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Seaton SE, Manning JC, Colville G, Mackintosh N. Creating a home with a critically ill child: A qualitative study exploring the experiences of parents of children admitted to paediatric critical care following treatment in neonatal care. Aust Crit Care 2024:S1036-7314(24)00211-X. [PMID: 39174382 DOI: 10.1016/j.aucc.2024.07.082] [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: 02/09/2024] [Revised: 07/09/2024] [Accepted: 07/20/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Survival of children with complex medical conditions has increased over time. Around 5% of children admitted to a neonatal unit (NNU) later have an admission to a paediatric intensive care unit (PICU) in early life. No work to date has explored the needs of parents who have a child admitted to both of these healthcare settings. OBJECTIVE The overall aim of this study was to understand parents' experiences as they navigate the transition between admissions to the NNU and the PICU. This paper reports on one of the themes (creating a home) identified inductively from the dataset. METHODS We used a qualitative research design using semistructured interviews with parents who had a child (or children) who had been admitted to neonatal care after birth and then subsequently were also admitted to a PICU. We recruited a national purposive sample of parents with experiences of having a child treated in an NNU before being admitted to the PICU. We undertook the interviews and transcribed them before taking a reflexive thematic analysis approach. RESULTS A total of 15 mothers and three fathers, of 17 children, were interviewed between January and March 2022. 'We identified 'creating a home' as a key inductive theme with three subthemes: (i) developing parental roles; (ii) creating a physical home; and (iii) creating core memories. CONCLUSIONS There is a growing cohort of children living with chronic health conditions. In this work, we have explored how their parents establish a home whilst often spending significant periods within the public arena of intensive care. Families across settings need support from healthcare professionals to help them develop their role as parents, build a home, and to create memories together.
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Affiliation(s)
- Sarah E Seaton
- Department of Population Health Sciences, University of Leicester, University Road, LE1 7RH, UK.
| | - Joseph C Manning
- School of Healthcare, University of Leicester, University Road, LE1 7RH, UK; Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - Gillian Colville
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Nicola Mackintosh
- Department of Population Health Sciences, University of Leicester, University Road, LE1 7RH, UK
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Ochoa-Brezmes J, Del Villar Guerra P, de Llano JA, Marugán de Miguelsanz JM. Increasing trend in patients with life-limiting and complex chronic conditions. An Pediatr (Barc) 2024; 101:95-103. [PMID: 39089965 DOI: 10.1016/j.anpede.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/23/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES To estimate the frequency of patients with diagnoses associated with life-limiting conditions (LLCs) or complex chronic conditions (CCCs). METHODS Retrospective mixed population-based and hospital-based cohort study. Study universe consisted of the population aged less than 18 years of an autonomous community in Spain in the 2001-2021 period; the cases were patients admitted to hospital with a diagnosis associated with LLC or CCC during this period. We estimated age-adjusted annual prevalences and analysed changes in trends using joinpoint regression. RESULTS The prevalence of LLCs increased significantly from 20.7 per 10 000 inhabitants under 18 years in 2001 to 51.3 per 10 000 in 2019. There was also a significant increase in CCCs from 39.9 per 10 000 in 2001 to 54.4 per 10 000 in 2019. The prevalence of patients with any of these conditions rose from 45 per 10 000 in 2001 to 86.8 per 10 000 in 2019; 30.3% of these patients had conditions of both types. There was a turning point in this increasing trend between 2019 and 2020, coinciding with the COVID-19 pandemic. CONCLUSIONS The prevalence of patients requiring specialized care has increased progressively in the last 20 years, similar to what has happened in other countries. The magnitude of the affected population must be taken into account when planning specialized paediatric palliative care and complex chronic care services.
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Affiliation(s)
| | | | - Jesús Andrés de Llano
- Servicio de Pediatría, Complejo Asistencial Universitario de Palencia, Palencia, Spain
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Isayama T, Miyakoshi K, Namba F, Hida M, Morioka I, Ishii K, Miyashita S, Uehara S, Kinoshita Y, Suga S, Nakahata K, Uchiyama A, Otsuki K. Survival and unique clinical practices of extremely preterm infants born at 22-23 weeks' gestation in Japan: a national survey. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326355. [PMID: 38777561 DOI: 10.1136/archdischild-2023-326355] [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: 09/23/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To investigate prognosis and clinical practices of infants born at 22-23 weeks' gestational age (wkGA) in Japan. DESIGN A national institutional-level electronic questionnaire surveys performed in September 2021. SETTING All perinatal centres across Japan. PATIENTS Infants born at 22-23 wkGA in 2018-2020. MAIN OUTCOME MEASURES Proportion of active resuscitation and survival at neonatal intensive care unit (NICU) discharge, and various clinical practices. RESULTS In total, 255 of 295 NICUs (86%) responded. Among them, 145 took care of infants born at 22-23 wkGA and answered the questions regarding their outcomes and care. In most NICUs (129 of 145 (89%)), infants born at 22+0 wkGA can be actively resuscitated. In almost half of the NICUs (79 of 145 (54%)), infants born at ≥22+0 wkGA were always actively resuscitated. Among 341 and 757 infants born alive at 22 and 23 wkGA, respectively, 85% (291 of 341) and 98% (745 of 757) received active resuscitation after birth. Among infants actively resuscitated at birth, 63% (183 of 291) and 80% (594 of 745) of infants born at 22 and 23 wkGA survived, respectively. The survey revealed unique clinical management for these infants in Japan, including delivery with caul in caesarean section, cut-cord milking after clamping cord, immediate intubation at birth, hydrocortisone use for chronic lung disease, analgesia/sedation use for infants on mechanical ventilation, routine echocardiography and brain ultrasound, probiotics administration, routine glycerin enema and skin dressing to prevent pressure ulcers. CONCLUSIONS Many 22-23 wkGA infants were actively resuscitated in Japan and had a high survival rate. Various unique clinical practices were highlighted.
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Affiliation(s)
- Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Kei Miyakoshi
- Obstetrics and Gynecology, International Catholic Hospital, Tokyo, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Mariko Hida
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Keisuke Ishii
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Susumu Miyashita
- Department of Maternal Fetal Medicine, Miyagi Children's Hospital, Sendai, Miyagi, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Katsutoshi Nakahata
- Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Atsushi Uchiyama
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Katsufumi Otsuki
- Department of Obstetrics and Gynecology, Showa University Koto Toyosu Hospital, Koto-ku, Tokyo, Japan
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van Hasselt TJ, Gale C, Battersby C, Davis PJ, Draper E, Seaton SE. Paediatric intensive care admissions of preterm children born <32 weeks gestation: a national retrospective cohort study using data linkage. Arch Dis Child Fetal Neonatal Ed 2024; 109:265-271. [PMID: 37923384 DOI: 10.1136/archdischild-2023-325970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Survival of babies born very preterm (<32 weeks gestational age) has increased, although preterm-born children may have ongoing morbidity. We aimed to investigate the risk of admission to paediatric intensive care units (PICUs) of children born very preterm following discharge home from neonatal care. DESIGN Retrospective cohort study, using data linkage of National Neonatal Research Database and the Paediatric Intensive Care Audit Network datasets. SETTING All neonatal units and PICUs in England and Wales. PATIENTS Children born very preterm between 1 January 2013 and 31 December 2018 and admitted to neonatal units. MAIN OUTCOME MEASURES Admission to PICU after discharge home from neonatal care, before 2 years of age. RESULTS Of the 40 690 children discharged home from neonatal care, there were 2308 children (5.7%) with at least one admission to PICU after discharge. Of these children, there were 1901 whose first PICU admission after discharge was unplanned.The percentage of children with unplanned PICU admission varied by gestation, from 10.2% of children born <24 weeks to 3.3% born at 31 weeks.Following adjustment, unplanned PICU admission was associated with lower gestation, male sex (adjusted OR (aOR) 0.79), bronchopulmonary dysplasia (aOR 1.37), necrotising enterocolitis requiring surgery (aOR 1.39) and brain injury (aOR 1.42). For each week of increased gestation, the aOR was 0.90. CONCLUSIONS Most babies born <32 weeks and discharged home from neonatal care do not require PICU admission in the first 2 years. The odds of unplanned admissions to PICU were greater in the most preterm and those with significant neonatal morbidity.
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Affiliation(s)
- Tim J van Hasselt
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Peter J Davis
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elizabeth Draper
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Sarah E Seaton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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Seaton SE, Battersby C, Davis PJ, Fenton AC, Anderson J, van Hasselt TJ, Draper E. Characteristics of children requiring admission to neonatal care and paediatric intensive care before the age of 2 years in England and Wales: a data linkage study. Arch Dis Child 2024; 109:387-394. [PMID: 38346868 DOI: 10.1136/archdischild-2023-325986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/13/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To quantify the characteristics of children admitted to neonatal units (NNUs) and paediatric intensive care units (PICUs) before the age of 2 years. DESIGN A data linkage study of routinely collected data. SETTING National Health Service NNUs and PICUs in England and Wales PATIENTS: Children born from 2013 to 2018. INTERVENTIONS None. MAIN OUTCOME MEASURE Admission to PICU before the age of 2 years. RESULTS A total of 384 747 babies were admitted to an NNU and 4.8% (n=18 343) were also admitted to PICU before the age of 2 years. Approximately half of all children admitted to PICU under the age of 2 years born in the same time window (n=18 343/37 549) had previously been cared for in an NNU.The main reasons for first admission to PICU were cardiac (n=7138) and respiratory conditions (n=5386). Cardiac admissions were primarily from children born at term (n=5146), while respiratory admissions were primarily from children born preterm (<37 weeks' gestational age, n=3550). A third of children admitted to PICU had more than one admission. CONCLUSIONS Healthcare professionals caring for babies and children in NNU and PICU see some of the same children in the first 2 years of life. While some children are following established care pathways (eg, staged cardiac surgery), the small proportion of children needing NNU care subsequently requiring PICU care account for a large proportion of the total PICU population. These differences may affect perceptions of risk for this group of children between NNU and PICU teams.
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Affiliation(s)
- Sarah E Seaton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Peter J Davis
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, Bristol, UK
| | - Alan C Fenton
- Newcastle Neonatal Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Tim J van Hasselt
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth Draper
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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Peterson J, Smith DM, Johnstone ED, Mahaveer A. Perinatal optimisation for periviable birth and outcomes: a 4-year network analysis (2018-2021) across a change in national guidance. Front Pediatr 2024; 12:1365720. [PMID: 38694726 PMCID: PMC11061457 DOI: 10.3389/fped.2024.1365720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/11/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction The British Association of Perinatal Medicine (BAPM) released their revised framework for extremely preterm infant management in 2019. This revised framework promotes consideration of perinatal optimisation and survival-focused care from 22 weeks gestation onwards. This was a departure from the previous BAPM framework which recommended comfort care as the only recommended management for infants <23 + 0 weeks. Methods Our study evaluates the clinical impact that this updated framework has had across the Northwest of England. We utilised anonymised network data from periviable infants delivered across the region to examine changes in perinatal optimisation practices and survival outcomes following the release of the latest BAPM framework. Results Our data show that after the introduction of the updated framework there has been an increase in perinatal optimisation practices for periviable infants and an 80% increase in the number of infants born at 22 weeks receiving survival-focused care and admission to a neonatal unit. Discussion There remain significant discrepancies in optimisation practices by gestational age, which may be contributing to the static survival rates that were observed in the lowest gestational ages.
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Affiliation(s)
- J. Peterson
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- St Mary’s Maternity Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - D. M. Smith
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - E. D. Johnstone
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- St Mary’s Maternity Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - A. Mahaveer
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- St Mary’s Maternity Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Galloway I, Roehr CC, Tan K. Withdrawal and withholding of life sustaining treatment (WWLST): an under recognised factor in the morbidity or mortality of periviable infants?-a narrative review. Transl Pediatr 2024; 13:459-473. [PMID: 38590374 PMCID: PMC10998991 DOI: 10.21037/tp-23-468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/07/2024] [Indexed: 04/10/2024] Open
Abstract
Background and Objective The morbidity and mortality of infants born extremely preterm varies substantially across networks, within countries and throughout the globe. Most of the literature tends to focus on the management at birth and choices around active resuscitation of extremely preterm infants. Withdrawal and withholding of life sustaining treatment (WWLST) is an important and central process in the neonatal intensive care unit (NICU) and practices vary substantially. As such, our objective in this review was to explore whether end of life decisions also contribute to variations in the morbidity and mortality of periviable infants. Methods This narrative literature review is based on studies from the last 15 years found using several searches of medical databases (OVID Medline, Scopus and Cochrane Systematic Reviews) performed between March 2021 and December 2023. Key Content and Findings Just as outcomes in periviable infants vary, the rates of and processes behind WWLST differ in the periviable population. Variation increases as gestational age decreases. Parental involvement is crucial to share decision making but the circumstances and rates of parental involvement differ. Strict guidelines in end-of-life care may not be appropriate, however there is a need for more targeted guidance for periviable infants as a specific population. The current literature available relating to periviable infants or WWLST is minimal, with many datasets rapidly becoming outdated. Conclusions Further research is needed to establish the role of WWLST in variation of periviable infants' outcomes. The unification of data, acquisition of more recent datasets and inclusion of variables relating to end-of-life decisions in data collection will aid in this process.
