Publications
370 results found
Modi N, Simon C, 2016, Child health care: adequate training for all UK GPs is long overdue, British Journal of General Practice, Vol: 66, Pages: 228-229, ISSN: 1478-5242
Uthaya SN, Liu X, Babalis D, et al., 2016, Nutritional Evaluation and Optimisation in Neonates (NEON): a randomised double-blind controlled trial of amino-acid regimen and intravenous lipid composition in preterm parenteral nutrition, American Journal of Clinical Nutrition, Vol: 103, Pages: 1443-1452, ISSN: 1938-3207
BackgroundParenteral nutrition is central to the care of very immature infants. Current international recommendations favour higher amino-acid intakes and fish oil-containing lipid emulsions. ObjectiveThe aim of this two-by-two factorial, double-blind multicentre randomised controlled trial was to compare the effect of high (immediate Recommended Daily Intake: Imm-RDI) versus low (incremental introduction: Inc-AA) parenteral amino-acid delivery, commenced within 24 hours of birth, on body composition, and a multi-component lipid emulsion containing 30% soy bean oil, 30% medium chain triglycerides, 25% olive oil and 15% fish oil (SMOF) versus soybean oil based lipid emulsion (SO) on Intra-Hepato-Cellular Lipid (IHCL) content. ResultsWe randomised 168 infants born <31 weeks gestation. We evaluated outcomes at term in 133 infants. There were no significant differences between Imm-RDI and Inc-AA groups for non-adipose mass (adjusted mean difference (95% CI): 1.0g (-108, 111) p=0.98) or between SMOF and SO groups for IHCL (adjusted mean ratio SMOF:SO (95% CI): 1.1 (0.8, 1.6) p=0.58). SMOF does not affect IHCL content. There was a significant interaction (p=0.05) between the two interventions for non-adipose mass. There were no significant interactions between group differences for either primary outcome measure after adjusting for additional confounders. Imm-RDI infants were more likely than Inc-AA infants to have blood urea nitrogen levels greater than 7mmol/l or 10mmol/l respectively (75% vs 49%; p<0.01 and 49% vs 18%; p<0.01). Head circumference at term was smaller in the Imm-RDI group (mean difference (95% CI): -0.8cm (-1.5, -0.1) p= 0.02). There were no significant differences in any pre-specified secondary outcomes including adiposity, liver function tests, incidence of conjugated hyperbilirubinaemia, weight, length, mortality and brain volumes. ConclusionsImmediate delivery of Recommended Daily Intake of parenteral amino-acids does not benefit body compo
Modi N, 2016, Neena Modi: Dogged, determined, driven, BMJ, Vol: 353, ISSN: 0959-8138
Modi N, 2016, Time to bring fetal growth assessment into the 21st century, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 123, ISSN: 1470-0328
Ougham K, Modi N, 2016, The NDAU report 2015, The NDAU report 2015, London, UK, Publisher: The Neonatal Data Analysis Unit, Imperial College London, 4
Holmes E, MacIntyre D, Modi N, et al., 2016, Handing on health to the next generation: Early life exposures, Metabolic Phenotyping in Personalized and Public Healthcare, Pages: 213-264, ISBN: 9780128003442
In this chapter, the role of metabolic phenotyping is described in relation to the improved understanding of the complex biochemical processes that occur in the fetus and in early life. The reasons for the importance of this type of medical supervision are discussed, and the factors that operate both in utero and in the first stages of a baby's life are given. The development of the metabolic phenotype as life begins and continues is explained, including the importance of symbiotic bacteria (the microbiome). The changing metabolic phenotyping in various conditions such as premature birth, maternal obesity, gestational diabetes, pre-eclampsia, and others is discussed in detail. Postnatal factors that influence ongoing health are then discussed in relation to metabolic processes. Finally, a strategy is proposed for monitoring infant and maternal health using metabolic phenotyping.
