools, examinations, radiology, and laboratory services. Management costs relate to administration, maintenance, and depreciation cost of medical equipment. Cluster analysis and Tobit regression are employed, allowing for the assessment of the total cost per patient per day taking into account the main cost determinants: birth weight, gestational age, and discharge status. The findings highlight great variability in the costs for patients in the same diagnosis-related group, ranging from a minimum of €267 to a maximum of €265,669. This suggests the inefficiency of the diagnosis-related group system. Patients with very low birth weight incurred costs approximately twice the reimbursement set by the policy; a loss of €36,420 is estimated for every surviving baby with a birth weight lower than 1,170 grams. On the contrary, at term, newborns cost about €20,000 less than the diagnosis-related group reimbursement. The actual system benefits hospitals that mainly treat term infants with respiratory distress syndrome and penalizes hospitals taking care of very low birth weight patients. As a result, strategic behavior and "up-coding" might occur. We conduct a cluster analysis that suggests a birth weight adjustment to determine new fees that would be fairer than the current costs.
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Adu-Bonsaffoh K, Oppong SA, Dassah ET, Seffah JD. Challenges in preterm birth research: Ghanaian perspective. Placenta 2020; 98:24-28. [PMID: 33039028 DOI: 10.1016/j.placenta.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 01/30/2023]
Abstract
Preterm birth is highly prevalent in Ghana. It is a major public health concern because of the high burden as well as the associated immediate and long-term consequences including increased healthcare cost. Studies conducted in high-income countries may not be sufficiently generalizable in our context. Locally generated evidence-based interventions will be indispensable in improving the clinical management and prevention of preterm birth in the country. However, there are limited published literature on preterm birth and prematurity in the country. This review seeks to discuss the major challenges associated with preterm birth research in Ghana and proposes evidence-based strategies to improve biomedical and epidemiological research on preterm birth and prematurity. The limited high quality preterm birth research is partly attributable to a variety of challenges related to accurate gestational age estimation, research training, capacity and support including funding, efficient ethics committees, local and international collaboration as well as effective health management information systems. Other related challenges include unavailability of reliable internet connectivity, poor compensation for researchers and lack of conductive research environment. There is the need to expedite advocacy on implementation of practical interventions and strategies aimed at increasing high quality research in the area of preterm birth and prematurity in the country. A paradigm shift in preterm birth research with appropriate integration of concerted multidisciplinary research groups should be constituted to put basic science research to clinical practice as well as the prevention of preterm birth in the country.
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Affiliation(s)
- K Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
| | - S A Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - E T Dassah
- School of Public Health, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Obstetrics & Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - J D Seffah
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Shea E, Perera F, Mills D. Towards a fuller assessment of the economic benefits of reducing air pollution from fossil fuel combustion: Per-case monetary estimates for children's health outcomes. ENVIRONMENTAL RESEARCH 2020; 182:109019. [PMID: 31838408 PMCID: PMC7024643 DOI: 10.1016/j.envres.2019.109019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Impacts on children's health are under-represented in benefits assessments of policies related to ambient air quality and climate change. To complement our previous compilation of concentration-response (C-R) functions for a number of children's health outcomes associated with air pollution, we provide per-case monetary estimates of the same health outcomes. OBJECTIVES Our goal was to establish per-case monetary estimates for a suite of prevalent children's health outcomes (preterm birth, low birth weight, asthma, autism spectrum disorder, attention-deficit/hyperactivity disorder, and IQ reduction) that can be incorporated into benefits assessments of air pollution regulations and climate change mitigation policies. METHODS We conducted a systematic review of the literature published between January 1, 2000 and June 30, 2018 to identify relevant economic costs for these six adverse health outcomes in children. We restricted our literature search to studies published in the U.S., with a supplemental consideration of studies from the U.K. and prioritized literature reviews with summary cost estimates and papers that provided lifetime cost of illness estimates. RESULTS Our literature search and evaluation process reviewed 1065 papers and identified 12 most relevant papers on per-case monetary estimates for preterm birth, low birth weight, asthma, autism spectrum disorder, and attention-deficit/hyperactivity disorder. Details are presented in full. We separately identified estimates of the lost lifetime earnings associated with the loss of a single IQ point. The final per-case cost estimates for each outcome were selected based on the most robust evidence. These estimates range from $23,573 for childhood asthma not persisting into adulthood to $3,109,096 for a case of autism with a concurrent intellectual disability. CONCLUSION To our knowledge, this is the first time that the child-specific health outcomes of preterm birth, low birth weight, asthma, autism spectrum disorder, attention-deficit/hyperactivity disorder, and IQ reduction have been systematically valued and presented in one place. This is an important addition to the body of health-related valuation literature as these outcomes have substantial economic costs that are not considered in most assessments of the benefits of air pollution and climate mitigation policies. In general, however, the available per-case estimates presented here did not incorporate the broad societal and long-term costs and are likely underestimates. Although our context has been air pollution and climate policies, the per-case monetary estimates presented here can be applied to other environmental exposures. Fuller assessments of health benefits to children and their corresponding economic gains will improve decision-making on environmental policy.