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Affiliation(s)
- Isobel Galloway
- Department of Paediatrics, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Charles Christoph Roehr
- Women’s and Children’s, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
- National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Kenneth Tan
- Department of Paediatrics, School of Clinical Sciences, Monash University, Victoria, Australia
- Monash Newborn, Monash Children’s Hospital, Victoria, Australia
- School of Medicine, Taylor’s University, Selangor, Malaysia
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Moorthy S, Adams GGW, Smith G, Biswas S, Aliyan W, Bhudia R, Saiyed A, Husain S. Validation of the East London Retinopathy of Prematurity algorithm to detect treatment-warranted retinopathy of prematurity: a cohort study. Br J Ophthalmol 2024; 108:471-475. [PMID: 36759150 DOI: 10.1136/bjo-2022-322522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/21/2023] [Indexed: 02/11/2023]
Abstract
AIM To validate the East London Retinopathy of Prematurity algorithm (EL-ROP) in a cohort of infants at risk of developing retinopathy of prematurity (ROP). METHODS The EL-ROP algorithm was applied retrospectively to routinely collected data from two tertiary neonatal units in England on infants eligible for ROP screening. The EL-ROP recommendation, to screen or not, was compared with the development of treatment-warranted ROP (TW-ROP) for each infant. The main outcome measures were (1) EL-ROP's sensitivity for predicting the future development of TW-ROP and (2) potential to reduce ROP screening examinations. RESULTS Data from 568 infants were included in the trial. The median (IQR) birth weight (g) was 875 (704 - 1103) and gestational age (weeks) was 27.0 (25.4 - 29.0). Maternal ethnicity was black (33%) and non-black (67%). 58(10%) developed TW-ROP and in every case this was predicted by the EL-ROP algorithm. It's sensitivity was 100% (95% CI 94-100%) specificity: 44% (95% CI 39-48%) positive predictive value: 17% (95%CI 16-18%), negative predictive value: 100%. CONCLUSIONS EL-ROP has been validated in a cohort of infants from two tertiary neonatal units in England. Further validation is required before its clinical usefulness can be assessed.
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Affiliation(s)
- Sonia Moorthy
- Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital City Road Campus, London, UK
| | - Gillian G W Adams
- Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital City Road Campus, London, UK
| | - Graham Smith
- Data Analytics, Omnivide, Sydney, New South Wales, Australia
| | - Susmito Biswas
- Paediatric Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK
| | - Waleed Aliyan
- Paediatric Ophthalmology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Roshni Bhudia
- Primary Care and Public Health, Imperial College London, London, UK
| | - Aamir Saiyed
- Emergency Department, Cardiff and Vale University Health Board, Cardiff, UK
| | - Shad Husain
- Neonatology, Homerton University Hospital Neonatal Unit, London, UK
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Schiff I, Shangaris P, Grinsted M, Sankaran S. Feticide Before Termination of Pregnancy in Singleton Pregnancy - Trends in England and Wales 2012-2020, a Cross-sectional Study. Reprod Sci 2024; 31:441-451. [PMID: 37749446 PMCID: PMC10827943 DOI: 10.1007/s43032-023-01352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
Feticide is the practice of inducing fetal demise before the termination of pregnancy. In England and Wales, it is recommended for terminations of pregnancy beyond 21+6 weeks of gestation. This project analyses the trends in feticide in singleton pregnancy in England and Wales between 2012 and 2020. This project was a retrospective study that analysed data extracted from the Health and Social Act 4 (HSA4) forms submitted to the Department of Health and Social Care (DHSC). The data extracted by the DHSC included the prevalence of feticide, methods of feticide and termination, statutory grounds, gestation, service provider, maternal age, ethnicity and obstetric history. In addition, data analysis was carried out to identify trends. Between 2012 and 2020, there were 9310 feticides in England and Wales, undertaken in 0.5% of all abortions. The prevalence of feticide fluctuated; however, there was an overall decrease from 1084 cases in 2012 to 1000 cases in 2020. Intracardiac injection of potassium chloride was the most frequent method of achieving feticide (67.2%). Just over half (55.8%) of feticides took place under Ground E of the Abortion Act 1967, with the main indication being congenital malformations of the nervous system. Two-fifths (40.2%) of feticides took place at 23 weeks, 22.8% at 22 weeks and 13.5% between 20 and 21 weeks. The remainder occurred at later gestations: 17.5% at 24-29 weeks and 5.9% beyond 29 weeks. During our study period, it was more common for feticides to be carried out as part of a medical termination than a surgical termination and 60.3% occurred in NHS hospitals. Women undergoing feticide were mostly aged 30-34 years (38.3%) and of White ethnicity (78.6%). Feticide is an essential component of comprehensive abortion care for women undergoing late second and third-trimester abortions. This study provides insight into how feticide is carried out in England and Wales and demonstrates the effect of the COVID-19 pandemic on reducing feticide prevalence. Future research should analyse in more detail the use of the different methods of feticide.
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Affiliation(s)
- Isabelle Schiff
- GKT School of Medical Education, King's College London, Guy's Campus, Great Maze Pond, London, UK
| | - Panicos Shangaris
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Guy's Campus, Great Maze Pond, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
- School of Life Course and Population Sciences, King's College London, 10th Floor North Wing St Thomas' Hospital, London, London, UK.
- Fetal Medicine Research Institute, King's College Hospital, London, UK.
- Department of Women and Children, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | | | - Srividhya Sankaran
- Department of Women and Children, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Health and Social Care, London, UK
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Creswell L, Rolnik DL, Lindow SW, O’Gorman N. Preterm Birth: Screening and Prediction. Int J Womens Health 2023; 15:1981-1997. [PMID: 38146587 PMCID: PMC10749552 DOI: 10.2147/ijwh.s436624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023] Open
Abstract
Preterm birth (PTB) affects approximately 10% of births globally each year and is the most significant direct cause of neonatal death and of long-term disability worldwide. Early identification of women at high risk of PTB is important, given the availability of evidence-based, effective screening modalities, which facilitate decision-making on preventative strategies, particularly transvaginal sonographic cervical length (CL) measurement. There is growing evidence that combining CL with quantitative fetal fibronectin (qfFN) and maternal risk factors in the extensively peer-reviewed and validated QUanititative Innovation in Predicting Preterm birth (QUiPP) application can aid both the triage of patients who present as emergencies with symptoms of preterm labor and high-risk asymptomatic women attending PTB surveillance clinics. The QUiPP app risk of delivery thus supports shared decision-making with patients on the need for increased outpatient surveillance, in-patient treatment for preterm labor or simply reassurance for those unlikely to deliver preterm. Effective triage of patients at preterm gestations is an obstetric clinical priority as correctly timed administration of antenatal corticosteroids will maximise their neonatal benefits. This review explores the predictive capacity of existing predictive tests for PTB in both singleton and multiple pregnancies, including the QUiPP app v.2. and discusses promising new research areas, which aim to predict PTB through cervical stiffness and elastography measurements, metabolomics, extracellular vesicles and artificial intelligence.
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Affiliation(s)
- Lyndsay Creswell
- Department of Obstetrics and Gynecology, The Coombe Hospital, Dublin, Ireland
| | - Daniel Lorber Rolnik
- Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC, Australia
| | - Stephen W Lindow
- Department of Obstetrics and Gynecology, The Coombe Hospital, Dublin, Ireland
| | - Neil O’Gorman
- Department of Obstetrics and Gynecology, The Coombe Hospital, Dublin, Ireland
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Frostig T, Benjamini Y, Kehat O, Weiss-Meilik A, Mandel D, Peleg B, Strauss Z, Mitelpunkt A. Developing a length of stay prediction model for newborns, achieving better accuracy with greater usability. Int J Med Inform 2023; 180:105267. [PMID: 37918217 DOI: 10.1016/j.ijmedinf.2023.105267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND One in ten newborn children is born prematurely. The elongated length of stay (LOS) of these children in the Neonatal Intensive Care Unit (NICU) has important implications on hospital occupancy figures, healthcare and management costs, as well as the psychology of parents. In order to allow accurate planning and resource allocation, this study aims to create a generalizable and robust model to predict the NICU LOS of preterm newborns. METHODS Data were collected from a large tertiary center NICU between 2011 and 2018 and relates to 5,362 newborns. The selected model was externally validated using a data set of 8,768 newborns from another tertiary center NICU. This report compares several models, such as Random Forest (RF), quantile RF, and other feature selection methods, including LASSO and AIC step-forward selection. In addition, a novel step-forward selection based on False Discovery Rate (FDR) for quantile regression is presented and evaluated. RESULTS A high-orderquantile regression model for predicting preterm newborns' LOS that uses only four features available at birth had more attractive properties than other richer ones. The model achieved a Mean Absolute Error (MAE) of 6.26 days on the internal validation set (average LOS 27.04) and an MAE of 6.04 days on the external validation set (average LOS 29.32). The suggested model surpassed the accuracy obtained by models in the literature. It is shown empirically that the FDR-based selection has better properties than the AIC-based step-forward selection approach. CONCLUSION This paper demonstrates a process to create a predictive model for NICU LOS in preterm newborns, where each step is reasoned. We obtain a simple and robust model for NICU LOS prediction, which achieves far better results than the current model used for financing NICUs. Utilizing this model, we have created an easy-to-use online web application to ease parents' worries and to assist NICU management: https://tzviel.shinyapps.io/calcuLOS.
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Affiliation(s)
- Tzviel Frostig
- Department of Statistics and Operation Research, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel.
| | - Yoav Benjamini
- Department of Statistics and Operation Research, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Sagol School of Neuroscience and the Edmond Safra Bioinformatics Center, Tel Aviv University Ramat Aviv, 69978, Tel Aviv, Israel
| | - Orli Kehat
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Dror Mandel
- Departments of Neonatology and Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Ben Peleg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-HaShomer, Israel
| | - Zipora Strauss
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-HaShomer, Israel
| | - Alexis Mitelpunkt
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Pediatric Rehabilitation, Department of Rehabilitation, Dana Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
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12
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Seaton SE, Agarwal R, Draper ES, Fenton AC, Kurinczuk JJ, Manktelow BN, Smith LK. Estimated neonatal survival of very preterm births across the care pathway: a UK cohort 2016-2020. Arch Dis Child Fetal Neonatal Ed 2023; 108:562-568. [PMID: 37080732 DOI: 10.1136/archdischild-2022-324987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Currently used estimates of survival are nearly 10 years old and relate to only those babies admitted for neonatal care. Due to ongoing improvements in neonatal care, here we update estimates of survival for singleton and multiple births at 22+0 to 31+6 weeks gestational age across the perinatal care pathway by gestational age and birth weight. DESIGN Retrospective analysis of routinely collected data. SETTING A national cohort from the UK and British Crown Dependencies. PATIENTS Babies born at 22+0 to 31+6 weeks gestational age from 1 January 2016 to 31 December 2020. INTERVENTIONS None. MAIN OUTCOME MEASURES Survival to 28 days. RESULTS Estimates of neonatal survival are provided for babies: (1) alive at the onset of care during the birthing process (n=43 763); (2) babies where survival-focused care was initiated (n=42 004); and (3) babies admitted for neonatal care (n=41 158). We have produced easy-to-use survival charts for singleton and multiple births. Generally, survival increased with increasing gestational age at birth and with increasing birth weight. For all births with a birthweight over 1000 g, survival was 90% or higher at all three stages of care. CONCLUSIONS Survival estimates are a vital tool to support and supplement clinical judgement within perinatal care. These up-to-date, national estimates of survival to 28 days are provided based on three stages of the perinatal care pathway to support ongoing clinical care. These novel results are a key resource for policy and practice including counselling parents and informing care provision.