Watson SI, Arulampalam W, Petrou S, et al., 2016, The effects of a one-to-one nurse-to-patient ratio on the mortality rate in neonatal intensive care: a retrospective, longitudinal, population-based study, Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 101, Pages: F195-F200, ISSN: 1468-2052
Objective To estimate the effect of the provision of a one-to-one nurse-to-patient ratio on mortality rates in neonatal intensive care units.Design A population-based analysis of operational clinical data using an instrumental variable method.Setting National Health Service neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit and participating in the Neonatal Economic, Staffing, and Clinical Outcomes Project.Participants 43 tertiary-level neonatal units observed monthly over the period January 2008 to December 2012.Intervention Proportion of neonatal intensive care days or proportion of intensive care admissions for which one-to-one nursing was provided.Outcomes Monthly in-hospital intensive care mortality rate.Results Over the study period, the provision of one-to-one nursing in tertiary neonatal units declined from a median of 9.1% of intensive care days in 2008 to 5.9% in 2012. A 10 percentage point decrease in the proportion of intensive care days on which one-to-one nursing was provided was associated with an increase in the in-hospital mortality rate of 0.6 (95% CI 1.2 to 0.0) deaths per 100 infants receiving neonatal intensive care per month compared with a median monthly mortality rate of 4.5 deaths per 100 infants per month. The results remained robust to sensitivity analyses that varied the estimation sample of units, the choice of instrumental variables, unit classification and the selection of control variables.Conclusions Our study suggests that decreases in the provision of one-to-one nursing in tertiary-level neonatal intensive care units increase the in-hospital mortality rate.
Parkinson JRC, Hyde MJ, Modi N, 2016, The search for biomarkers of long-term outcome after preterm birth, 84th Nestle-Nutrition-Institute Workshop on Next-Generation Nutritional Biomarkers to Guide Better Health Care, Publisher: Karger, Pages: 71-80, ISSN: 1664-2147
Preterm birth and survival rates are rising globally, and consequently there is a growing necessity to safeguard life-long health. Epidemiological and other studies from around the world point to a higher risk of adverse adult health outcomes following preterm birth. These reports encompass morbidities in multiple domains, poorer reproductive health, and reduced longevity. The contributions of genetic inheritance, intrauterine exposures, and postnatal care practices to this altered adult phenotype are not known. Early detection is essential to implement preventive measures and to test protective antenatal and neonatal interventions to attenuate aberrant health trajectories. A satisfactory biomarker of outcome must be predictive of later functional health and ideally remain stable over the period from infancy to childhood and adult life. To date, blood pressure is the index that best fulfils these criteria. High throughput ‘omic' technologies may identify biomarkers of later outcome and health risk. However, their potential can only be realized with initial investment in large, longitudinal cohort studies, which couple serial metabolomic profiling with functional health assessments across the life course.
Raban S, Santhakumaran S, Keraan Q, et al., 2016, A randomised controlled trial of high vs low volume initiation and rapid vs slow advancement of milk feeds in infants with birthweights 1000 g in a resource-limited setting, Paediatrics and International Child Health, Vol: 36, Pages: 288-295, ISSN: 2046-9047
Background: Optimal feeding regimens for infants ≤ 1000 g have not been established and are a global healthcare concern.Aims and objectives: A controlled trial to establish the safety and efficacy of high vs low volume initiation and rapid vs slow advancement of milk feeds in a resource-limited setting was undertaken.Methods: Infants ≤ 1000 g birthweight were randomised to one of four arms, either low (4 ml/kg/day) or high (24 ml/kg/day) initiation and either slow (24 ml/kg/day) or rapid (36 ml/kg/day) advancement of exclusive feeds of human milk (mother’s or donor) until a weight of 1200 g was reached. After this point, formula was used to supplement insufficient mother’s milk. The primary outcome was time to reach 1500 g.Results: infants were recruited (51: low/slow; 47: low/rapid; 52: high/slow; 50: high/rapid). Infants on rapid advancement regimens reached 1500 g most rapidly (hazard ratio 1.48, 95% CI 1.05–2.09, P=0.03). The rapid advancement groups also regained birthweight more rapidly (hazard ratio 1.77, 95% CI 1.26–2.50, P=0.001). There was no apparent effect of high vs low initiation volumes but there was some evidence of interaction between interventions. There were no significant differences in other secondary outcomes, including necrotising enterocolitis, feed intolerance and late-onset sepsis.Conclusions: In this small pilot study, higher initiation feed volumes and larger daily increments appeared to be well tolerated and resulted in more rapid early weight gain. These data provide justification for a larger study in resource-limited settings to address mortality, necrotising enterocolitis and other important outcomes.