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Affiliation(s)
- E Shea
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - F Perera
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - D Mills
- Peak to Peak Economics, LLC, Boulder, CO, USA.
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Karnati S, Kollikonda S, Abu-Shaweesh J. Late preterm infants - Changing trends and continuing challenges. Int J Pediatr Adolesc Med 2020; 7:36-44. [PMID: 32373701 PMCID: PMC7193066 DOI: 10.1016/j.ijpam.2020.02.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Late preterm infants, defined as newborns born between 340/7-366/7 weeks of gestational age, constitute a unique group among all premature neonates. Often overlooked because of their size when compared to very premature infants, this population is still vulnerable because of physiological and structural immaturity. Comprising nearly 75% of babies born less than 37 weeks of gestation, late preterm infants are at increased risk for morbidities involving nearly every organ system as well as higher risk of mortality when compared to term neonates. Neurodevelopmental impairment has especially been a concern for these infants. Due to various reasons, the rate of late preterm births continue to rise worldwide. Caring for this high risk population contributes a significant financial burden to health systems. This article reviews recent trends in regarding rate of late preterm births, common morbidities and long term outcomes with special attention to neurodevelopmental outcomes.
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Affiliation(s)
- Sreenivas Karnati
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
| | - Swapna Kollikonda
- Department of Obstetrics and Gynecology, Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jalal Abu-Shaweesh
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
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Hrabalkova L, Takahashi T, Kemp MW, Stock SJ. Antenatal Corticosteroids for Fetal Lung Maturity - Too Much of a Good Thing? Curr Pharm Des 2020; 25:593-600. [PMID: 30914016 DOI: 10.2174/1381612825666190326143814] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/22/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Between 5-15% of babies are born prematurely worldwide, with preterm birth defined as delivery before 37 completed weeks of pregnancy (term is at 40 weeks of gestation). Women at risk of preterm birth receive antenatal corticosteroids as part of standard care to accelerate fetal lung maturation and thus improve neonatal outcomes in the event of delivery. As a consequence of this treatment, the entire fetal organ system is exposed to the administered corticosteroids. The implications of this exposure, particularly the long-term impacts on offspring health, are poorly understood. AIMS This review will consider the origins of antenatal corticosteroid treatment and variations in current clinical practices surrounding the treatment. The limitations in the evidence base supporting the use of antenatal corticosteroids and the evidence of potential harm to offspring are also summarised. RESULTS Little has been done to optimise the dose and formulation of antenatal corticosteroid treatment since the first clinical trial in 1972. International guidelines for the use of the treatment lack clarity regarding the recommended type of corticosteroid and the gestational window of treatment administration. Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice. Lastly, there is limited evidence regarding the long-term effects on the different fetal organ systems exposed in utero, particularly when the timing of corticosteroid administration is sub-optimal. CONCLUSION Further investigations are urgently needed to determine the most safe and effective treatment regimen for antenatal corticosteroids, particularly regarding the type of corticosteroid and optimal gestational window of administration. A clear consensus on the use of this common treatment could maximise the benefits and minimise potential harms to offspring.
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Affiliation(s)
- Lenka Hrabalkova
- Tommy's Centre for Maternal and Fetal Health at the MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Matthew W Kemp
- Tohoku University Hospital, Sendai, Miyagi, Japan.,Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia
| | - Sarah J Stock
- Tommy's Centre for Maternal and Fetal Health at the MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
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Chen C, Zhang JW, Xia HW, Zhang HX, Betran AP, Zhang L, Hua XL, Feng LP, Chen D, Sun K, Guo CM, Qi HB, Duan T, Zhang J. Preterm Birth in China Between 2015 and 2016. Am J Public Health 2019; 109:1597-1604. [PMID: 31536409 DOI: 10.2105/ajph.2019.305287] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To describe the incidence, risk factors, and potential causes of preterm birth (PTB) in China between 2015 and 2016.Methods. The China Labor and Delivery Survey was a population-based multicenter study conducted from 2015 to 2016. We assigned each birth a weight based on the sampling frame. We calculated the incidence of PTB and the multivariable logistic regression, and we used 2-step cluster analysis to examine the relationships between PTB and maternal, fetal, and placental conditions.Results. The weighted nationwide incidence of PTB was 7.3% of all births and 6.7% of live births at 24 or more weeks of gestation. Of the PTBs, 70.5% were born after 34 weeks and 42.7% were iatrogenic. Nearly two thirds of all preterm births were attributable to maternal, fetal, or placental conditions, and one third had unknown etiology.Conclusions. This study provided information on the incidence of PTB in China and identified several factors associated with PTB. The high frequency of iatrogenic PTB calls for a careful assessment and prudent management of such pregnancies, as PTB has short- and long-term health consequences.