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Affiliation(s)
- Sarah E Seaton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Ridhi Agarwal
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth S Draper
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Alan C Fenton
- Newcastle Neonatal Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Bradley N Manktelow
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Lucy K Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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13
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Doucette SM, Tang S, Kehler H, Creighton D, Lodha A. Utility of the 21-month neurodevelopmental outcome for predicting neurodevelopmental impairment at 36 months for preterm infants <29 weeks gestation. J Perinatol 2023; 43:1406-1412. [PMID: 37714894 DOI: 10.1038/s41372-023-01777-3] [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] [Received: 07/17/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To determine the sensitivity and specificity of the 21-month neurodevelopmental outcome for predicting the presence of neurodevelopmental impairment at 36 months corrected age in a population of preterm infants under 29 weeks gestation. STUDY DESIGN This is a retrospective observational cohort study. Preterm infants born under 29 weeks gestation who were followed up at both 18-21 months and 36 months corrected age with outcome data available were enrolled. RESULTS Overall, 713 preterm infants <29 weeks gestation and were included in the final analysis. The specificity of the 21-month assessment for predicting neurodevelopmental impairment at 36 months corrected age was 66% (95% confidence interval[CI] 62-71%) with a positive predictive value of 61% (95% CI 56-66%). CONCLUSION In preterm neonates born <29 weeks gestation, the 18-21 months corrected neurodevelopmental outcome had low specificity and positive predictive value for predicting the presence of neurodevelopmental impairment at 36 months corrected age.
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Affiliation(s)
- Stefani M Doucette
- Division of Neonatology, Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Selphee Tang
- Alberta Health Services, Calgary, Alberta, Canada
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Heather Kehler
- Alberta Health Services, Calgary, Alberta, Canada
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Creighton
- Division of Neonatology, Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Abhay Lodha
- Division of Neonatology, Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
- Alberta Health Services, Calgary, Alberta, Canada.
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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14
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Hurt L, Odd D, Mann M, Beetham H, Dorgeat E, Isaac TC, Ashman A, Wood F. What matters to families about the healthcare of preterm or low birth weight infants: A qualitative evidence synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107893. [PMID: 37473603 DOI: 10.1016/j.pec.2023.107893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE We examined what matters to families about the healthcare provided to preterm or LBW infants in hospital and the community, to ensure that care meets the needs of infants and parents. METHODS We searched databases to identify eligible studies examining the views and expectations of families. Study quality was assessed using the CASP checklist for qualitative studies. The GRADE-CERQual approach was used to assess confidence in review findings. Studies were sampled and data analysed using thematic synthesis. RESULTS 222 studies (227 papers) were eligible for inclusion. 54 studies (57 papers) were sampled based on data richness, methodological quality, and representation across settings. Eight analytical themes were identified. Confidence in results was moderate to high. What mattered was a positive outcome for the child; active involvement in care; being supported to cope at home after discharge; emotional support; the healthcare environment; information needs met; logistical support available; and positive relationships with staff. CONCLUSION Although parents and family members reported a variety of experiences in the care of their infant, we found high consistency in what matters to families. PRACTICE IMPLICATIONS This review identifies approaches to improve experiences of parents which are consistent with the Family Centred Care model of healthcare.
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Affiliation(s)
- Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.
| | - David Odd
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | | | - Emma Dorgeat
- Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Fiona Wood
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
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15
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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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16
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Bansal S, Kaushal M, Nimbalkar S, Bhat S. Resuscitation in the “Periviable” Period—Commentary of Opposing Views. JOURNAL OF NEONATOLOGY 2023; 37:264-269. [DOI: 10.1177/09732179231173775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
The periviable period is defined as delivery between 20 0/7 weeks and 25 6/7 weeks of gestation. It has long been considered a “gray area,” as there are still no clear guidelines on initial resuscitation and subsequent treatment of the newborn. This lack of guidance compounds the uncertainty in decision-making in low- and middle-income countries with limited resources. The decision to treat or not has far-reaching economic, social, cultural, and sometimes even religious implications for the parents and family. This review explores the perspectives of parents, caregivers, and policymakers in detail to utilize the existing evidence better. We present arguments for and against resuscitation in the periviable period, discussing concerns surrounding neurodevelopmental outcomes, cost, parental concerns, nonuniformity of evidence, and ethical considerations. A large survival gap exists between developed and developing countries, and the infrastructure and clinical care network in low- and middle-income country are not strong enough to provide adequate support for these infants and their families. Antenatal factors, socioeconomic and cultural issues, center capacity, and resuscitation capacity of birthing centers should be considered when making decisions. The neonatologists are expected to be impartial, provide information, and not advise based on their beliefs and outlook; while preserving the autonomy of parents. The only way forward is for parents and caregivers to work together to develop a logical and ethical approach that can be accepted as national and institutional policies.
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Affiliation(s)
- Satvik Bansal
- Gaja Raja Medical College, Gwalior, Madhya Pradesh, India
| | - Monica Kaushal
- Department Neonatology, Emirates Specialty Hospital, Dubai Health Care City, Dubai, UAE
- Irani Hospital, Dubai, UAE
| | - Somashekhar Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karasmad, Gujarat, India
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17
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Wilkinson DJ, Bertaud S. End of life care in the setting of extreme prematurity - practical challenges and ethical controversies. Semin Fetal Neonatal Med 2023; 28:101442. [PMID: 37121832 PMCID: PMC10914670 DOI: 10.1016/j.siny.2023.101442] [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] [Indexed: 05/02/2023]
Abstract
While the underlying principles are the same, there are differences in practice in end of life decisions and care for extremely preterm infants compared with other newborns and older children. In this paper, we review end of life care for extremely preterm infants in the delivery room and in the neonatal intensive care unit. We identify potential justifications for differences in the end of life care in this population as well as practical and ethical challenges.
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Affiliation(s)
- Dominic Jc Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, UK; John Radcliffe Hospital, Oxford, UK; Murdoch Children's Research Institute, Melbourne, Australia; Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore.
| | - Sophie Bertaud
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, UK
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18
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McCormack S, Patel K, Smith C. Blended diet for enteral tube feeding in young people: A systematic review of the benefits and complications. J Hum Nutr Diet 2023; 36:1390-1405. [PMID: 36692240 DOI: 10.1111/jhn.13143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Interest and use of blended diets (BD) for young people who are tube fed has significantly increased in the last decade, driven primarily by the desires of motivated caregivers. This review identified, appraised and synthesised the available evidence on the benefits and complications of BD versus commercial feeds. METHODS A systematic review following PRISMA guidance and registered with PROSPERO was conducted across PubMed, Embase, CINAHL, Scopus and Cochrane up to August 2022. INCLUSION CRITERIA English language studies including (1) children, (2) original research (interventional and observational) and (3) examination of BD outcomes. Exclusion criteria were (1) unoriginal research or case reports, (2) focus on feeding management, preparations or attitudes and (3) comparing commercial blends only. Data were synthesised using an established narrative synthesis approach using the Mixed Methods Appraisal Tool. RESULTS Eight hundred and six database results were identified and 61 were sought for retrieval. A full-text article review revealed seven eligible studies, involving 267 participants (age range 9 months to 26 years). Studies reported differences in gastrointestinal symptoms (n = 222), medication use (n = 119), growth (n = 189) and complications or adverse events (n = 91). The results indicate positive outcomes, particularly in gastrointestinal symptom control, with few reports of mild adverse events in the included studies. CONCLUSIONS There is a paucity of data in this area and much heterogeneity in the included studies, but the available literature points towards positive outcomes. This is an important and highly relevant topic, and more primary research, ideally using standardised reporting, is required to answer the key questions.
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Affiliation(s)
- Siobhan McCormack
- Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
- Department of Child Development and Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Kamal Patel
- Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
- Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
| | - Chris Smith
- Department of Paediatric Dietetics, Royal Alexandra Children's Hospital, Brighton, UK
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19
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Na JY, Jung D, Cha JH, Kim D, Son J, Hwang JK, Kim TH, Park HK. Learning-Based Longitudinal Prediction Models for Mortality Risk in Very-Low-Birth-Weight Infants: A Nationwide Cohort Study. Neonatology 2023; 120:652-660. [PMID: 37459839 DOI: 10.1159/000530738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/12/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Prediction models assessing the mortality of very-low-birth-weight (VLBW) infants were confined to models using only pre- and perinatal variables. We aimed to construct a prediction model comprising multifactorial clinical events with data obtainable at various time points. METHODS We included 15,790 (including 2,045 in-hospital deaths) VLBW infants born between 2013 and 2020 who were enrolled in the Korean Neonatal Network, a nationwide registry. In total, 53 prenatal and postnatal variables were sequentially added into the three discrete models stratified by hospital days: (1) within 24 h (TL-1d), (2) from day 2 to day 7 after birth (TL-7d), (3) from day 8 after birth to discharge from the neonatal intensive care unit (TL-dc). Each model predicted the mortality of VLBW infants within the affected period. Multilayer perception (MLP)-based network analysis was used for modeling, and ensemble analysis with traditional machine learning (ML) analysis was additionally applied. The performance of models was compared using the area under the receiver operating characteristic curve (AUROC) values. The Shapley method was applied to reveal the contribution of each variable. RESULTS Overall, the in-hospital mortality was 13.0% (1.2% in TL-1d, 4.1% in TL-7d, and 7.7% in TL-dc). Our MLP-based mortality prediction model combined with ML ensemble analysis had AUROC values of 0.932 (TL-1d), 0.973 (TL-7d), and 0.950 (TL-dc), respectively, outperforming traditional ML analysis in each timeline. Birth weight and gestational age were constant and significant risk factors, whereas the impact of the other variables varied. CONCLUSION The findings of the study suggest that our MLP-based models could be applied in predicting in-hospital mortality for high-risk VLBW infants. We highlight that mortality prediction should be customized according to the timing of occurrence.
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Affiliation(s)
- Jae Yoon Na
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Donggoo Jung
- Department of Artificial Intelligence, Hanyang University, Seoul, Republic of Korea
| | - Jong Ho Cha
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Daehyun Kim
- Department of Artificial Intelligence, Hanyang University, Seoul, Republic of Korea
| | - Joonhyuk Son
- Department of Pediatric Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jae Kyoon Hwang
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Kim
- Department of Computer Science, Hanyang University, Seoul, Republic of Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
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20
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Calthorpe RJ, Poulter C, Smyth AR, Sharkey D, Bhatt J, Jenkins G, Tatler AL. Complex roles of TGF-β signaling pathways in lung development and bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol 2023; 324:L285-L296. [PMID: 36625900 PMCID: PMC9988523 DOI: 10.1152/ajplung.00106.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
As survival of extremely preterm infants continues to improve, there is also an associated increase in bronchopulmonary dysplasia (BPD), one of the most significant complications of preterm birth. BPD development is multifactorial resulting from exposure to multiple antenatal and postnatal stressors. BPD has both short-term health implications and long-term sequelae including increased respiratory, cardiovascular, and neurological morbidity. Transforming growth factor β (TGF-β) is an important signaling pathway in lung development, organ injury, and fibrosis and is implicated in the development of BPD. This review provides a detailed account on the role of TGF-β in antenatal and postnatal lung development, the effect of known risk factors for BPD on the TGF-β signaling pathway, and how medications currently in use or under development, for the prevention or treatment of BPD, affect TGF-β signaling.