Gale C, Modi N, 2015, Neonatal randomised point-of-care trials are feasible and acceptable in the UK: results from two national surveys, Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 101, Pages: 86-86, ISSN: 1468-2052
Mazmanyan P, Mellor K, Dore CJ, et al., 2015, A randomised controlled trial of flow driver and bubble continuous positive airway pressure in preterm infants in a resource-limited setting, Archives of Disease in Childhood. Fetal and Neonatal Edition, Vol: 101, Pages: 16-20, ISSN: 1359-2998
Objectives The variable-flow flow driver (FD; EME) and continuous-flow bubble (Fisher-Paykel) continuous positive airway pressure (CPAP) systems are widely used. As these differ in cost and technical requirements, determining comparative efficacy is important particularly where resources are limited.Design We performed a randomised, controlled, equivalence trial of CPAP systems. We specified the margin of equivalence as 2 days. We analysed binary variables by logistical regression adjusted for gestation, and log transformed continuous variables by multiple linear regression adjusted for gestation, sex and antenatal steroids.Setting A neonatal unit with no blood gas analyser or surfactant availability and limited X-ray and laboratory facilitiesPatients Neonates <37 weeks of gestation.Interventions We provided CPAP at delivery followed by randomisation to FD or bubble (B).Outcomes Primary outcome included total days receiving CPAP; secondary outcomes included days receiving CPAP, supplemental oxygen, ventilation, death, pneumothorax and nasal excoriation.Results We randomised 125 infants (B 66, FD 59). Differences in infant outcomes on B and FD were not statistically significant. The median (range) for CPAP days for survivors was B 0.8 (0.04 to 17.5), FD 0.5 (0.04 to 5.3). B:FD (95% CI) ratios were CPAP days 1.3 (0.9 to 2.1), CPAP plus supplementary oxygen days 1.2 (0.7 to 1.9). B:FD (95% CI) ORs were death 2.3 (0.2 to 28), ventilation 2.1 (0.5 to 9), nasal excoriation 1.2 (0.2 to 8) and pneumothorax 2.4 (0.2 to 26).Conclusions In a resource-limited setting we found B CPAP equivalent to FD CPAP in the total number of days receiving CPAP within a margin of 2 days.
Taylor S, Williams B, Magnus D, et al., 2015, From MDG to SDG: good news for global child health?, LANCET, Vol: 386, Pages: 1213-1214, ISSN: 0140-6736
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Mills L, Modi N, 2015, Clinician enteral feeding preferences for very preterm babies in the UK, ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 100, Pages: F372-F373, ISSN: 1359-2998
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- Citations: 7
Andreas NJ, Hyde MJ, Gomez-Romero M, et al., 2015, Multiplatform characterization of dynamic changes in breast milk during lactation., Electrophoresis, Vol: 36, Pages: 2269-2285, ISSN: 1522-2683
The multicomponent analysis of human breast milk (BM) by metabolic profiling is a new area of study applied to determining milk composition, and is capable of associating BM composition with maternal characteristics, and subsequent infant health outcomes. A multi-platform approach combining high-performance as well as ultra-performance liquid-chromatography (HPLC-MS and UPLC-MS), gas chromatography (GC-MS), capillary electrophoresis (CE-MS) coupled to mass spectrometry and (1) H NMR spectroscopy was used to comprehensively characterize metabolic profiles from seventy BM samples. A total of 710 metabolites spanning multiple molecular classes were defined. The utility of the individual and combined analytical platforms was explored in relation to numbers of metabolites identified, as well as the reproducibility of the methods. The greatest number of metabolites were identified by the single phase HPLC-MS method, whilst CE-MS uniquely profiled amino acids in detail and NMR was the most reproducible, whereas GC-MS targeted volatile compounds and short chain fatty acids. Dynamic changes in BM composition were characterized over the first 3 months of lactation. Metabolites identified as altering in abundance over lactation included fucose, di- and triacylglycerols and short chain fatty acids, known to be important for infant immunological, neurological and gastrointestinal development, as well as being an important source of energy. This extensive metabolic coverage of the dynamic BM metabolome provides a baseline for investigating the impact of maternal characteristics, as well as establishing the impact of environmental and dietary factors on the composition of BM, with a focus on the downstream health consequences this may have for infants. This article is protected by copyright. All rights reserved.