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Affiliation(s)
- Chang Chen
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Jin Wen Zhang
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Hong Wei Xia
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Hui Xin Zhang
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Ana Pilar Betran
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Lin Zhang
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Xiao Lin Hua
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Li Ping Feng
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Dan Chen
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Kang Sun
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Chun Ming Guo
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Hong Bo Qi
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Tao Duan
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
| | - Jun Zhang
- Chang Chen, Jin Wen Zhang, Dan Chen, Chun Ming Guo, and Jun Zhang are with the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Hui Xin Zhang is with the Department of Obstetrics, Fourth Hospital of Hebei Medical University, Hebei, China. Ana Pilar Betran is with the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. Lin Zhang and Xiao Lin Hua are with the Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Li Ping Feng is with the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Kang Sun is with the Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Hong Bo Qi is with the Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Tao Duan is with the Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai
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Carter RA, Pan K, Harville EW, McRitchie S, Sumner S. Metabolomics to reveal biomarkers and pathways of preterm birth: a systematic review and epidemiologic perspective. Metabolomics 2019; 15:124. [PMID: 31506796 PMCID: PMC7805080 DOI: 10.1007/s11306-019-1587-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Most known risk factors for preterm birth, a leading cause of infant morbidity and mortality, are not modifiable. Advanced molecular techniques are increasingly being applied to identify biomarkers and pathways important in disease development and progression. OBJECTIVES We review the state of the literature and assess it from an epidemiologic perspective. METHODS PubMed, Embase, CINAHL, and Cochrane Central were searched on January 31, 2019 for original articles published after 1998 that utilized an untargeted metabolomic approach to identify markers of preterm birth. Eligible manuscripts were peer-reviewed and included original data from untargeted metabolomics analyses of maternal tissue derived from human studies designed to determine mechanisms and predictors of preterm birth. RESULTS Of 2823 results, 14 articles met the inclusion requirements. There was little consistency in study design, outcome definition, type of biospecimen, or the inclusion of covariates and confounding factors, and few consistent associations with metabolites were identified in this review. CONCLUSION Studies to date on metabolomic predictors of preterm birth are highly heterogeneous in both methodology and resulting metabolite identification. There is an urgent need for larger studies in well-defined populations, to determine biomarkers predictive of preterm birth, and to reveal mechanisms and targets for development of intervention strategies.
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Affiliation(s)
- R A Carter
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - K Pan
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA.
| | - E W Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - S McRitchie
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC, 28081, USA
| | - S Sumner
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC, 28081, USA
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Gyamfi-Bannerman C, Zupancic JAF, Sandoval G, Grobman WA, Blackwell SC, Tita ATN, Reddy UM, Jain L, Saade GR, Rouse DJ, Iams JD, Clark EAS, Thorp JM, Chien EK, Peaceman AM, Gibbs RS, Swamy GK, Norton ME, Casey BM, Caritis SN, Tolosa JE, Sorokin Y, VanDorsten JP. Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery: A Secondary Analysis of a Randomized Clinical Trial. JAMA Pediatr 2019; 173:462-468. [PMID: 30855640 PMCID: PMC6503503 DOI: 10.1001/jamapediatrics.2019.0032] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/01/2019] [Indexed: 01/12/2023]
Abstract
Importance Administration of corticosteroids to women at high risk for delivery in the late preterm period (34-36 weeks' gestation) improves short-term neonatal outcomes. The cost implications of this intervention are not known. Objective To compare the cost-effectiveness of treatment with antenatal corticosteroids with no treatment for women at risk for late preterm delivery. Design, Setting, and Participants This secondary analysis of the Antenatal Late Preterm Steroids trial, a multicenter randomized clinical trial of antenatal corticosteroids vs placebo in women at risk for late preterm delivery conducted from October 30, 2010, to February 27, 2015. took a third-party payer perspective. Maternal costs were based on Medicaid rates and included those of betamethasone, as well as the outpatient visits or inpatient stay required to administer betamethasone. All direct medical costs for newborn care were included. For infants admitted to the neonatal intensive care unit, comprehensive daily costs were stratified by the acuity of respiratory illness. For infants admitted to the regular newborn nursery, nationally representative cost estimates from the literature were used. Effectiveness was measured as the proportion of infants without the primary outcome of the study: a composite of treatment in the first 72 hours of continuous positive airway pressure or high-flow nasal cannula for 2 hours or more, supplemental oxygen with a fraction of inspired