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Affiliation(s)
- Rebecca J Calthorpe
- Lifespan & Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Poulter
- Department of Pediatrics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Alan R Smyth
- Lifespan & Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jayesh Bhatt
- Department of Pediatrics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Amanda L Tatler
- NIHR Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
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21
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Chmelova K, Berrington J, Shenker N, Zalewski S, Rankin J, Embleton N. Exploring Human Milk, Nutrition, Growth, and Breastfeeding Rates at Discharge(HUMMINGBIRD Study): a protocol for a pilot randomised controlled trial. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001803. [PMID: 36882232 PMCID: PMC10008155 DOI: 10.1136/bmjpo-2022-001803] [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: 11/29/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Mother's own breast milk (MOM) is the optimal nutrition for preterm infants as it reduces the incidence of key neonatal morbidities and improves long-term outcomes. However, MOM shortfall is common and either preterm formula or pasteurised donor human milk (DHM) may be used, although practice varies widely. Limited data suggest that the use of DHM may impact maternal beliefs and behaviours and therefore breastfeeding rates. The aim of this pilot study is to determine if longer duration of DHM exposure increases breastfeeding rates, and if a randomised controlled trial (RCT) design is feasible. METHODS AND ANALYSIS The Human Milk, Nutrition, Growth, and Breastfeeding Rates at Discharge (HUMMINGBIRD) Study is a feasibility and pilot, non-blinded RCT with a contemporaneous qualitative evaluation. Babies born less than 33 weeks' gestation or with birth weight <1500 g whose mothers intend to provide MOM are randomly assigned to either control (DHM used to make up shortfall until full feeds and preterm formula thereafter) or intervention (DHM used for shortfall until 36 weeks' corrected age or discharge if sooner). The primary outcome is breast feeding at discharge. Secondary outcomes include growth, neonatal morbidities, length of stay, breastfeeding self-efficacy and postnatal depression using validated questionnaires. Qualitative interviews using a topic guide will explore perceptions around use of DHM and analysed using thematic analysis. ETHICS APPROVAL AND DISSEMINATION Nottingham 2 Research Ethics Committee granted approval (IRAS Project ID 281071) and recruitment commenced on 7 June 2021. Results will be disseminated in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN57339063.
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Affiliation(s)
- Kristina Chmelova
- Neonatal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Janet Berrington
- Neonatal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, UK
| | - Natalie Shenker
- Department of Surgery and Cancer, Imperial College London Institute of Reproductive and Developmental Biology, London, UK
- Rothamsted Research, Harpenden, UK
| | - Stefan Zalewski
- Neonatal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nick Embleton
- Neonatal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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22
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Sawtell M, van Blankenstein E, Bilal T, Hall T, Juniper L, Kotsoni J, Lee J, Modi N, Battersby C. Views of parents, adults born preterm and professionals on linkage of real-world data of preterm babies. Arch Dis Child Fetal Neonatal Ed 2023; 108:194-199. [PMID: 36261144 DOI: 10.1136/archdischild-2022-324272] [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: 04/08/2022] [Accepted: 09/26/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore views of parents of preterm babies, adults born preterm and professionals, on the linkage of real-world health and education data for research on improving future outcomes of babies born preterm. DESIGN Three-stage mixed-methods participatory design involving focus groups, a national survey and interviews. Survey participants who expressed uncertainty or negative views were sampled purposively for invitation to interview. Mixed methods were used for data analysis. SETTING AND PARTICIPANTS All data collection was online. Participants were: focus groups-17 parents; survey-499 parents, 44 adults born preterm (total 543); interviews-6 parents, 1 adult born preterm, 3 clinicians, 2 teachers. RESULTS Three key themes were identified: (1) Data linkage and opt-out consent make sense for improving future outcomes. We found clear demand for better information on long-term outcomes and strong support for data linkage with opt-out consent as a means of achieving this. (2) Information requirements-what, how and when. There was support for providing information in different formats and discussing linkage near to, or following discharge from, the neonatal unit, but not sooner. (3) Looking to the future; the rights of young people. We identified a desire for individuals born preterm to be consulted in the future on the use of their data. CONCLUSION With appropriate information provision, at the right time, parents, adults born preterm and professionals are supportive of data linkage for research, including where temporary identifiers and opt-out consent are used. Resources are being co-produced to improve communication about routine data linkage.
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Affiliation(s)
- Mary Sawtell
- Social Research Unit, University College London Institute of Education, London, UK
| | | | | | | | | | | | | | - Neena Modi
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Cheryl Battersby
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Wang XL, Leung E, Fung GPG, Lam HS. Gestational age-specific neonatal mortality in Hong Kong: a population-based retrospective study. World J Pediatr 2023; 19:158-169. [PMID: 36409452 DOI: 10.1007/s12519-022-00633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The neonatal period is the most vulnerable period during childhood, with the risk of death being the highest even in developed countries/regions. Hong Kong's neonatal mortality (1‰) is among the world's lowest and has remained similar for 15 years. This study aimed to explore neonatal deaths in Hong Kong in detail and determine whether neonatal mortality is reducible at such a low level. METHODS Live births in public hospitals in Hong Kong during 01 Jan 2006-31 Dec 2017 were included. Relevant data were extracted from the electronic medical records. Gestational age-specific mortality was calculated, and the trends were analyzed using the Cochran-Armitage trend test. Causes of death were summarized, and risk factors were identified in multivariate logistic regression analysis. RESULTS In 490,034 live births, 755 cases (1.54‰) died during the neonatal period, and 293 (0.6‰) died during the post-neonatal period. The neonatal mortality remained similar overall (P = 0.17) and among infants born at 24-29 weeks' gestation (P = 0.4), while it decreased in those born at 23 (P = 0.04), 30-36 (P < 0.001) and ≥ 37 (P < 0.001) weeks' gestation. Neonates born at < 27 weeks' gestation accounted for a significantly increased proportion among cases who died (27.6% to 51.9%), with hemorrhagic conditions (24%) being the leading cause of death. Congenital anomalies were the leading cause of death in neonates born ≥ 27 weeks' gestation (52%), but its cause-specific mortality decreased (P = 0.002, 0.6‰ to 0.41‰), with most of the decrease attributed to trisomy 13/18 and multiple anomalies. CONCLUSION Reduction of neonatal mortality in developed regions may heavily rely on improved quality of perinatal and neonatal care among extremely preterm infants.
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Affiliation(s)
- Xue-Lian Wang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eman Leung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Genevieve Po Gee Fung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hugh Simon Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Paediatrics, 6/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong SAR, China.
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Biagetti C, Correani A, Antognoli L, Burattini I, D'Ascenzo R, Bellagamba MP, Andresciani E, Garzone AMF, Cogo P, Carnielli VP. Which birth weight threshold to start parenteral nutrition? A single center experience. Eur J Clin Nutr 2023; 77:474-480. [PMID: 36627415 DOI: 10.1038/s41430-022-01257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 12/17/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To analyze the need for parenteral nutrition (PN) in infants with a birth weight (BW) between 1250 and 1499 g. METHODS Retrospective evaluation of clinical, nutritional, growth and neurodevelopmental data of infants with a BW between 1250 and 1499 g consecutively admitted to our institution between 2004 and 2020. RESULTS Of the 503 infants admitted during the study period, 130 (26%) received PN: in 97 (19%) PN was medically indicated, while in 33 (7%) there was no clear indication. Patients who received medically indicated PN were younger, smaller, and sicker than the 373 infants who were managed with enteral nutrition, and their weight gain was lower (14.6 ± 4.1 vs 16.9 ± 4.2 g∙kg-1 ∙ d-1, p = 0.000). Body size at 36 weeks and 2-year anthropometry and neurodevelopment of the infants managed with enteral nutrition were not different from our reference values. CONCLUSIONS After lowering the BW threshold for bridging PN from 1500 to 1250 g, we found that PN was started in only 20% of infants with a BW between 1250 and 1500 g. Withholding PN if not medically indicated did not result neither in growth faltering nor in reduced neurodevelopment.
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Affiliation(s)
- Chiara Biagetti
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| | - Alessio Correani
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| | - Luca Antognoli
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| | - Ilaria Burattini
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| | - Rita D'Ascenzo
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| | - Maria Paola Bellagamba
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| | - Emanuela Andresciani
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| | - Angela Maria Felicita Garzone
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| | - Paola Cogo
- Department of Medicine, University Hospital S Maria della Misericordia, University of Udine, Piazzale Kolbe 3, 33100, Udine, Italy
| | - Virgilio P Carnielli
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy.
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Rolnitsky A, Unger S, Urbach D, Bell CM. The price of neonatal intensive care outcomes - in-hospital costs of morbidities related to preterm birth. Front Pediatr 2023; 11:1068367. [PMID: 36824649 PMCID: PMC9941343 DOI: 10.3389/fped.2023.1068367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Neonatal care for preterm babies is prolonged and expensive. Our aim was to analyze and report costs associated with common preterm diagnoses during NICU stay. METHODS We analyzed data from the Ontario healthcare data service. Diagnoses were collated by discharge ICD codes, and categorized by gestational age. We calculated typical non parametric statistics, and for each diagnosis we calculated median shifts and generalized linear mode. RESULTS We included data on 12,660 infants between 23 and 30 weeks gestation in 2005-2017. Calculated cost increment with diagnosis were: Intestinal obstruction: $94,738.08 (95%CI: $70,093.3, $117,294.2), Ventriculoperitoneal shunt: $86,456.60 (95%CI: $60,773.7, $111,552.2), Chronic Lung Disease $77,497.70 (95%CI: $74,937.2, $80,012.8), Intestinal perforation $57,997.15 (95%CI:$45,324.7, $70,652.6), Retinopathy of Prematurity: $55,761.80 (95%CI: $53,916.2, $57,620.1), Patent Ductus Arteriosus $53,453.70 (95%CI: $51,206.9, $55692.7, Post-haemorrhagic ventriculomegaly $41,822.50 (95%CI: $34,590.4, $48,872.4), Necrotizing Enterocolitis $39,785 (95%CI: $35,728.9, $43,879), Meningitis $38,871.85 (95%CI: $25,272.7, $52,224.4), Late onset sepsis $32,954.20 (95%CI: $30,403.7, 35.515), Feeding difficulties $24,820.90 (95%CI: $22,553.3, $27,064.7), Pneumonia $23,781.70 (95%CI: $18,623.8, $28,881.6), Grade >2 Intraventricular Haemorrhage $14,777.38 (95%CI: $9,821.7, $20,085.2). Adjusted generalized linear model of diagnoses as coefficients for cost confirmed significance and robustness of the model. CONCLUSION Cost of care for preterm infant is expensive, and significantly increases with prematurity complication. Interventions to reduce those complications may enable resource allocation and better understanding of the needs of the neonatal health services.
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Affiliation(s)
- Asaph Rolnitsky
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Sharon Unger
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - David Urbach
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Baker S, Kandasamy Y. Machine learning for understanding and predicting neurodevelopmental outcomes in premature infants: a systematic review. Pediatr Res 2023; 93:293-299. [PMID: 35641551 PMCID: PMC9153218 DOI: 10.1038/s41390-022-02120-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/25/2022] [Accepted: 05/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Machine learning has been attracting increasing attention for use in healthcare applications, including neonatal medicine. One application for this tool is in understanding and predicting neurodevelopmental outcomes in preterm infants. In this study, we have carried out a systematic review to identify findings and challenges to date. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases were searched in February 2022, with articles then screened in a non-blinded manner by two authors. RESULTS The literature search returned 278 studies, with 11 meeting the eligibility criteria for inclusion. Convolutional neural networks were the most common machine learning approach, with most studies seeking to predict neurodevelopmental outcomes from images and connectomes describing brain structure and function. Studies to date also sought to identify features predictive of outcomes; however, results varied greatly. CONCLUSIONS Initial studies in this field have achieved promising results; however, many machine learning techniques remain to be explored, and the consensus is yet to be reached on which clinical and brain features are most predictive of neurodevelopmental outcomes. IMPACT This systematic review looks at the question of whether machine learning can be used to predict and understand neurodevelopmental outcomes in preterm infants. Our review finds that promising initial works have been conducted in this field, but many challenges and opportunities remain. Quality assessment of relevant articles is conducted using the Newcastle-Ottawa Scale. This work identifies challenges that remain and suggests several key directions for future research. To the best of the authors' knowledge, this is the first systematic review to explore this topic.