Marlow N, Morris T, Brocklehurst P, et al., 2015, A randomised trial of granulocyte-macrophage colony-stimulating factor for neonatal sepsis: childhood outcomes at 5 years, Archives of Disease in Childhood. Fetal and Neonatal Edition, Vol: 100, Pages: F320-F326, ISSN: 1359-2998
Objective: We performed a randomised trial in verypreterm, small for gestational age (SGA) babies todetermine if prophylaxis with granulocyte macrophagecolony stimulating factor (GM-CSF) improves outcomes(the PROGRAMS trial). GM-CSF was associated withimproved neonatal neutrophil counts, but no change inother neonatal or 2-year outcomes. As subtle benefits inoutcome may not be ascertainable until school age weperformed an outcome study at 5 years.Patients and methods: 280 babies born at 31 weeksof gestation or less and SGA were entered into the trial.Outcomes were assessed at 5 years to determineneurodevelopmental and general health status andeducational attainment.Results: We found no significant differences incognitive, general health or educational outcomesbetween 83 of 106 (78%) surviving children in the GMCSFarm compared with 81 of 110 (74%) in the controlarm. Mean mental processing composite (equivalent toIQ) at 5 years were 94 (SD 16) compared with 95(SD 15), respectively (difference in means −1 (95%CI −6to 4), and similar proportions were in receipt of specialeducational needs support (41% vs 35%; risk ratio 1.2(95% CI 0.8 to 1.9)). Performance on Kaufmann-ABCsubscales and components of NEPSY were similar. Thesuggestion of worse respiratory outcomes in the GM-CSFgroup at 2 years was replicated at 5 years.Conclusions: The administration of GM-CSF to verypreterm SGA babies is not associated with improved ormore adverse neurodevelopmental, general health oreducational outcomes at 5 years.
Gale C, Logan KM, Jeffries S, et al., 2015, Sexual dimorphism in relation to adipose tissue and intrahepatocellular lipid deposition in early infancy, International Journal of Obesity, Vol: 39, Pages: 629-632, ISSN: 1476-5497
Andreas NJ, Hyde MJ, Gale C, et al., 2014, Effect of Maternal Body Mass Index on Hormones in Breast Milk: A Systematic Review, PLOS ONE, Vol: 9, ISSN: 1932-6203
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- Citations: 76
Modi N, 2014, The science of paediatrics, child health research, and the Royal College of Paediatrics and Child Health, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 99, Pages: 971-973, ISSN: 0003-9888
Uthaya S, Modi N, 2014, Practical preterm parenteral nutrition: Systematic literature review and recommendations for practice, EARLY HUMAN DEVELOPMENT, Vol: 90, Pages: 747-753, ISSN: 0378-3782
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- Citations: 13
Gale C, Thomas EL, Jeffries S, et al., 2014, Adiposity and hepatic lipid in healthy full-term, breastfed, and formula-fed human infants: a prospective short-term longitudinal cohort study (vol 99, pg 1034, 2014), AMERICAN JOURNAL OF CLINICAL NUTRITION, Vol: 100, Pages: 1213-1213, ISSN: 0002-9165
Battersby C, Santhakumaran S, Upton M, et al., 2014, The impact of a regional care bundle on maternal breast milk use in preterm infants: outcomes of the East of England quality improvement programme, ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 99, Pages: F395-F401, ISSN: 1359-2998
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- Citations: 19
Uthaya S, Mancini A, Beardsley C, et al., 2014, Managing palliation in the neonatal unit, ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 99, Pages: F349-F352, ISSN: 1359-2998
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- Citations: 11
Villaseñor A, Garcia-Perez I, García A, et al., 2014, Breast milk metabolome characterization in a single phase extrac-tion, multiplatform analytical approach, Analytical Chemistry, Vol: 86, Pages: 8245-8252, ISSN: 0003-2700
Gale C, Santhakumaran S, Wells J, et al., 2014, PC.14 Adjustment of directly measured adipose tissue volume in infants., Arch Dis Child Fetal Neonatal Ed, Vol: 99 Suppl 1, Pages: A40-A41
Direct measurement of adipose tissue using magnetic resonance imaging (MRI) is increasingly used to characterise body composition. Optimal techniques for adjusting direct measures of infant adipose tissue remain to be determined.