oxygen of 30% or more for 4 hours or more, and extracorporeal membrane oxygenation or mechanical ventilation. This secondary analysis was initially started in June 2016 and revision of the analysis began in May 2017. Exposures Betamethasone treatment. Main Outcomes and Measures Incremental cost-effectiveness ratio. Results Costs were determined for 1426 mother-infant pairs in the betamethasone group (mean [SD] maternal age, 28.6 [6.3] years; 827 [58.0%] white) and 1395 mother-infant pairs in the placebo group (mean [SD] maternal age, 27.9 [6.2] years; 794 [56.9%] white). Treatment with betamethasone was associated with a total mean (SD) woman-infant-pair cost of $4681 ($5798), which was significantly less than the mean (SD) amount of $5379 ($8422) for women and infants in the placebo group (difference, $698; 95% CI, $186-$1257; P = .02). The Antenatal Late Preterm Steroids trial determined that betamethasone use is effective: respiratory morbidity decreased by 2.9% (95% CI, -0.5% to -5.4%). Thus, the cost-effectiveness ratio was -$23 986 per case of respiratory morbidity averted. Inspection of the bootstrap replications confirmed that treatment was the dominant strategy in 5000 samples (98.8%). Sensitivity analyses showed that these results held under most assumptions. Conclusions and Relevance The findings suggest that antenatal betamethasone treatment is associated with a statistically significant decrease in health care costs and with improved outcomes; thus, this treatment may be an economically desirable strategy.
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Affiliation(s)
- Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - John A. F. Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Grecio Sandoval
- George Washington University Biostatistics Center, Washington, DC
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Sean C. Blackwell
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Children’s Memorial Hermann Hospital, Houston
| | - Alan T. N. Tita
- Department of Obstetrics and Gynecology, University of Alabama, Birmingham
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Lucky Jain
- Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia
| | - George R. Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Jay D. Iams
- Department of Obstetrics and Gynecology, Ohio State University, Columbus
| | - Erin A. S. Clark
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City
| | - John M. Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Edward K. Chien
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Alan M. Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Ronald S. Gibbs
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Geeta K. Swamy
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Mary E. Norton
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Brian M. Casey
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - Steve N. Caritis
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jorge E. Tolosa
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - J. Peter VanDorsten
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston
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Petrou S, Yiu HH, Kwon J. Economic consequences of preterm birth: a systematic review of the recent literature (2009-2017). Arch Dis Child 2019; 104:456-465. [PMID: 30413489 DOI: 10.1136/archdischild-2018-315778] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite extensive knowledge on the functional, neurodevelopmental, behavioural and educational sequelae of preterm birth, relatively little is known about its economic consequences. OBJECTIVE To systematically review evidence around the economic consequences of preterm birth for the health services, for other sectors of the economy, for families and carers, and more broadly for society. METHODS Updating previous reviews, systematic searches of Medline, EconLit, Web of Science, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase and Scopus were performed using broad search terms, covering the literature from 1 January 2009 to 28 June 2017. Studies reporting economic consequences, published in the English language and conducted in a developed country were included. Economic consequences are presented in a descriptive manner according to study time horizon, cost category and differential denominators (live births or survivors). RESULTS Of 4384 unique articles retrieved, 43 articles met the inclusion criteria. Of these, 27 reported resource use or cost estimates associated with the initial period of hospitalisation, while 26 reported resource use or costs incurred following the initial hospital discharge, 10 of which also reported resource use or costs associated with the initial period of hospitalisation. Only two studies reported resource use or costs incurred throughout the childhood years. Initial hospitalisation costs varied between $576 972 (range $111 152-$576 972) per infant born at 24 weeks' gestation and $930 (range $930-$7114) per infant born at term (US$, 2015 prices). The review also revealed a consistent inverse association between gestational age at birth and economic costs regardless of date of publication, country of publication, underpinning study design, follow-up period, age of assessment or costing approach, and a paucity of evidence on non-healthcare costs. Several categories of economic costs, such as additional costs borne by families as a result of modifications to their everyday activities, are largely overlooked by this body of literature. Moreover, the number and coverage of economic assessments have not increased in comparison with previous review periods. CONCLUSION Evidence identified by this review can be used to inform clinical and budgetary service planning and act as data inputs into future economic evaluations of preventive or treatment interventions. Future research should focus particularly on valuing the economic consequences of preterm birth in adulthood.