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Affiliation(s)
- Stephanie Baker
- College of Science and Engineering, James Cook University, Cairns, QLD, 4878, Australia.
| | - Yogavijayan Kandasamy
- grid.417216.70000 0000 9237 0383Department of Neonatology, Townsville Hospital and Health Service, Townsville, QLD 4810 Australia ,grid.1011.10000 0004 0474 1797College of Medicine and Dentistry, James Cook University, Townsville, QLD 4810 Australia
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Hawn VS, Muhtadi R, Suman P, Latuga MS, Quinn G, Mian U. Premature infants with gestational age less than 25 weeks require increased ophthalmology resources for retinopathy of prematurity. J AAPOS 2022; 26:307.e1-307.e5. [PMID: 36404441 DOI: 10.1016/j.jaapos.2022.09.007] [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] [Received: 03/08/2022] [Revised: 09/11/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND It is unclear how increasing survival of low gestational age (GA) infants affects ophthalmologic screening and treatment rates for retinopathy of prematurity (ROP). This study compared the examination and treatment rates of infants born at GA of <25 weeks and those born at GA of at least 25 weeks. METHODS This was a retrospective study of patients who met institutional ROP screening criteria and were admitted to two neonatal intensive care units (NICUs) from January 2017 to June 2020. Variables analyzed were GA, birth weight, number of ophthalmology examinations, worst stage of ROP, presence of type 1 ROP, and comorbidities associated with ROP. The χ2, Fisher exact, and two-tailed t tests, as well as univariate and multivariable logistic regression, were used for statistical analysis. RESULTS Compared to the GA≥25 group, the GA<25 group had a higher number of total exams (10 vs 4.3 [P < 0.001]), higher average worst stage of ROP (1.4 vs 0.3 [P < 0.001]) and higher rate of type 1 ROP (21% vs 1.4% [P < 0.001]), as well as higher mortality (37% vs 8.11% [P < 0. 001]). Multivariable logistic regression analysis controlling for GA, sepsis, and number of transfusions revealed that only GA was significantly associated with developing type 1 ROP. CONCLUSIONS Infants with GA <25 weeks had more severe ROP and required significantly more ophthalmologic examinations than GA ≥25. It is important for ROP services to plan for this increased screening load, especially if the number of such lower-weight infants in their NICUs increases.
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Affiliation(s)
- Vivian S Hawn
- Albert Einstein College of Medicine, Bronx, New York
| | - Rakin Muhtadi
- Albert Einstein College of Medicine, Bronx, New York
| | - Pamela Suman
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Mariam S Latuga
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Graham Quinn
- Division of Ophthalmology, Children's Hospital of Pennsylvania, Philadelphia
| | - Umar Mian
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York.
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28
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Wehrle FM, Bartal T, Adams M, Bassler D, Hagmann CF, Kretschmar O, Natalucci G, Latal B. Similarities and Differences in the Neurodevelopmental Outcome of Children with Congenital Heart Disease and Children Born Very Preterm at School Entry. J Pediatr 2022; 250:29-37.e1. [PMID: 35660491 DOI: 10.1016/j.jpeds.2022.05.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the similarities and differences in the neurodevelopmental outcome of children with congenital heart disease (CHD) undergoing cardiopulmonary bypass surgery compared with children born very preterm (VPT) at school entry. STUDY DESIGN IQ, motor abilities, behavior, and therapy use were assessed in 155 children with CHD as part of a prospective, single-center, longitudinal study, and in 251 children born VPT as part of a national follow-up register at the same center. Group differences were tested using independent t-tests and χ2-tests. Equivalence testing was used to investigate similarities between the groups. RESULTS Mild (ie, 70 ≤ IQ < 85) and severe intellectual impairments (ie, IQ < 70) occurred in 17.4% and 4.5% of children with CHD compared with 22.1% and 5.5% in children VPT, respectively. Motor and behavioral functions were impaired in 57.0% and 15.3% of children with CHD compared with 37.8% and 11.5% of children born VPT, respectively. Children with CHD had poorer global motor abilities (d = -0.26) and poorer dynamic balance (d = -0.62) than children born VPT, and children born VPT had poorer fine motor abilities than children with CHD (d = 0.34; all P < .023). Peer problems were statistically similar between the groups (P = .020). Therapies were less frequent in children with CHD compared with children born VPT (23.4% vs 40.3%; P < .001). CONCLUSIONS Children with CHD undergoing cardiopulmonary bypass surgery and children born VPT share an overall risk for neurodevelopmental impairments that manifest in different domains. Despite this, children with CHD receive fewer therapies, indicating a lack of awareness of the neurodevelopmental burden these children face.
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Affiliation(s)
- Flavia M Wehrle
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Department of Neonatology and Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Timm Bartal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Mark Adams
- Newborn Research, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Newborn Research, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Cornelia F Hagmann
- Department of Neonatology and Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Department of Cardiology, University Children's Hospital, Zurich, Switzerland
| | - Giancarlo Natalucci
- Newborn Research, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Family Larsson-Rosenquist Center for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
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Gallagher K, Shaw C, Parisaei M, Marlow N, Aladangady N. Attitudes About Extremely Preterm Birth Among Obstetric and Neonatal Health Care Professionals in England: A Qualitative Study. JAMA Netw Open 2022; 5:e2241802. [PMID: 36374500 PMCID: PMC9664260 DOI: 10.1001/jamanetworkopen.2022.41802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Variation in attitudes between health care professionals involved in the counseling of parents facing extremely preterm birth (<24 wk gestational age) may lead to parental confusion and professional misalignment. Objective To explore the attitudes of health care professionals involved in the counseling of parents facing preterm birth on the treatment of extremely preterm infants. Design, Setting, and Participants This qualitative study used Q methods to explore the attitudes of neonatal nurses, neonatologists, midwives, and obstetricians involved in the care of extremely preterm infants in 4 UK National Health Service perinatal centers between February 10, 2020, and April 30, 2021. Each participating center had a tertiary level neonatal unit and maternity center. Individuals volunteered participation through choosing to complete the study following a presentation by researchers at each center. A link to the online Q study was emailed to all potential participants by local principal investigators. Participants ranked 53 statements about the treatment of extremely preterm infants in an online quasi-normal distribution grid from strongly agree (6) to strongly disagree (-6). Main Outcomes and Measures Distinguishing factors per professional group (representing different attitudes) identified through by-person factor analysis of Q sort-data were the primary outcome. Areas of shared agreement (consensus) between professional groups were also explored. Q sorts achieving a factor loading of greater than 0.46 (P < .01) on a given factor were included. Results In total, 155 health care professionals volunteered participation (128 [82.6%] women; mean [SD] age, 41.6 [10.2] years, mean [SD] experience, 14.1 [9.6] years). Four distinguishing factors were identified between neonatal nurses, 3 for midwives, 5 for neonatologists, and 4 for obstetricians. Analysis of factors within and between professional groups highlighted significant variation in attitudes of professionals toward parental engagement in decision-making, the perceived importance of potential disability in decision-making, and the use of medical technology. Areas of consensus highlighted that most professionals disagreed with statements suggesting disability equates to reduced quality of life. The statement suggesting the parents' decision was considered the most important when considering neonatal resuscitation was placed in the neutral (middistribution) position by all professionals. Conclusions and Relevance The findings of this qualitative study suggest that parental counseling at extremely low gestations is a complex scenario further complicated by the differences in attitudes within and between professional disciplines toward treatment approaches. The development of multidisciplinary training encompassing all professional groups may facilitate a more consistent and individualized approach toward parental engagement in decision-making.
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Affiliation(s)
- Katie Gallagher
- EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Chloe Shaw
- EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Maryam Parisaei
- Department of Obstetrics and Gynaecology, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
| | - Neil Marlow
- EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Narendra Aladangady
- Department of Neonatology, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
- Centre for Paediatrics, Barts and the London School of Medicine and Dentistry, QMUL, London, United Kingdom
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Kim HM, Horwood LJ, Harris SL, Bora S, Darlow BA, Woodward LJ. Self-reported executive function problems in adults born very low birthweight. Paediatr Perinat Epidemiol 2022; 36:643-653. [PMID: 35604649 PMCID: PMC9542013 DOI: 10.1111/ppe.12891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Executive function difficulties are common among children born very preterm and/or very low birthweight (<1500 g; VLBW), but little is known about whether they persist into adulthood. OBJECTIVES Examine the nature and pattern of self-reported executive functioning at 23 and 28 years of age using data from a national cohort study of adults born VLBW and a comparison group of same-age full-term (FT) born adults. Also examined were associations between executive function difficulties and socio-economic outcomes. METHODS All infants born VLBW in New Zealand during 1986 were prospectively included in an audit of retinopathy of prematurity (n = 413), with 250 (77% of survivors) followed to median age 28 years. A comparison group of FT adults was also recruited at age 23 and followed to 28 years (n = 100). Across both adult assessments, executive functioning was assessed using the Behaviour Rating Inventory of Executive Function-Adult Version (BRIEF-A) and analysed with semi-parametric models to examine the effects of age and group on executive function. RESULTS At 23 and 28 years, VLBW adults had increased risk of executive function impairment compared with FT adults in behaviour regulation (relative risk [CI] 2.37, 95% confidence interval (CI)1.27, 4.45), meta-cognition (RR 6.03, 95% CI 2.18, 16.78) and global functioning (RR 3.20, 95% CI 1.40, 7.28). Impaired global executive functioning was associated with lower socio-economic status (regression estimate [b] = -0.43, 95% CI -0.59, -0.27) and a reduced likelihood of home ownership by age 28 years (RR 0.98, 95% CI 0.96, 1.00), even after controlling for sex, ethnicity and parental socio-economic backgrounds for both groups. CONCLUSION(S) VLBW-born adults continue to experience more executive function difficulties in their everyday life relative to term controls at age 28 years. These difficulties were negatively associated with their socio-economic opportunities as young adults.
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Affiliation(s)
- Hyun Min Kim
- Canterbury Child Development Research GroupUniversity of CanterburyChristchurchNew Zealand
| | - L. John Horwood
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
| | - Sarah L. Harris
- Department of PaediatricsUniversity of OtagoChristchurchNew Zealand
| | - Samudragupta Bora
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Brian A. Darlow
- Department of PaediatricsUniversity of OtagoChristchurchNew Zealand
| | - Lianne J. Woodward
- Canterbury Child Development Research GroupUniversity of CanterburyChristchurchNew Zealand,Faculty of Health and Child Wellbeing Research InstituteUniversity of CanterburyChristchurchNew Zealand
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31
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Nath S, Zylbersztejn A, Viner RM, Cortina-Borja M, Lewis KM, Wijlaars LPMM, Hardelid P. Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study. BMC Health Serv Res 2022; 22:936. [PMID: 35864495 PMCID: PMC9302562 DOI: 10.1186/s12913-022-08319-1] [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] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 07/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited understanding of the drivers of increasing infant accident and emergency (A&E) attendances and emergency hospital admissions across England. We examine variations in use of emergency hospital services among infants by local areas in England and investigate the extent to which infant and socio-economic factors explain these variations. METHODS Birth cohort study using linked administrative Hospital Episode Statistics data in England. Singleton live births between 1-April-2012 and 31-March-2019 were followed up for 1 year; from 1-April-2013 (from the discharge date of their birth admission) until their first birthday, death or 31-March-2019. Mixed effects negative binomial models were used to calculate incidence rate ratios for A&E attendances and emergency admissions and mixed effects logistic regression models estimated odds ratio of conversion (the proportion of infants subsequently admitted after attending A&E). Models were adjusted for individual-level factors and included a random effect for local authority (LA). RESULTS The cohort comprised 3,665,414 births in 150 English LAs. Rates of A&E attendances and emergency admissions were highest amongst: infants born < 32 weeks gestation; with presence of congenital anomaly; and to mothers < 20-years-old. Area-level deprivation was positively associated with A&E attendance rates, but not associated with conversion probability. A&E attendance rates were highest in the North East (916 per 1000 child-years, 95%CI: 911 to 921) and London (876 per 1000, 95%CI: 874 to 879), yet London had the lowest emergency admission rates (232 per 1000, 95%CI: 231 to 234) and conversion probability (25% vs 39% in South West). Adjusting for individual-level factors did not significantly affect variability in A&E attendance and emergency admission rates by local authority. CONCLUSIONS Drivers of A&E attendances and emergency admissions include individual-level factors such being born premature, with congenital anomaly and from socio-economically disadvantaged young parent families. Support for such vulnerable infants and families should be provided alongside preventative health care in primary and community care settings. The impact of these services requires further investigation. Substantial geographical variations in rates were not explained by individual-level factors. This suggests more detailed understanding of local and underlying service-level factors would provide targets for further research on mechanisms and policy priority.
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Affiliation(s)
- Selina Nath
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Ania Zylbersztejn
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Russell M Viner
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Kate Marie Lewis
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Linda P M M Wijlaars
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Pia Hardelid
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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Rimmer MP, Henderson I, Parry-Smith W, Raglan O, Tamblyn J, Heazell AEP, Higgins LE. Worth the paper it's written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK. Int J Epidemiol 2022; 52:295-308. [PMID: 35724686 PMCID: PMC9908049 DOI: 10.1093/ije/dyac100] [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] [Received: 09/15/2021] [Accepted: 04/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Medical Certificate of Stillbirth (MCS) records data about a baby's death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. METHODS A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual 'ideal MCSs' and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. RESULTS There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70-0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24-0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3-64.9%)] included certificates issued for fetal demise at <24 weeks' gestation [23/696; 3.3% (95% CI 2.2-4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1-1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1-97.1%)]. Of 540/1246 [43.3% (95% CI 40.6-46.1%)] 'unexplained' stillbirths, only 119/540 [22.0% (95% CI 18.8-25.7%)] remained unexplained; the majority were redesignated as either fetal growth restriction [FGR: 195/540; 36.1% (95% CI 32.2-40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2-38.2)]. Overall, FGR [306/1246; 24.6% (95% CI 22.3-27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5-22.1%)] FGR cases were originally attributed correctly. CONCLUSION This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory.