Battersby C, Santhakumaran S, Costeloe K, et al., 2014, PC.15 The UK Neonatal Collaborative Necrotising Enterocolitis (NEC) Study: development of an evidence-based case-definition for NEC., Arch Dis Child Fetal Neonatal Ed, Vol: 99 Suppl 1
Lack of a universal case-definition hinders (NEC) surveillance and clinical trials. Bell's staging, although widely used, was devised to guide surgical management after diagnosis(1). We aimed to develop an evidence-based NEC case-definition.
Darmasseelane K, Hyde MJ, Santhakumaran S, et al., 2014, Mode of Delivery and Offspring Body Mass Index, Overweight and Obesity in Adult Life: A Systematic Review and Meta-Analysis (vol 9, e87896, 2014), PLOS ONE, Vol: 9, ISSN: 1932-6203
Gale C, Thomas EL, Jeffries S, et al., 2014, Adiposity and hepatic lipid in healthy full-term, breastfed, and formula-fed human infants: a prospective short-term longitudinal cohort study, American Journal of Clinical Nutrition, Vol: 99, Pages: 1034-1040, ISSN: 0002-9165
Background: The effect of mode of infant feeding on adiposity deposition is not fully understood.Objective: The objective was to test the hypothesis that differences in total and regional adipose tissue content and intrahepatocellular lipid (IHCL) arise in early infancy between breast- and formula-fed infants and to describe longitudinal changes.Design: This prospective longitudinal cohort study was performed in 2 hospitals in the United Kingdom. Healthy, full-term, appropriate weight-for-gestational age infants were recruited; adipose tissue volume and distribution were directly quantified by using whole-body magnetic resonance imaging; IHCL was assessed by in vivo proton magnetic resonance spectroscopy. Measurements were performed after birth (median age: 13 d) and at 6–12 wk of age. Method of infant feeding was recorded prospectively by using maternally completed feeding diaries. Breastfed was defined as >80% of feeds consisting of breast milk at both points; formula-fed was defined as >80% of feeds consisting of formula milk at both points.Results: Longitudinal results were obtained from 70 infants (36 breastfed, 9 mixed-fed, and 25 formula-fed). No differences were found in total or regional adipose tissue or IHCL between breastfed and formula-fed infants. In pooled analyses including all feeding groups, IHCL and total adipose tissue approximately doubled between birth and 6–12 wk: IHCL after birth (median: 0.949; IQR: 0.521–1.711) and at 6–12 wk (1.828; 1.376–2.697; P < 0.001) and total adipose tissue after birth (0.749 L; 0.620–0.928 L) and at 6–12 wk (1.547 L; 1.332–1.790 L; P < 0.001). Increasing adiposity was characterized by greater relative increases in subcutaneous than in internal adipose tissue depots.Conclusions: No differences were detectable in adipose tissue or IHCL accretion between breastfed and formula-fed infants up to 2 mo. The substantial increase in IHCL seen over this period in bo
Wong HS, Santhakumaran S, Statnikov Y, et al., 2014, Retinopathy of prematurity in English neonatal units: a national population-based analysis using NHS operational data, ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 99, Pages: F196-F202, ISSN: 1359-2998
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Gale C, Santhakumaran S, Wells JCK, et al., 2014, Adjustment of directly measured adipose tissue volume in infants, International Journal of Obesity, Vol: 38, Pages: 995-999, ISSN: 1476-5497
Shah PS, Lee SK, Lui K, et al., 2014, The International Network for Evaluating Outcomes of very low birth weight, very preterm neonates (iNeo): a protocol for collaborative comparisons of international health services for quality improvement in neonatal care, BMC PEDIATRICS, Vol: 14
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- Citations: 56
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