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Affiliation(s)
- Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hei Hang Yiu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Joseph Kwon
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Adu-Bonsaffoh K, Gyamfi-Bannerman C, Oppong S, Seffah J. Determinants and outcomes of preterm births at a tertiary hospital in Ghana. Placenta 2019; 79:62-67. [DOI: 10.1016/j.placenta.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
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Rüdiger M, Heinrich L, Arnold K, Druschke D, Reichert J, Schmitt J. Impact of birthweight on health-care utilization during early childhood - a birth cohort study. BMC Pediatr 2019; 19:69. [PMID: 30823910 PMCID: PMC6397462 DOI: 10.1186/s12887-019-1424-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/31/2019] [Indexed: 11/15/2022] Open
Abstract
Background Comprehensive data are needed to evaluate the burden of low birthweight. Analysis of routine data on health-care utilization during early childhood were used to test the hypothesis that infants with low birthweight have (i) increased inpatient health-care utilization, (ii) higher hospital costs and (iii) different morbidity pattern in early childhood when compared with normal birthweight infants. Methods Children born between 2007 and 2013 that were insured at birth with the statutory health insurance AOK PLUS were included (N = 118,166, equaling 49% of the Saxon newborns) and classified into very low (< 1500 g, VLBW), low (1500-2499 g, LBW) birthweight and reference group (> 2500 g). Outcomes were: inpatient health-care utilization quantified by number and length of hospital stays; costs of hospitalizations including medication; reasons of hospitalizations for each year of life (YOL). Results 72, 38 and 22% of VLBW-, LBW- and reference group were hospitalized after perinatal period within the first YOL with a more than 5-fold increased risk in VLBW to be hospitalized for hemangioma, convulsions, hydrocephalus, hernia and respiratory problems. Median (IQR) cumulative cost of inpatient care during the first four YOLs was 2953 (1213-7885), 1331 (0–3451) and 0 (0–2062) Euro for respective groups. Inpatient early childhood health-care utilization (after first YOL) was higher in VLBW compared to healthy, normal birth weight infants (RR 3.92 [95%-CI 3.63, 4.23]), residents of rural areas (RR 1.37 [95%-CI 1.35, 1.40]) and in boys (RR 1.31 [95%-CI 1.29, 1.33]). Conclusion This large population-based birth-cohort study indicates a high clinical and economic burden of low birthweight which is not restricted to the first year of life. Electronic supplementary material The online version of this article (10.1186/s12887-019-1424-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mario Rüdiger
- Department for Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Luise Heinrich
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Katrin Arnold
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Diana Druschke
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jörg Reichert
- Department for Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Muganthan T, Boyle EM. Early childhood health and morbidity, including respiratory function in late preterm and early term births. Semin Fetal Neonatal Med 2019; 24:48-53. [PMID: 30348617 DOI: 10.1016/j.siny.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Late preterm (LP) and early term (ET) infants have generally been considered in the same way as their healthy full term (FT) counterparts. It is only in the last decade that an increased risk of later poor health in children born LP has been recognised; evidence for health outcomes following ET birth is still emerging. However, reports are largely consistent in highlighting an increased risk, which lessens approaching FT but is measurable and persists into adolescence and beyond. The most thoroughly explored area to date is respiratory morbidity. This article reviews the body of available evidence for effects of LP birth on pulmonary function and ongoing morbidity, and other areas where an increased risk of health problems has been identified in this population. Implications for delivery of health care are considered and areas for further research are highlighted.
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Affiliation(s)
- Trishula Muganthan
- Neonatal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Elaine M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Abstract
Despite an increasing body of knowledge on the adverse clinical sequelae associated with late preterm birth and early term birth, little is known about their economic consequences or the cost-effectiveness of interventions aimed at their prevention or alleviation of their effects. This review assesses the health economic evidence surrounding late preterm and early term birth. Evidence is gathered on hospital resource use associated with late preterm and early term birth, economic costs associated with late preterm and early term birth, and economic evaluations of prevention and treatment strategies. The article highlights the limited perspective and time horizon of most studies of economic costs in this area; the limited evidence surrounding health economic aspects of early term birth; the gaps in current knowledge; and it discusses directions for future research in this area, including the need for validated tools for measuring preference-based health-related quality-of-life outcomes in infants that will aid cost-effectiveness-based decision-making.