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Affiliation(s)
- Michael P Rimmer
- United Kingdom Audit and Research Collaborative in Obstetrics and Gynaecology, UK,MRC Centre for Reproductive Health, Queens Medical Research Institute, Edinburgh BioQuarter, Edinburgh, UK
| | - Ian Henderson
- United Kingdom Audit and Research Collaborative in Obstetrics and Gynaecology, UK,Warwick Medical School, University of Warwick, Coventry, UK
| | - William Parry-Smith
- United Kingdom Audit and Research Collaborative in Obstetrics and Gynaecology, UK,Department of Obstetrics and Gynaecology, Shrewsbury and Telford NHS Trust, Apley, UK
| | - Olivia Raglan
- United Kingdom Audit and Research Collaborative in Obstetrics and Gynaecology, UK,Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Trust, London, UK
| | - Jennifer Tamblyn
- United Kingdom Audit and Research Collaborative in Obstetrics and Gynaecology, UK,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK,Department of Reproductive Medicine, Seacroft Hospital, Leeds, UK
| | | | - Lucy E Higgins
- Corresponding author. Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK. E-mail:
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Soni R, Tscherning Wel-Wel C, Robertson NJ. Neuroscience meets nurture: challenges of prematurity and the critical role of family-centred and developmental care as a key part of the neuroprotection care bundle. Arch Dis Child Fetal Neonatal Ed 2022; 107:242-249. [PMID: 33972264 DOI: 10.1136/archdischild-2020-319450] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 04/01/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023]
Abstract
Advances in neonatal-perinatal medicine have resulted in increased survival at lower gestations. Although the incidence of germinal matrix haemorrhage-intraventricular haemorrhage and cystic periventricular leucomalacia is reducing, a new phenotype of preterm brain injury has emerged consisting of a combination of destructive and dysmaturational effects. Consequently, severe neurological disability is reported at a lower rate than previously, but the overall morbidity associated with premature birth continues to present a large global burden and contributes significantly to increased financial costs to health systems and families. In this review, we examine the developmental milestones of fetal brain development and how preterm birth can disrupt this trajectory. We review common morbidities associated with premature birth today. Although drug-based and cell-based neuroprotective therapies for the preterm brain are under intense study, we outline basic, sustainable and effective non-medical, family-centred and developmental care strategies which have the potential to improve neurodevelopmental outcomes for this population and need to be considered part of the future neuroprotection care bundle.
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Affiliation(s)
- Roopali Soni
- Neonatology, Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar .,Department of Neonatology, Mediclinic Parkview Hospital, Dubai, UAE
| | - Charlotte Tscherning Wel-Wel
- Neonatology, Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar.,Center of Physiopathology Toulouse-Purpan(CPTP), University of Toulouse, Toulouse, France
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Ravelo J, Adams G, Husain S. Identification of treatment-warranted retinopathy of prematurity by neonatal nurse specialist. Arch Dis Child Fetal Neonatal Ed 2022; 107:299-302. [PMID: 34426506 DOI: 10.1136/archdischild-2021-322266] [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: 05/05/2021] [Accepted: 08/04/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the accuracy in the identification of infants with treatment-warranted retinopathy of prematurity (ROP) by a trained and experienced ROP neonatal nurse specialist compared with skilled ophthalmologists. METHODS A single-centre, prospective, blinded, agreement study was performed on a cohort of infants undergoing ROP screening. An experienced ROP neonatal nurse specialist obtained retinal images using a wide field digital retinal imaging system (WFDRI) on 127 infants and identified those with treatment-warranted ROP. This interpretation was compared with the interpretation of the same images by skilled ophthalmologists. The accuracy of the ROP nurse specialist's interpretation was assessed for sensitivity and specificity compared with the gold standard interpretation by the ophthalmologists. RESULTS The ROP nurse specialist performed 345 ROP screens on both eyes of 127 infants. The mean (SD) gestation age (weeks) and birth weight (g) of the infants screened was 26.8 (2.8) and 929 (327), respectively. The nurse specialist correctly identified all 8 infants with treatment-warranted ROP and 118/119 infants without. The sensitivity and specificity (95% CI) of ROP screening episodes were 100% (63% to 100%) and 99.7% (98.4% to 100.0%), respectively. CONCLUSION A trained and experienced ROP neonatal nurse specialist can correctly identify infants with treatment-warranted ROP using WFDRI. Further work is required to examine the generalisability of this finding and its impact on ROP screening services.
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Affiliation(s)
- Janette Ravelo
- Neonatology Department, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Gillian Adams
- Strabismus and Paediatric Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Shahid Husain
- Neonatology Department, Homerton University Hospital NHS Foundation Trust, London, UK .,Genetics and Child Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
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Partanen E, Mårtensson G, Hugoson P, Huotilainen M, Fellman V, Ådén U. Auditory Processing of the Brain Is Enhanced by Parental Singing for Preterm Infants. Front Neurosci 2022; 16:772008. [PMID: 35444514 PMCID: PMC9014198 DOI: 10.3389/fnins.2022.772008] [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: 09/07/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
As the human auditory system is highly malleable in infancy, perinatal risk factors, such as preterm birth, may affect auditory development. In comparison to healthy full-term infants, preterm infants show abnormal auditory brain responses at term age, which may have long-term detrimental outcomes. To achieve an optimal neonatal care environment for preterm-born infants, many early interventions have been developed. Musical interventions developed for neonatal intensive care units (NICUs) have shown beneficial effects on vital functions and weight gain of preterm infants and might also influence basic auditory processing and thereby enhance outcomes. In the present study, we tested the effect of parental singing during kangaroo care on auditory processing of standardized audio stimuli. Preterm infants (born between 24 and 32 weeks of gestation) were randomized to singing intervention (n = 13) or control (n = 8) groups. The auditory processing was tested using two audio paradigms assessed with magnetoencephalography (MEG) at term corresponding age. To verify that the paradigms elicit responses in MEG, we studied 12 healthy full-term infants. In the singing intervention group, parents were instructed by a music therapist twice a week for 4 weeks to sing or hum during kangaroo care in an infant-directed way. The control group received standard kangaroo care. The results show that the infants in the singing intervention group show larger neural responses than those in the control group when controlling for the total amount of singing during kangaroo care. Our findings suggest that incorporating singing into kangaroo care may be beneficial for preterm infants, but the effect may not be due to exposure to singing but instead positive parenting, improved parental self-esteem and improved caregiver sensitivity.
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Affiliation(s)
- Eino Partanen
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Centre of Excellence in Music, Mind, Body and Brain (MMBB), Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- *Correspondence: Eino Partanen,
| | - Gustaf Mårtensson
- Department of Women and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Pernilla Hugoson
- Department of Women and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Music, Art, and Culture Studies, Faculty of Humanities and Social Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Minna Huotilainen
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Centre of Excellence in Music, Mind, Body and Brain (MMBB), Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- CICERO Learning Network, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Vineta Fellman
- Department of Pediatrics and Clinical Sciences, Lund University, Lund, Sweden
- Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Ulrika Ådén
- Department of Women and Children’s Health, Karolinska Institute, Stockholm, Sweden
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Abstract
Debates about treatment for the tiniest premature babies focus on three different approaches - universal non-resuscitation, selective resuscitation, and universal resuscitation. Doctors, hospitals, and professional societies differ on which approach is preferable. The debate is evolving as studies show that survival rates for babies born at 22 and 23 weeks of gestation are steadily improving at centers that offer active treatment to these babies. Still, many centers do not offer such treatment or, if they do, actively discourage it. The doctors and centers that discourage treatment have concerns about the chances for survival, neurodevelopmental impairment among survivors, and cost. Centers that offer and encourage treatment cite evidence that many babies born at 22 weeks can survive, that most survivors have good neurodevelopmental outcomes, and that NICU care for tiny babies is cost-effective compared to many common and uncontroversial treatments. The debate touches on many fundamental ethical issues that have been present in neonatology since its inception as a medical specialty.
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Arattu Thodika FMS, Nanjundappa M, Dassios T, Bell A, Greenough A. Pulmonary hypertension in infants with bronchopulmonary dysplasia: risk factors, mortality and duration of hospitalisation. J Perinat Med 2022; 50:327-333. [PMID: 34847313 DOI: 10.1515/jpm-2021-0366] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Pulmonary hypertension (PH) is a complication of bronchopulmonary dysplasia (BPD) and associated with increased mortality and morbidity. Our aim was to identify, in infants with BPD, the effect of PH on health-care utilisation and health related cost of care. METHODS An electronic data recording system was used to identify infants ≤32 weeks of gestation who developed BPD. PH was classified as early (≤28 days after birth) or late (>28 days after birth). RESULTS In the study period, 182 infants developed BPD; 22 (12.1%) developed late PH. Development of late PH was associated with a lower gestational age [24.6 (23.9-26.9) weeks, p=0.001] and a greater need for positive pressure ventilation on day 28 after birth (100%) compared to infants without late PH (51.9%) (odds ratio (OR) 19.5, 95% CI: 2.6-148), p<0.001. Late PH was associated with increased mortality (36.4%) compared those who did not develop late PH (1.9%) after adjusting for gestational age and ventilation duration (OR: 26.9, 95% CI: 3.8-189.4), p<0.001. In infants who survived to discharge, late PH development was associated with a prolonged duration of stay [147 (118-189) days] compared to the infants that did not develop late PH [109 (85-149) days] (p=0.03 after adjusting for gestational age). Infants who had late PH had a higher cost of stay compared to infants with BPD who did not develop late PH (median £113,494 vs. £78,677, p=0.016 after adjusting for gestational age). CONCLUSIONS Development of late PH was associated with increased mortality, a prolonged duration of stay and higher healthcare cost.
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Affiliation(s)
- Fahad M S Arattu Thodika
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mahesh Nanjundappa
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Aaron Bell
- Department of Paediatric Cardiology, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK.,NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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Belay DM, Worku WZ, Wondim A, Hailemeskel HS, Bayih WA. Predictors of Survival Among Preterm Neonates Admitted to Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. Front Pediatr 2022; 10:800300. [PMID: 35372165 PMCID: PMC8965609 DOI: 10.3389/fped.2022.800300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pre-maturity is the primary cause of neonatal mortality in the world. Although prematurity was the leading cause of neonatal mortality, the survival rate and its predictors may be varied from setting to setting and time to time due to different reasons. Therefore, this study aimed to assess the survival probability and predictors of mortality among preterm neonates at Felege Hiwot comprehensive specialized hospital. Methods This is a retrospective follow-up study that included 542 randomly selected preterm neonates admitted at Felege Hiwot comprehensive specialized hospital from the period of 2016-2020. Semi-parametric and parametric survival models were fitted to identify the survival probability of preterm neonates and its association with different predictors. The best fit model was selected using Akaike's information criteria, Bayesian information criteria and likelihood ratio criteria. Results The cumulative incidence and incidence rate of mortality among preterm neonates were 31 per 100 live births and 3.5 per 100 neonate days, respectively. From the adjusted cox-proportional-hazard model, predictors with higher preterm mortality risk include the presence of neonatal respiratory distress syndrome [AHR = 2.55, 95% CI: 1.23; 3.74], perinatal asphyxia [AHR = 4.26, 95% CI: 1.35; 6.79] and jaundice [AHR = 3.25, 95% CI: 2.14, 7.24]. However, admission weight of 1,500-2,499 g (AHR = 0.23, 95% CI: 0.11, 0.56) and ≥2,500 g (AHR = 0.12, 95% CI: 0.02; 0.32), early breastfeeding [AHR = 0.44, 95% CI: 0.36; 0.48] and kangaroo mother care [AHR = 0.11, 95% CI: 0.03; 0.15] were protective factors of preterm mortality. Conclusion The cumulative incidence of mortality among preterm neonates was consistent with the national incidence of preterm mortality. Factors such as respiratory distress syndrome, perinatal asphyxia, breastfeeding, kangaroo mother care, admission weight, and jaundice are significant predictors of survival. Therefore, considerable attention such as intensive phototherapy, optimal calorie feeding, oxygenation, and good thermal care should be given for admitted preterm neonates.