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Quantifying the Impact of Common Feeding Interventions on Nutritive Sucking Performance Using a Commercially Available Smart Bottle. J Perinat Neonatal Nurs 2019; 33:331-339. [PMID: 31651627 DOI: 10.1097/jpn.0000000000000435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An estimated 25% to 40% of infants experience difficulties with learning to breast- or bottle-feed. Yet, guidelines and evidence-based support for common feeding practices are limited. The objective of this case report was to quantify the impact of feeding interventions on nutritive sucking performance after discharge in an outpatient setting. This observational case series involved 2 infants. To determine the impact of cumulative interventions, pre- and postintervention effect sizes were calculated. Sucking performance metrics of interest included nipple movement peak sucking amplitude, duration, frequency, and smoothness. Interventions included positional changes and changes in nipple flow rate, among others. For both infants, cumulative interventions had the greatest impact on suck frequency; postintervention, infants were able to increase their rate of nutritive sucking per burst. Other aspects of sucking performance were differentially impacted for each baby. Researchers agree that neonatal and infant feeding has been understudied and that the evidence for common interventions needs to be strengthened. We have demonstrated the implementation of readily available technology that can be used to quantify the direct impact of any intervention on actual sucking performance. In doing so, we can individualize care to support skill development and improve outcomes for infants at risk for ongoing feeding challenges.
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Lind A, Dahlgren J, Raffa L, Allvin K, Ghazi Mroué D, Andersson Grönlund M. Visual Function and Fundus Morphology in Relation to Growth and Cardiovascular Status in 10-Year-Old Moderate-to-Late Preterm Children. Am J Ophthalmol 2018; 195:121-130. [PMID: 30081018 DOI: 10.1016/j.ajo.2018.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To study visual function and ocular fundus morphology in relation to growth, metabolic status, and blood pressure in moderate-to-late preterm (MLP) children at 10 years of age. DESIGN Prospective cohort study. METHODS In this population-based observational study, nonsyndromic MLP children born in Gothenburg, Sweden, were examined neonatally in the years 2002-2003 concerning length, weight, head circumference, and insulin-like growth factor I (IGF-I). At 10 years of age, 33 children (10 girls) were examined regarding previously mentioned variables, and regarding visual acuity, refraction, fundus morphology, IGF binding protein 3, leptin, adiponectin, and blood pressure. An age- and sex-matched control group consisted of 28 children (9 girls). RESULTS Myopia was more commonly found in MLP children than in controls (P = .004, 95% CI 1.8 to 49.8). The MLP group had smaller optic disc area (P = .01, 95% CI -0.5 to -0.1), smaller rim area (P = .001, 95% CI -0.5 to -0.2), fewer branching points (P = .0001, 95% CI -5.7 to -2.1), and higher index of tortuosity of arteries (P = .03, 95% CI 0.002 to 0.03) and veins (P = .02, 95% CI 0.003 to 0.02). Refraction correlated with IGF-I (P = .0005, rs = 0.60 in right eye, and P = .002, rs = 0.55 in left eye) at 10 years of age. Tortuosity of arteries at assessment correlated with neonatal IGF-I levels (P = .03, rs = -0.39). Tortuosity of veins correlated with a leptin/adiponectin ratio at assessment (P = .04, rs = 0.37). CONCLUSION The findings suggest that being born MLP is associated with myopia, smaller optic disc and rim areas, and abnormal retinal vascularization. Furthermore, metabolic status and growth factors seem to have an impact on ocular development.
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Affiliation(s)
- Alexandra Lind
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Jovanna Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lina Raffa
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Kerstin Allvin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Deala Ghazi Mroué
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Ophthalmology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Sanghera RS, Boyle EM. Outcomes of infants born near term: not quite ready for the "big wide world"? Minerva Pediatr 2018; 71:47-58. [PMID: 30299031 DOI: 10.23736/s0026-4946.18.05406-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Until recently, there has been a strongly held belief on the part of neonatal and pediatric clinicians that outcomes for infants born close to term are not different from those of babies born at full term. In the last decade, however, this assumption has been challenged by reports suggesting that this is not correct, and highlighting differences in morbidity and mortality both in the short and long term. This has led to development of new terminology to more accurately reflect the impact of immaturity associated with birth at 32-33 weeks (moderately preterm) and 34-36 weeks (late preterm) of gestation. These babies account for around 5-7% of all births and more than 75% of the preterm births in developed countries, so this new recognition of the associated increase in adverse outcomes may have a substantial impact on health care services. This review article will discuss the changing perceptions and concepts of gestational age in the preterm population, and explore the recent and emerging evidence around neonatal, early childhood, school-age, adolescent and adult outcomes for babies who are born moderately preterm and late preterm. It highlights important neonatal and childhood morbidities and will summarize associated health care, developmental and educational problems of affected children. The implications for the provision of ongoing primary and secondary health care, educational and social support to this large and heterogeneous group of individuals will be discussed.
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Affiliation(s)
- Ranveer S Sanghera
- Neonatal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Elaine M Boyle
- Neonatal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK - .,Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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Preventing preterm birth: New approaches to labour therapeutics using Nanoparticles. Best Pract Res Clin Obstet Gynaecol 2018; 52:48-59. [DOI: 10.1016/j.bpobgyn.2018.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/30/2018] [Accepted: 03/29/2018] [Indexed: 11/19/2022]
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Chawla S, Natarajan G, Chowdhury D, Das A, Walsh M, Bell EF, Laptook AR, Van Meurs K, D’Angio CT, Stoll BJ, DeMauro SB, Shankaran S. Neonatal Morbidities among Moderately Preterm Infants with and without Exposure to Antenatal Corticosteroids. Am J Perinatol 2018; 35:1213-1221. [PMID: 29702710 PMCID: PMC6156933 DOI: 10.1055/s-0038-1642059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We aimed to compare the rates of "surfactant treated respiratory disease" and other neonatal morbidities among moderately preterm (MPT) infants exposed to no, partial, or a complete course of antenatal corticosteroids (ANS). STUDY DESIGN This observational cohort study evaluated MPT infants (290/7-336/7 weeks' gestational age), born between January 2012 and November 2013 and enrolled in the "MPT Registry" of the National Institute of Child Health and Human Development Neonatal Research Network. RESULTS Data were available for 5,886 infants, including 676 with no exposure, 1225 with partial, and 3,985 with a complete course of ANS. Among no, partial, and complete ANS groups, respectively, there were significant differences in rates of delivery room resuscitation (4.1, 1.4, and 1.2%), surfactant-treated respiratory disease (26.5, 26.3, and 20%), and severe intracranial hemorrhage (3, 2, and 0.8%). Complete ANS course was associated with lower surfactant-treated respiratory disease, compared with partial ANS (odds ratio [OR] 0.62; 95% confidence interval [CI] 0.52-0.74), and no ANS groups (OR 0.52; 95% CI 0.41-0.66) on adjusted analysis. CONCLUSION In MPT infants, ANS exposure is associated with lower delivery room resuscitation, surfactant-treated respiratory disease, and severe intracranial hemorrhage; with the lowest frequency of morbidities associated with a complete course.
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Affiliation(s)
- Sanjay Chawla
- Department of Pediatrics, Children’s Hospital of Michigan and Hutzel Women’s Hospital, Detroit, Michigan
| | - Girija Natarajan
- Department of Pediatrics, Children’s Hospital of Michigan and Hutzel Women’s Hospital, Detroit, Michigan
| | - Dhuly Chowdhury
- Biostatistics and Epidemiology Division, RTI International, Rockville, Maryland
| | - Abhik Das
- Biostatistics and Epidemiology Division, RTI International, Rockville, Maryland
| | - Michele Walsh
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Abbot R. Laptook
- Department of Pediatrics, Women and Infants’ Hospital of Rhode Island, Providence, Rhode Island
| | - Krisa Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California
| | - Carl T. D’Angio
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Barbara J. Stoll
- McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | - Sara B. DeMauro
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Seetha Shankaran
- Department of Pediatrics, Children’s Hospital of Michigan and Hutzel Women’s Hospital, Detroit, Michigan
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Leal MDC, Szwarcwald CL, Almeida PVB, Aquino EML, Barreto ML, Barros F, Victora C. Saúde reprodutiva, materna, neonatal e infantil nos 30 anos do Sistema Único de Saúde (SUS). CIENCIA & SAUDE COLETIVA 2018; 23:1915-1928. [DOI: 10.1590/1413-81232018236.03942018] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/12/2018] [Indexed: 02/05/2023] Open
Abstract
Resumo Este estudo apresenta um sumário das intervenções realizadas no âmbito do setor público e os indicadores de resultado alcançados na saúde de mulheres e crianças, destacando-se os avanços no período 1990-2015. Foram descritos indicadores de atenção pré-natal, assistência ao parto e saúde materna e infantil utilizando dados provenientes de Sistemas de Informação Nacionais de nascidos vivos e óbitos; inquéritos nacionais; e publicações obtidas de diversas outras fontes. Foram também descritos os programas governamentais desenvolvidos para a melhoria da saúde das mulheres e das crianças, bem como outros intersetoriais para redução da pobreza. Houve grande queda nas taxas de fecundidade, universalização da atenção pré-natal e hospitalar ao parto, aumento do acesso à contracepção e aleitamento materno, e diminuição das hospitalizações por aborto e da subnutrição. Mantém-se em excesso a sífilis congênita, taxa de cesarianas e nascimentos prematuros. A redução na mortalidade na infância foi de mais de 2/3, mas não tão marcada no componente neonatal. A razão de mortalidade materna decresceu de 143,2 para 59,7 por 1000 NV. Embora alguns poucos indicadores tenham demonstrado piora ou mantido a estabilidade, a grande maioria apresentou acentuadas melhoras.