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Affiliation(s)
- Demeke Mesfin Belay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Workie Zemene Worku
- Department of Community Health Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Wondim
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Shimels Hailemeskel
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Uthaya S, Longford N, Battersby C, Oughham K, Lanoue J, Modi N. Early versus later initiation of parenteral nutrition for very preterm infants: a propensity score-matched observational study. Arch Dis Child Fetal Neonatal Ed 2022; 107:137-142. [PMID: 34795009 PMCID: PMC8867269 DOI: 10.1136/archdischild-2021-322383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the impact of timing of initiation of parenteral nutrition (PN) after birth in very preterm infants. DESIGN Propensity-matched analysis of data from the UK National Neonatal Research Database. PATIENTS 65 033 babies <31 weeks gestation admitted to neonatal units in England and Wales between 2008 and 2019. INTERVENTIONS PN initiated in the first 2 days (early) versus after the second postnatal day (late). Babies who died in the first 2 days without receiving PN were analysed as 'late'. MAIN OUTCOME MEASURES The main outcome measure was morbidity-free survival to discharge. The secondary outcomes were survival to discharge, growth and other core neonatal outcomes. FINDINGS No difference was found in the primary outcome (absolute rate difference (ARD) between early and late 0.50%, 95% CI -0.45 to 1.45, p=0.29). The early group had higher rates of survival to discharge (ARD 3.3%, 95% CI 2.7 to 3.8, p<0.001), late-onset sepsis (ARD 0.84%, 95% CI 0.48 to 1.2, p<0.001), bronchopulmonary dysplasia (ARD 1.24%, 95% CI 0.30 to 2.17, p=0.01), treated retinopathy of prematurity (ARD 0.50%, 95% CI 0.17 to 0.84, p<0.001), surgical procedures (ARD 0.80%, 95% CI 0.20 to 1.40, p=0.01) and greater drop in weight z-score between birth and discharge (absolute difference 0.019, 95% CI 0.003 to 0.035, p=0.02). Of 4.9% of babies who died in the first 2 days, 3.4% were in the late group and not exposed to PN. CONCLUSIONS Residual confounding and survival bias cannot be excluded and justify the need for a randomised controlled trial powered to detect differences in important functional outcomes.
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Affiliation(s)
- Sabita Uthaya
- Department of Neonatal Medicine, Imperial College London, London, UK
| | - Nicholas Longford
- Department of Neonatal Medicine, Imperial College London, London, UK
| | - Cheryl Battersby
- Department of Neonatal Medicine, Imperial College London, London, UK
| | - Kayleigh Oughham
- Department of Neonatal Medicine, Imperial College London, London, UK
| | - Julia Lanoue
- Department of Neonatal Medicine, Imperial College London, London, UK
| | - Neena Modi
- Department of Neonatal Medicine, Imperial College London, London, UK
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Abstract
Survival rates for babies born at 22 weeks of gestation are steadily improving at centers that offer active treatment to these babies. Still, many centers do not offer such treatment or, if they do, actively discourage it. Thus, parents will be given very different advice at different centers for babies born at the borderline of viability. Those doctors and centers that discourage treatment have concerns about the chances for survival, neurodevelopmental impairment among survivors, and cost. Yet there is strong evidence that many babies born at 22 weeks can survive, most survivors have good neurodevelopmental outcomes, and neonatal intensive care for tiny babies is cost-effective compared to many common and uncontroversial treatments. Given this growing body of evidence, policies discouraging or forbidding treatment of babies born at 22 weeks will require stronger ethical justification than has been given to date.
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Outcomes of laparotomy in preterm infants with extremely low operative weight (< 1000 g). Pediatr Surg Int 2022; 38:409-414. [PMID: 34984534 DOI: 10.1007/s00383-021-05056-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Most studies on outcomes of surgery in extremely premature neonates include cases based on birth weight irrespective of weight at the time of surgery. Reported figures may not accurately reflect what is truly experienced in babies with smaller weight at the time of surgery. This study sought to document the outcomes of laparotomy in preterms at extremely low operative (ELOW) of < 1000 g. METHODS Preterm infants weighing < 1000 g at the time of laparotomy were identified from a prospectively collected database. Data were collected over 12 years (Sept 2007-Mar 2020). Primary outcome investigated was in-hospital mortality. Other outcomes including long-term morbidities are reported. RESULTS 79 ELOW infants were included. Median gestational age was 25 weeks (23-29 weeks) and median birth weight 680 g (382-986 g). The median weight at laparotomy was 755 g (380-993 g) at a median age of 11 days of life (1-38 days). The commonest diagnoses at laparotomy included: necrotising enterocolitis 44 (56%), spontaneous intestinal perforation 20 (25%) and meconium obstruction of prematurity 5 (6%). The median predicted mortality using CRIB II scoring system was 35%. 21 (27%) in-hospital mortality was recorded. Babies who died had significantly lower operative weight (610 vs 767 g p = 0.0303) compared to those who survived despite no significant difference in birth weight. 30% had one or more surgical complications. 50% had no recorded morbidity at 2-year assessment while 19% had severe impairment. CONCLUSION 73% of preterm infants that underwent laparotomy at < 1000 g survived to discharge and 50% of survivors had no long-term morbidity. Association between mortality and lower operative weight at laparotomy is shown. This study provides a focused data on the ELOW category of patients which could more accurately guide counselling and management decisions.
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Rodrigues C, Zeitlin J, Carvalho AR, Gonzaga D, Barros H. Behavioral and emotional outcomes at preschool age in children born very preterm: The role of breast milk feeding practices. Early Hum Dev 2022; 165:105535. [PMID: 35038626 DOI: 10.1016/j.earlhumdev.2021.105535] [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: 05/28/2021] [Revised: 11/10/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Breast milk feeding (BMF) improved neurodevelopment in children born very preterm (VPT, <32 weeks of gestation), but knowledge about its effect on other mental health outcomes remains limited. OBJECTIVE To estimate the association of BMF practices with behavioral and emotional problems at preschool age in children born VPT. METHODS We studied 263 children born VPT during 2011-12 and enrolled in the Portuguese EPICE cohort. At the age of 3, information on BMF initiation and duration was collected and behavioral and emotional problems were assessed using the parents' completed Child Behavior Checklist 1.5-5 years (CBCL/1½-5). Children were categorized for all CBCL/1½-5 sub-scales and for Diagnostic and Statistical Manual of Mental Disorders (DSM5)-oriented scales. Risk ratios were estimated to assess the association of BMF with subclinical/clinical problems, fitting a Poisson regression. RESULTS Behavioral or emotional subclinical/clinical problems were found in almost 20% of children (11.8% in the clinical range). BMF was consistently associated with lower adverse behavioral and emotional outcomes, particularly risks of externalizing problems, somatic complaints, aggressive behavior, as well as autism spectrum and attention deficit/hyperactivity symptoms, although the magnitude of the unadjusted risks was attenuated by adjustment for relevant confounders and wider confidence intervals included the null. CONCLUSION Lower exposure to BMF seemed to increase the risk of adverse behavioral and emotional outcomes at preschool age in children born VPT. These results raise questions about explanatory pathways and strengthen evidence underpinning BMF promotion for VPT children.
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Affiliation(s)
- Carina Rodrigues
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, F-75004 Paris, France
| | - Ana Raquel Carvalho
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Diana Gonzaga
- Centro Materno-Infantil do Norte, Centro Hospital Universitário do Porto, Porto, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
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Yeoh M, Rafferty S, Saw C, Beedie J, Davis JW. Fifteen-minute consultation: Outcomes of the extremely preterm infant (<27 weeks): what to tell the parents. Arch Dis Child Educ Pract Ed 2022; 108:163-166. [PMID: 35045993 DOI: 10.1136/archdischild-2020-321178] [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: 01/04/2021] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Abstract
An extremely preterm infant is one born at less than 27 weeks' gestation. Over time, survival rates in this population have improved. This cohort remains at high risk of mortality and life-long morbidity. The birth of extremely preterm infants is an important public health issue and one which concerns neonatologists, paediatricians, general practitioners and parents alike. This paper aims to provide guidance for the antenatal discussion between clinicians and expectant families and may serve as a template to facilitate open communication.
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Affiliation(s)
- Melanie Yeoh
- Neonatal Clinical Care Unit, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia
| | | | - Chia Saw
- Paediatrics, St John of God Midland Public Hospital, Perth, Western Australia, Australia
| | - Joanne Beedie
- Helping Little Hands (Parent Support Charity), Perth, Western Australia, Australia.,Parent Representative, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia
| | - Jonathan W Davis
- Neonatal Clinical Care Unit, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia .,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Newborn Emergency Transport Service Western Australia (NETS WA), Perth Children's Hospital, Perth, Western Australia, Australia
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Peng HB, Zhan YL, Chen Y, Jin ZC, Liu F, Wang B, Yu ZB. Prediction Models for Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review. Front Pediatr 2022; 10:856159. [PMID: 35633976 PMCID: PMC9133667 DOI: 10.3389/fped.2022.856159] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To provide an overview and critical appraisal of prediction models for bronchopulmonary dysplasia (BPD) in preterm infants. METHODS We searched PubMed, Embase, and the Cochrane Library to identify relevant studies (up to November 2021). We included studies that reported prediction model development and/or validation of BPD in preterm infants born at ≤32 weeks and/or ≤1,500 g birth weight. We extracted the data independently based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). We assessed risk of bias and applicability independently using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). RESULTS Twenty-one prediction models from 13 studies reporting on model development and 21 models from 10 studies reporting on external validation were included. Oxygen dependency at 36 weeks' postmenstrual age was the most frequently reported outcome in both development studies (71%) and validation studies (81%). The most frequently used predictors in the models were birth weight (67%), gestational age (62%), and sex (52%). Nearly all included studies had high risk of bias, most often due to inadequate analysis. Small sample sizes and insufficient event patients were common in both study types. Missing data were often not reported or were discarded. Most studies reported on the models' discrimination, while calibration was seldom assessed (development, 19%; validation, 10%). Internal validation was lacking in 69% of development studies. CONCLUSION The included studies had many methodological shortcomings. Future work should focus on following the recommended approaches for developing and validating BPD prediction models.
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Affiliation(s)
- Hai-Bo Peng
- Department of Neonatology, Affiliated Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Yuan-Li Zhan
- Department of Neonatology, Affiliated Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - You Chen
- Department of Neonatology, Affiliated Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Zhen-Chao Jin
- Department of Neonatology, Affiliated Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Fang Liu
- Department of Neonatology, Affiliated Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Bo Wang
- Department of Pediatrics, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Zhang-Bin Yu
- Department of Neonatology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
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Teoh LJ, Solebo AL, Rahi JS. Temporal trends in the epidemiology of childhood severe visual impairment and blindness in the UK. Br J Ophthalmol 2021; 107:717-724. [PMID: 34949577 DOI: 10.1136/bjophthalmol-2021-320119] [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: 08/02/2021] [Accepted: 12/02/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIMS Understanding temporal trends in childhood visual disability is necessary for planning and evaluating clinical services and health policies. We investigate the changing epidemiology of severe visual impairment (SVI) and blindness (BL) in children in the UK in the 21st century. METHODS Comparative analysis of two national population-based epidemiological studies of incident childhood SVI/BL (ICD-10 definition; visual acuity worse than 1.0 LogMAR in the better eye). We carry out comparative analysis of studies conducted in 2000 and 2015 using identical methods. RESULTS Overall annual and cumulative incidence rates remained broadly stable in 2015 at 0.38 per 10 000 (95% CI 0.34 to 0.41) for 0-15 years old and 5.65 per 10 000 (5.16 to 6.18) by 16 years, respectively, and with annual incidence in infancy (3.52 per 10 000, 3.13 to 3.97) remaining considerably higher than any other age. Mortality among children diagnosed in infancy declined (from 61.4 to 25.6 per 1000), despite an increase (from 77% to 84%, p=0.037) in the overall proportion with significant non-ophthalmic impairments/disorders. The relative contribution of all the main groups of disorders increased over time, most notably cerebral visual impairment (from 50% to 61%). Aetiological factors operating prenatally continued to predominate, with an increased relative contribution of hereditary conditions in all children (from 35% to 57%, p<0.001). The substantially elevated rates for any ethnic minority group and those born preterm were unchanged, with amplification of increased rates associated with low birth weight. CONCLUSION The changing landscape of healthcare and increased survival of affected children, is reflected in increasing clinical complexity and heterogeneity of all-cause SVI/BL alongside declining mortality.
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Affiliation(s)
- Lucinda J Teoh
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.,Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ameenat Lola Solebo
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.,Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Moorfields NIHR Biomedical Research Centre, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Jugnoo S Rahi
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK .,Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Moorfields NIHR Biomedical Research Centre, London, UK.,UCL Institute of Ophthalmology, London, UK
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Di Stefano LM, Wood K, Mactier H, Bates SE, Wilkinson D. Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals. Arch Dis Child Fetal Neonatal Ed 2021; 106:596-602. [PMID: 33927001 PMCID: PMC8543207 DOI: 10.1136/archdischild-2020-321273] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Decisions about treatments for extremely preterm infants (EPIs) born in the 'grey zone' of viability can be ethically complex. This 2020 survey aimed to determine views of UK neonatal staff about thresholds for treatment of EPIs given a recently revised national Framework for Practice from the British Association of Perinatal Medicine. METHODS The online survey requested participants indicate the lowest gestation at which they would be willing to offer active treatment and the highest gestation at which they would withhold active treatment of an EPI at parental request (their lower and upper thresholds). Relative risks were used to compare respondents' views based on profession and neonatal unit designation. Further questions explored respondents' conceptual understanding of viability. RESULTS 336 respondents included 167 consultants, 127 registrars/fellows and 42 advanced neonatal nurse practitioners (ANNPs). Respondents reported a median grey zone for neonatal resuscitation between 22+1 and 24+0 weeks' gestation. Registrars/fellows were more likely to select a lower threshold at 22+0 weeks compared with consultants (Relative Risk (RR)=1.37 (95% CI 1.07 to 1.74)) and ANNPs (RR=2.68 (95% CI 1.42 to 5.06)). Those working in neonatal intensive care units compared with other units were also more likely to offer active treatment at 22+0 weeks (RR=1.86 (95% CI 1.18 to 2.94)). Most participants understood a fetus/newborn to be 'viable' if it was possible to survive, regardless of disability, with medical interventions accessible to the treating team. CONCLUSION Compared with previous studies, we found a shift in the reported lower threshold for resuscitation in the UK, with greater acceptance of active treatment for infants <23 weeks' gestation.
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Affiliation(s)
- Lydia Mietta Di Stefano
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | - Helen Mactier
- Neonatology, Princess Royal Maternity Hospital, Glasgow, UK,School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Sarah Elizabeth Bates
- Department of Paediatrics and Neonatology, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Dominic Wilkinson
- Newborn Care, John Radcliffe Hospital, Oxford, UK .,Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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Sokou R, Tritzali M, Piovani D, Konstantinidi A, Tsantes AG, Ioakeimidis G, Lampridou M, Parastatidou S, Iacovidou N, Kokoris S, Nikolopoulos GK, Kopterides P, Bonovas S, Tsantes AE. Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry. Diagnostics (Basel) 2021; 11:diagnostics11111955. [PMID: 34829302 PMCID: PMC8619208 DOI: 10.3390/diagnostics11111955] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To compare the prognostic accuracy of the most commonly used indexes of mortality over time and evaluate the potential of adding thromboelastometry (ROTEM) results to these well-established clinical scores. METHODS The study population consisted of 473 consecutive term and preterm critically-ill neonates. On the first day of critical illness, modified Neonatal Multiple Organ Dysfunction (NEOMOD) scoring system, Score for Neonatal Acute Physiology (SNAP II), Perinatal extension of SNAP (SNAPPE), and SNAPPE II, were calculated and ROTEM standard extrinsically activated (EXTEM) assay was performed simultaneously. Time-to-event methodology for competing-risks was used to assess the performance of the aforementioned indexes in predicting in-hospital mortality over time. Time-dependent receiver operator characteristics curves for censored observation were compared across indexes. The addition of EXTEM parameters to each index was tested in terms of discrimination capacity. RESULTS The modified NEOMOD score performed similarly to SNAPPE. Both scores performed significantly better than SNAP II and SNAPPE II. Amplitude recorded at 10 min (A10) was the EXTEM parameter most strongly associated with mortality (A10 < 37 mm vs. ≥37 mm; sHR = 5.52; p < 0.001). Adding A10 to each index apparently increased the prognostic accuracy in the case of SNAP II and SNAPPE II. However, these increases did not reach statistical significance. CONCLUSION Although the four existing indexes considered showed good to excellent prognostic capacity, modified NEOMOD and SNAPPE scores performed significantly better. Though larger studies are needed, adding A10 to well-established neonatal severity scores not including biomarkers of coagulopathy might improve their prediction of in-hospital mortality.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece; (A.K.); (G.I.); (M.L.); (S.P.)
- Correspondence: ; Tel.: +30-2132077346 or +30-2132077000
| | - Maroula Tritzali
- First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Thivon 1, Goudi, 11527 Athens, Greece;
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece; (A.K.); (G.I.); (M.L.); (S.P.)
| | - Andreas G. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece; (A.G.T.); (S.K.); (A.E.T.)
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece; (A.K.); (G.I.); (M.L.); (S.P.)
| | - Maria Lampridou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece; (A.K.); (G.I.); (M.L.); (S.P.)
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece; (A.K.); (G.I.); (M.L.); (S.P.)
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 15772 Athens, Greece;
| | - Styliani Kokoris
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece; (A.G.T.); (S.K.); (A.E.T.)
| | | | - Petros Kopterides
- Intensive Care Unit, Excela Health Westmoreland Hospital, Greensburg, PA 15601, USA;
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Argirios E. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece; (A.G.T.); (S.K.); (A.E.T.)
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Fraser LK, Gibson-Smith D, Jarvis S, Norman P, Parslow RC. Estimating the current and future prevalence of life-limiting conditions in children in England. Palliat Med 2021; 35:1641-1651. [PMID: 33323043 PMCID: PMC8532217 DOI: 10.1177/0269216320975308] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous studies showed increasing number of children with a life-limiting or life-threatening condition who may benefit from input from pediatric palliative care services. AIM To estimate the current prevalence of children with a life-limiting condition and to model future prevalence of this population. DESIGN Observational study using national inpatient hospital data. A population-based approach utilizing ethnic specific population projections was used to estimate future prevalence. SETTING/PARTICIPANTS All children aged 0-19 years with a life-limiting condition diagnostic code recorded in Hospital Episodes Statistics data in England from 2000/01 to 2017/18. RESULTS Data on 4,543,386 hospital episodes for 359,634 individuals were included. The prevalence of children with a life-limiting condition rose from 26.7 per 10,000 (95%CI 26.5-27.0) in 2001/02 to 66.4 per 10,000 (95% CI: 66.0-66.8) in 2017/18. Using a more restricted definition of a life-limiting condition reduced the prevalence from 66.4 to 61.1 per 10,000 (95%CI 60.7-61.5) in 2017/18. Highest prevalence was in the under 1-year age group at 226.5 per 10,000 and children with a congenital abnormality had the highest prevalence (27.2 per 10,000 (95%CI: 26.9-27.5)).The prevalence was highest among the most deprived group and in children of Pakistani origin.Predicted future prevalence of life-limiting conditions ranged from 67.0 (95%CI 67.7-66.3) to 84.22 (95%CI 78.66-90.17) per 10,000 by 2030. CONCLUSIONS The prevalence of children with a life-limiting or life-threatening condition in England has risen over the last 17 years and is predicted to increase. Future data collections must include the data required to assess the complex health and social care needs of these children.
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Affiliation(s)
- Lorna K Fraser
- Department of Health Sciences, Martin House Research Centre, University of York, York, UK
| | - Deborah Gibson-Smith
- Department of Health Sciences, Martin House Research Centre, University of York, York, UK
| | - Stuart Jarvis
- Department of Health Sciences, Martin House Research Centre, University of York, York, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Roger C Parslow
- Leeds Institute of Cardiovascular and Molecular Medicine, School of Medicine, University of Leeds, Leeds, UK
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Nath S, Hardelid P, Zylbersztejn A. Are infant mortality rates increasing in England? The effect of extreme prematurity and early neonatal deaths. J Public Health (Oxf) 2021; 43:541-550. [PMID: 32119086 PMCID: PMC8458015 DOI: 10.1093/pubmed/fdaa025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/31/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infant mortality has been rising in England since 2014. We examined potential drivers of these trends. METHODS We used aggregate data on all live births, stillbirths and linked infant deaths in England in 2006-2016 from the Office for National Statistics. We compared trends in infant mortality rates overall, excluding births at <24 weeks of gestation, by quintile of SES and gestational age. RESULTS Infant mortality decreased from 4.78 deaths/1000 live births in 2006 to 3.54/1000 in 2014 (annual decrease of 0.15/1000) and increased to 3.67/1000 in 2016 (annual increase of 0.07/1000). This rise was driven by increases in deaths at 0-6 days of life. After excluding infants born at <24 weeks of gestation, infant mortality continued to decrease after 2014. The risk of infant death was 94% higher in the most versus least deprived SES quintile, which reduced to a 55% higher risk after adjusting for gestational age. CONCLUSIONS The observed increase in infant mortality rates since 2014 is wholly explained by an increasing number of deaths at 0-6 days of age among babies born at <24 weeks of gestation. Policies focused on improving maternal health to reduce preterm birth could substantially reduce the socio-economic gap in infant survival.
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Affiliation(s)
- Selina Nath
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Pia Hardelid
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Ania Zylbersztejn
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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50
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Boo NY, Chee SC, Neoh SH, Ang EBK, Ang EL, Choo P, Ahmad Kamar A, Syed-Abdullah FI, Wong AC. Ten-year trend of care practices, morbidities and survival of very preterm neonates in the Malaysian National Neonatal Registry: a retrospective cohort study. BMJ Paediatr Open 2021; 5:e001149. [PMID: 34595358 PMCID: PMC8438971 DOI: 10.1136/bmjpo-2021-001149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives To determine a 10-year trend of survival, morbidities and care practices, and predictors of in-hospital mortality in very preterm neonates (VPTN, gestation 22 to <32 weeks) in the Malaysian National Neonatal Registry. Design Retrospective cohort study. Setting 43 Malaysian neonatal intensive care units. Patients 29 010 VPTN (without major malformations) admitted between 1 January 2009 and 31 December 2018. Main outcome measures Care practices, survival, admission hypothermia (AH, <36.5°C), late-onset sepsis (LOS), pneumothorax, necrotising enterocolitis grade 2 or 3 (NEC), severe intraventricular haemorrhage (sIVH, grade 3 or 4) and bronchopulmonary dysplasia (BPD). Results During this 10-year period, there was increased use of antenatal steroid (ANS), lower segment caesarean section (LSCS) and early continuous positive airway pressure (eCPAP); but decreased use of surfactant therapy. Survival had increased from 72% to -83.9%. The following morbidities had decreased: LOS (from 27.9% to 7.1%), pneumothorax (from 6.0% to 2.7%), NEC (from 8.1% to 4.7%) and sIVH (from 12.2% to 7.5%). However, moderately severe AH (32.0°C-35.9°C) and BPD had increased. Multiple logistic regression analyses showed that lower birth weight, no ANS, no LSCS, admission to neonatal intensive care unit with <100 VPTN admissions/year, no surfactant therapy, no eCPAP, moderate and severe AH, LOS, pneumothorax, NEC and sIVH were significant predictors of mortality. Conclusion Survival and major morbidities had improved modestly. Failure to use ANS, LSCS, eCPAP and surfactant therapy, and failure to prevent AH and LOS increased risk of mortality.
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Affiliation(s)
- Nem Yun Boo
- Population Medicine, Universiti Tunku Abdul Rahman - Kampus Bandar Sungai Long, Kajang, Selangor, Malaysia
| | | | - Siew Hong Neoh
- Paediatrics, Tunku Azizah Hospital, Kuala Lumpur, Federal Territory, Malaysia
| | - Eric Boon-Kuang Ang
- Paediatrics, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Ee Lee Ang
- Paediatriccs, Tengku Ampuan Rahimah Hospital, Klang, Selangor, Malaysia
| | - Pauline Choo
- Paediatrics, Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan, Malaysia
| | - Azanna Ahmad Kamar
- Paediatrics, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Ann Cheng Wong
- Paediatrics, Sarawak General Hospital, Kuching, Sarawak, Malaysia
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