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Bonnevier A, Brodszki J, Björklund LJ, Källén K. Underlying maternal and pregnancy-related conditions account for a substantial proportion of neonatal morbidity in late preterm infants. Acta Paediatr 2018; 107:1521-1528. [PMID: 29575302 DOI: 10.1111/apa.14321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
Abstract
AIM We studied the impact of maternal and pregnancy-related conditions and the effect of gestational age itself, on the health of infants born late preterm. METHODS Singletons born in gestational weeks 34 + 0 to 41 + 6 in 1995-2013 in the southern region of Sweden were identified from a perinatal register. We found 14 030 infants born late preterm and 294 814 born at term. A hierarchical system was developed to examine the impact of pregnancy complications. The outcomes studied were as follows: neonatal death, central nervous system (CNS) or respiratory disease, infection, neonatal admission and respiratory support. Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained using logistic regression analyses. RESULTS Late preterm infants were at increased risk for all outcomes compared to term infants, with adjusted ORs from 13.1 (95% CI: 12.7-13.6) for neonatal admission to 2.3 (95% CI: 1.8-2.9) for infections. Late preterm birth after preterm prelabour rupture of membranes was associated with an overall lower risk compared to late preterm births due to other causes. Exposure to antepartum haemorrhage or maternal diabetes increased the risk for CNS and respiratory morbidity. CONCLUSION Morbidity decreased in late preterm infants with increasing gestational age. Underlying conditions accounted for a substantial part of the morbidity.
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Affiliation(s)
- Anna Bonnevier
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jana Brodszki
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lars J Björklund
- Department of Pediatric Surgery and Neonatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Bouchet N, Gayet-Ageron A, Lumbreras Areta M, Pfister RE, Martinez de Tejada B. Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study. BMC Pregnancy Childbirth 2018; 18:17. [PMID: 29310615 PMCID: PMC5759878 DOI: 10.1186/s12884-017-1650-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 12/28/2017] [Indexed: 02/02/2023] Open
Abstract
Background Late preterm (LPT) newborns, defined as those born between 34 0/7 and 36 6/7 gestational weeks, have higher short- and long-term morbidity and mortality than term infants (≥37 weeks). A categorization to justify a non-spontaneous LPT delivery has been proposed to distinguish evidence-based from non-evidence-based criteria. This study aims to describe rates and temporal trends of non-spontaneous LPT neonates delivered according to evidence-based or non-evidence-based criteria and to evaluate the number of avoidable LPT deliveries, including severe neonatal morbidity rates and associated risk factors. Methods Retrospective cohort study including all LPT neonates born at a Swiss university maternity unit between January 1, 2002 and December 31, 2012. Trends of LPT neonates and neonatal complications were assessed across time using Poisson regression and risk factors for neonatal complications by logistic regression. Results Among 40,609 singleton live births, 4223 (10.5%) were preterm and 2017 (4.9%) LPT. In the latter group, 26.2% were non-spontaneous (evidence-based: 12.0%; non-evidence-based: 14.2%). The most frequent indications for evidence-based non-spontaneous LPT delivery were severe preeclampsia (51.8%) and abnormal fetal tracing (24.7%). Indications for non-evidence-based non-spontaneous LPT deliveries were hemorrhage (36.2%) and mild preeclampsia (15.7%). LPT birth rates remained stable over time. The rate of neonatal complications after non-evidence-based LPT birth remained high over time (43.8% vs. 43.5% in 2002 and 2012, respectively; P = 0.645), whereas the annual proportion of neonatal complications overall showed a decreasing trend (from 38.0% in 2002 to 33.5% in 2012; P = 0.051). Conclusions LPT birth rates were stable over time, but neonatal complications remained high, particularly after non-evidence-indicated LPT birth. A total of 287 LPT births could have been potentially avoided if an evidence-based protocol for delivery indications had been used. Efforts should be made to avoid non-spontaneous LPT births in order to reduce neonatal complications.
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Affiliation(s)
- Noémie Bouchet
- Obstetrics Unit, Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, 30 Boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- Clinical Research Centre and Division of Clinical Epidemiology, Department of Community Health and Medicine, Geneva University Hospitals and Faculty of Medicine, 6 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Marina Lumbreras Areta
- Obstetrics Unit, Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, 30 Boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Riccardo Erennio Pfister
- Neonatology Unit, Department of Pediatrics, Geneva University Hospitals and Faculty of Medicine, 30 Boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Begoña Martinez de Tejada
- Obstetrics Unit, Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, 30 Boulevard de la Cluse, 1205, Geneva, Switzerland.
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